Study finds lack of follow-up care for more than two-thirds of children with concussion

In a study that looked at data over a 10-year period, York University researchers, in collaboration with Children's Hospital of Eastern Ontario (CHEO) and the Institute for Clinical Evaluative Sciences (ICES), found that more than two-thirds of youth and children with an acute concussion do not seek medical follow-up or clearance as recommended by current international concussion guidelines.

In one of the first studies in Canada to look at pediatric concussion and follow-up, Professor Alison Macpherson in the Faculty of Health, School of Kinesiology & Health Science at York University and former York University Ph.D. student Liraz Fridman, conducted research that included data from over 120,000 children aged 5-19 years of age. The goal of the study was to determine whether children and youth with concussion receive follow-up visits in accordance with the recommended guidelines.

The team looked at population-based administrative data housed at ICES from all concussion-related visits to emergency department and physician offices in Ontario from 2003-2013.

Researchers analyzed the percentage of children and youth seen for follow-up. Over the decade of study, the data showed that there was an increase in the number of children who sought follow-up care after being evaluated for a concussion by 2013 but over two-thirds still did not receive follow-up care in accordance with international recommended guidelines.

"That two-thirds of children were still not being seen for follow-up was surprising considering that international recommendations have been in place since 2001," says Fridman.

In Ontario, concussion-related emergency department and office visits rates per 100,000 children have quadrupled from 2003 to 2013, with similar increases noted in the United States. Concussions can have long-term effects on memory and cognition, and may increase the vulnerability of psychological implications, such as depression and anxiety.

In 2003, 11 per cent of children and youth were seen for a follow-up after sustaining a concussion and by 2013 that number jumped to 30 per cent.

"A lack of sufficient follow-up care puts children and youth at risk for another concussion or more serious consequences," says Macpherson.

Researchers say it is unclear why those who have concussions do not receive adequate follow-up and treatment. However the study highlights the need for better education programs for health care professionals, parents, coaches, children and youth which may improve follow-up rates.

"Despite improvement over the past several years, the rate of follow-up visits after a pediatric concussion diagnosis remain unacceptably low." says Dr. Roger Zemek, Director of Clinical Research at the Children's Hospital of Eastern Ontario and a senior author. "This reinforces the ongoing need to ensure that the latest concussion guidelines are implemented broadly in order to standardize the approach to concussion diagnosis and management."