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

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

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Division of Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada.
Division of Emergency Medicine, CHU Sainte-Justine and Université de Montréal, Montréal, Québec, Canada.
Sections of Emergency Medicine and Gastroenterology, Department of Pediatrics, Alberta Children's Hospital and Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Division of Pediatric Emergency Medicine, Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada.
Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
McMaster University, School of Rehabilitation Science and CanChild Centre for Childhood Disability Research, Hamilton, Ontario, Canada.
Division of Emergency Medicine, Department of Pediatrics, Montréal Children's Hospital-McGill University Health Center, McGill University, Montréal, Québec, Canada.
Section of Emergency Medicine, Department of Pediatrics and Child Health, Children's Hospital of Winnipeg, University of Manitoba, Winnipeg, Manitoba, Canada.
Department of Emergency Medicine, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada.
Division of Pediatric Emergency Medicine, Department of Pediatrics, London Health Sciences Centre, Western University, London, Ontario, Canada.
Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada.



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


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.


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.


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).


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.


concussion; diagnosis; pediatric

[Indexed for MEDLINE]

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