Tuesday, March 11, 2014

Heads Up: Two New Studies on Concussion

Evaluation of a concussion in the Emergency Department (ED) is easier said than done—and it is for that reason that the Centers for Disease Control devised an Acute Concussion Evaluation (ACE) tool to aid in evaluation and follow-up instruction. While this tool was originally designed and then modified for ED usage, only recently has its benefit been studied in a pediatric emergency setting.

Photo by UC International via Wikimedia Commons
Fortunately, we are able to share the results of implementing the ACE program in a study by Zuckerbraun et al. (doi: 10.1542/ peds.2013-2600) being early released online this week. The authors looked at ED follow-up and adherence to a stepwise return to normal activity as directed by the ACE Care Plan (part of the ACE program) both pre- and post-implementation of this program in two pediatric EDs. The results are impressive and suggest this tool should be strongly considered for your local pediatric ED facility if it isn’t already.

Adding to our battery of evaluative tools for traumatic brain injury, especially mild brain injury that persists longer than you think it should, is the Medical Symptom Validity Test (MSVT), which can help detect exaggerated problems associated with persistent symptom complaints. A second study being released this week by Kirkwood et al. (doi: 10.1542/peds.2013-3195) enrolled almost 200 patients for neuropsychological evaluation after a mild traumatic brain injury and gave them the MSVT.

Since the return to school or play depends on duration of symptoms, knowing if these symptoms are valid or not can be important in determining when a child post-concussion can go back to school or athletics. That time course might be sped up if a patient fails the MSVT, and the authors share data to support that hypothesis. If you have not heard of this test or are interested in learning more to better address the validity of your patient’s persistent symptoms after a mild concussion, head for this study and learn more.

Together, both studies introduce some evaluative tools that may enhance your evaluation of traumatic brain injuries. Are you using either or both? Do you find them useful? Share your thoughts and comments with a response to this blog of via Facebook, Twitter, or even by posting an eLetter.

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