Nurse practitioners' recommendations for pharmacotherapy in the management of adolescent concussion

J Am Assoc Nurse Pract. 2018 Sep;30(9):499-510. doi: 10.1097/JXX.0000000000000070.


Background and purpose: Nurse practitioners (NPs) frequently treat acute conditions presenting in children and adolescents in the outpatient setting. No evidence-based guidance exists pertaining to the treatment of concussion with medications. The purpose of this study was to examine recommendations by NPs for pharmacotherapy of acute symptoms for adolescent concussion.

Methods: This is a secondary analysis of data from a web-based census survey of all licensed NPs in Oregon and Washington State, where they practice as independent providers with prescriptive authority. Based on a standardized adolescent patient scenario video, NPs were asked to indicate prescription or nonprescription medication recommendations for concussion symptoms. Open-ended descriptions of medication recommendations were coded, summarized, and described.

Conclusions: In narrative text, 78.4% of the 991 respondents recommended at least one type of prescription or nonprescription medication. Prescription medications (recommended by 17.2%) included antiemetics and antimigraine medications; nonprescription medications (recommended by 75.5%) included nonsteroidal anti-inflammatory drugs, over-the-counter pain relievers, and herbal medications. Pharmacotherapy recommendations varied by NP practice setting and rurality.

Implications for practice: Nurse practitioners have full prescriptive authority in many states. No guidelines inform medication use in managing acute concussion symptoms, yet many providers recommend their use.

MeSH terms

  • Adolescent
  • Adult
  • Brain Concussion / drug therapy*
  • Decision Making*
  • Drug Prescriptions / nursing
  • Drug Therapy / methods*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Nurse Practitioners / trends*
  • Oregon
  • Surveys and Questionnaires
  • Washington