P0094 - Assault-related Concussions: Visit Characteristics and Outcomes

Objective: While research and policy predominantly focus on concussions sustained in sports and recreation, other significant mechanisms of injury exist in the pediatric setting. Some evidence suggests that youth who experience motor vehicle crash-related concussions experience prolonged recovery, however little is known about outcomes from other mechanisms, particularly interpersonal assault. The objective of this study was to compare demographic characteristics, medical care, and outcomes among patients with assault-related concussion (ARC) versus sports and recreation-related concussion (SRC). We hypothesized that patients with ARC would experience prolonged time to recovery and would have increased emotional symptom burden.

Methods: We conducted a retrospective chart review of 62 patients with ARC compared to 62 patients with SRC presenting to the care network of a large tertiary care pediatric hospital. We manually abstracted patient demographics, initial medical care visit characteristics (including symptoms present and visio-vestibular testing, both recommended to be performed as part of concussion evaluation to maximize diagnostic accuracy), and outcome data of patients ages 8-18 years initially presenting for care between July 1, 2012 and June 30, 2014. We compared proportions using chi-square testing and Fisher’s exact test, means using student’s t-test, and medians using Wilcoxon rank-sum test, where appropriate.

Results: Patients with ARC were more likely to be Black, publicly insured, and present initially to the ED (Table 1). Significantly fewer patients with ARC received visio-vestibular testing at their initial visit compared to SRC patients (25% vs 75%, p<0.001). In the recovery period, the total number of reported physical, cognitive, emotional, and sleep symptoms did not differ between groups, however more than twice as many ARC patients reported decline in grades compared to patients with SRC (47% vs. 20%, p=0.012).

Although not statistically significant, clinically meaningful differences existed in specialist referral (53% ARC vs 40% SRC, p=0.086) and prescription of physical/vestibular therapy (29% ARC vs 16% SRC, p=0.150; Table 2). There was also a non-significant trend toward increased time to return to school (11 days vs. 8 days, p=0.252), symptom resolution (13.5 vs. 11.5 days, p=0.389) and full physician clearance (35 vs. 24 days, p=0.332) in the ARC group, with more variability observed among ARC patients (Table 2).

Conclusions: This study highlights several disparities in the initial evaluation and outcomes of pediatric patients based on mechanism of concussion-related injury. ARC patients received less concussion-specific diagnostic evaluation and reported more significant impact on educational outcomes. While this study only evaluated patients with a diagnosis of concussion, these disparities among patients who received a concussion diagnosis suggest there may be under-diagnosis of concussion in assault patients. Further examination in larger populations and with prospective studies is needed to ensure prompt diagnosis and treatment in ARC.