The Diagnosis of Concussion in Pediatric Emergency Departments: A Prospective Multicenter Study

J Emerg Med. 2018 Jun;54(6):757-765. doi: 10.1016/j.jemermed.2018.02.041. Epub 2018 Apr 21.


Background: The accurate identification of children with a concussion by emergency physicians is important to initiate appropriate anticipatory guidance and management.

Objectives: We compared the frequency of persistent concussion symptoms in children who were provided the diagnosis of concussion by an emergency physician versus those who met Berlin/Zurich international criteria for this diagnosis. We also determined the clinical variables independently associated with a physician-diagnosed concussion.

Methods: This was a planned secondary analysis of a prospective, multicenter cohort study. Participants were 5-17 years of age and met the Zurich/Berlin International Consensus Statement criteria for concussion.

Results: There were 2946 enrolled children. In those with physician-diagnosed concussion vs. no concussion, the frequency of persistent symptoms was 62.5% vs. 38.8% (p < 0.0001) at 1 week, 46.3% vs. 25.8% (p < 0.0001) at 2 weeks, and 33.0% vs. 23.0% (p < 0.0001) at 4 weeks. Of those meeting international criteria, 2340 (79.4%) were diagnosed with a concussion by an emergency physician and 12 variables were associated with this diagnosis. Five had an odds ratio (OR) > 1.5: older age (13-17 vs. 5-7 years, OR 2.9), longer time to presentation (≥16 vs. <16 h, OR 2.1), nausea (OR 1.7), sport mechanism (OR 1.7), and amnesia (OR 1.6).

Conclusions: Relative to international criteria, the more selective assignment of concussion by emergency physicians was associated with a greater frequency of persistent concussion symptoms. In addition, while most children meeting international criteria for concussion were also provided this diagnosis for concussion by an emergency physician, the presence of 5 specific variables made this diagnosis more likely.

Keywords: concussion; diagnosis; pediatric.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Brain Concussion / diagnosis*
  • Child
  • Child, Preschool
  • Cohort Studies
  • Consensus
  • Female
  • Humans
  • Male
  • Pediatric Emergency Medicine / methods
  • Prospective Studies
  • Regression Analysis