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J Neurotrauma. 2019 Apr 26. doi: 10.1089/neu.2018.6290. [Epub ahead of print]

Practice Patterns in Pharmacologic and Non-pharmacologic Therapies for Children with Mild Traumatic Brain Injury: A survey of 15 Canadian and United States Centers.

Author information

1
Children's Hospital Boston, Medicine, Division of Emergency Medicine , 300 Longwood Avenue , Boston, Massachusetts, United States , 02115 ; rebekah.mannix@childrens.harvard.edu.
2
Children's Hospital of Eastern Ontario, Clinical Research Unit , 401 Smyth Road , Ottawa, Ontario, Canada , K1H 8L1.
3
401 Smyth RoadCanada ; rzemek@cheo.on.ca.
4
University of Calgary, Psychology , 2500 University Dr NW , AD 254 , Calgary, Alberta, Canada , T2N1N4 ; kyeates@ucalgary.ca.
5
The Children's Hospital of Philadelphia, Center for Injury Research and Prevention, 19104, Pennsylvania, United States ; arbogast@email.chop.edu.
6
Children's National Health System, 8404, Emergency Medicine, Washington, District of Columbia, United States ; SATABAKI@childrensnational.org.
7
Children's Health Children's Medical Center Dallas, 2755, Emergency Medicine, Dallas, Texas, United States ; mohamed.badawy@utsouthwestern.edu.
8
University of Montreal, Psychology , C.P. 6128 , Succursale Centre-Ville , Montreal, Quebec, Canada , H3C3J7 ; miriam.beauchamp@umontreal.ca.
9
The Children's Hospital of Winnipeg, Emergency Medicine, Winnipeg, Manitoba, Canada ; dbeer@exchange.hsc.mb.ca.
10
UCSF School of Medicine, Pediatrics, San Francisco, California, United States ; Steven.Bin@ucsf.edu.
11
Montreal Childrens Hospital, 10040, Emergency Medicine, Montreal, Quebec, Canada ; brett.burstein@mail.mcgill.ca.
12
University of Alberta Faculty of Medicine and Dentistry, 12357, Edmonton, Alberta, Canada ; wcraig@ualberta.ca.
13
Children's Hospital of Philadelphia, 6567, Emergency Medicine, Philadelphia, Pennsylvania, United States ; corwind@email.chop.edu.
14
BC Children's Hospital, 37210, Emergency Medicine, Vancouver, British Columbia, Canada ; qdoan@bcchr.ca.
15
University of Manitoba, Surgery , 75 poseidon Bay , Winnipeg, Manitoba, Canada , R3M 3E4 ; mellis3@panamclinic.com.
16
Alberta Children's Hospital, 9978, Emergency Medicine, Calgary, Alberta, Canada ; stephen.freedman@ahs.ca.
17
The Montreal Children's Hospital, McGill University Health Center , 5252 Boul de Maisonneuve Ouest, Office 3F-45 , Montreal, Quebec, Canada , H4A 3S5 ; isabelle.gagnon8@mcgill.ca.
18
CHU Sainte-Justine Research Center , Montreal, Quebec, Canada ; graveljocelyn@hotmail.com.
19
University at Buffalo - The State University of New York, 12292, Orthopaedics, Buffalo, New York, United States ; leddy@buffalo.edu.
20
Stanford University School of Medicine, 10624, Emergency Medicine , 900 Welch Rd #350 , Stanford, California, United States , 94304 ; alumba@stanford.edu.
21
Children\'s Hospital of Philadelphia, 6567 , 34th and Civic Center Blvd , Philadelphia, Pennsylvania, United States , 19104 ; masterc@email.chop.edu.
22
The Mind Research Network , 1101 Yale Blvd. NE , Albuquerque, New Mexico, United States , 87106 ; amayer@mrn.org.
23
University of New Mexico, 1104, Division of Pediatric Emergency Medicine, Albuquerque, New Mexico, United States ; gpark@salud.unm.edu.
24
University at Buffalo School of Medicine and Biomedical Sciences, 12291, Pediatric Emergency Medicine, Buffalo, New York, United States ; mpenque@upa.chob.edu.
25
Cincinnati Children's Hospital Medical Center , 3333 Burnet Avenue , ML 2008 , Cincinnati, Ohio, United States , 45229 ; tara.rhine@cchmc.org.
26
656-715 Mcdermot AveWinnipeg, Canada , R3E3P4 ; krussell@chrim.ca.
27
University of Calgary, Calgary, Canada ; kjschnei@ucalgary.ca.
28
Children's National Health System, 8404, Critical Care Medicine , 111 Michigan Avenue, NW , Washington, District of Columbia, United States , 20010-2978 ; mbell@childrensnational.org.
29
University of Pittsburgh, Epidemiology, Pittsburgh, Pennsylvania, United States ; wisniew@edc.pitt.edu.

Abstract

Given the lack of evidence regarding effective pharmacologic and non-pharmacologic interventions for pediatric mild traumatic brain injury (mTBI) and the resultant lack of treatment recommendations reflected in consensus guidelines, variation in the management of pediatric mTBI is to be expected. We therefore surveyed practitioners across 15 centers in the United States and Canada who care for children with pediatric mTBI to evaluate common-practice variation in the management of pediatric mTBI. The survey, developed by a panel of pediatric mTBI experts, consisted of a 10-item survey instrument regarding providers' perception of common pediatric mTBI symptoms and mTBI interventions. Surveys were distributed electronically to a convenience sample of local experts at each center. Frequencies and percentages (with confidence intervals) were determined for survey responses. One hundred and seven respondents (71% response rate) included specialists in pediatric Emergency Medicine, Sports Medicine, Neurology, Neurosurgery, Neuropsychology, Neuropsychiatry, Physical and Occupational Therapy, Physiatry/Rehabilitation and General Pediatrics. Respondents rated headache as the most prevalently reported symptom after pediatric mTBI, followed by cognitive problems, dizziness, and irritability. Of the 65 (61%; [95% CI: 51,70]) respondents able to prescribe medications, non-steroidal anti-inflammatory medications (55%; [95% CI:42,68]) and acetaminophen (59%; [95% CI:46,71]) were most commonly recommended. One in five respondents reported prescribing amitriptyline for headache management after pediatric mTBI, whereas topiramate (8%; [95% CI: 3,17]) was less commonly reported. For cognitive problems, methylphenidate (11%; [95% CI: 4,21]) was used more commonly than amantadine (2%; [95% CI:0,8]). The most common non-pharmacologic interventions were rest ("always" or "often" recommended by 83% [95% CI: 63,92] of the 107 respondents), exercise (59%; [95%CI: 49,69]), vestibular therapy (42% [95%CI:33,53]) and cervical spine exercises (29% [95%CI:21,39]). Self-reported utilization for common pediatric mTBI interventions varied widely across our Canadian and United States consortium. Future effectiveness studies for pediatric mTBI are urgently needed to advance the evidence-based care.

KEYWORDS:

CLINICAL MANAGEMENT OF CNS INJURY; PEDIATRIC BRAIN INJURY; TRAUMATIC BRAIN INJURY

PMID:
31025612
DOI:
10.1089/neu.2018.6290

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