Emergency department surveillance of injuries and head injuries associated with baseball, football, soccer and ice hockey, children and youth, ages 5 to 18 years, 2004 to 2014

Evaluating Adherence to Return to School and Activity Protocols in Children After Concussion

OBJECTIVE

The need to have a pediatric-specific concussion management protocol on Return to School (RTS) and Return to Activity (RTA) after concussion has been recognized internationally. The first step to evaluate the protocol effectiveness is to establish whether children and youth are adhering to these recommendations. The objective of this study was to explore the prevalence and predictors of adherence to RTS and RTA concussion management protocols for children/youth.

DESIGN

A prospective cohort of children/youth with concussion.

SETTING

Childhood Disability Research Centre.

PARTICIPANTS

One hundred thirty-nine children/youth aged 5 to 18 years, diagnosed with concussion and symptomatic upon enrollment, were followed for up to 6 months. Primary recruitment occurred from a Children's Hospital Emergency Department.

INTERVENTION

Provision of RTS/RTA guidelines.

MAIN OUTCOME MEASURES

Measurement of adherence came from multiple sources, including the child's and parent's knowledge of protocols, research personnel evaluations, and self-reported stages of RTS/RTA and Post-Concussion Symptom Scale (PCSS) scores.

RESULTS

Spearman correlations and logistic regression were used, investigating the relationship between PCSS and progression of protocols and determining predictors of adherence. Significant negative associations between total PCSS score and stage of RTS/RTA protocols were found. Fifty-three percent and 56% of the participants adhered to the RTS and RTA protocols, respectively.

CONCLUSIONS

Children's knowledge of protocols and total PCSS scores significantly predicted adherence to RTS/RTA and may be the most important factors in predicting adherence during recovery from concussion.

Epidemiology of soccer-related head injury in children 5-14 years in Victoria, Australia

AIM

Our aim was to use epidemiological data to determine the incidence of soccer-related head injuries in children aged 5-14 years who presented at emergency departments (EDs) or were admitted in hospitals in Victoria, Australia.

METHODS

ED presentation and hospital admission de-identified aggregate data were from the Victorian Injury Surveillance Unit. Soccer participation data were compared with the soccer-related head injury data to determine the incidence of this injury among these children.

RESULTS

The incidence of ED presentations was 0.17% of children participating in soccer during the study period (financial years 2011-2012 to 2015-2016). The 10-14-years age group presented with more head injuries than the 5-9-years age group. For the admissions data, soccer had a significantly lower (P = 0.0379) incidence of head injury when compared with 'sport as a whole'.

CONCLUSIONS

The low incidence of soccer-related head injuries presenting to an ED or admission to hospital is consistent with international findings.

Loss and recovery after concussion: Adolescent patients give voice to their concussion experience

Background

Most concussion studies have focused on the perspectives and expertise of health‐care providers and caregivers. Very little qualitative research has been done, engaging the adolescents who have suffered concussion and continue to experience the consequences in their everyday life.

Objective

To understand the experiences of recovery from the perspective of adolescent patients of concussion and to present the findings through their voices.

Methods

Two semi‐structured focus groups and two narrative interviews were conducted with a small group of 7 adolescents. Grounded theory was used to analyse the data.

Results

Participants experience continuing difficulty 1‐5 years after treatment with cognitive, emotional, social and mental well‐being. The overriding experience among older adolescents (17‐20) is a sense of irreversibility of the impact of concussion in all these areas.

Conclusion

There is a significant gap between the medical determination of recovery and what patients understand as recovery. Adolescents do not feel ‘recovered’ more than a year after they are clinically assessed as ‘good to go’. Systematic follow‐up and support from a multi‐disciplinary health‐care team would strengthen youths' coping and resilience.

What Comes First: Return to School or Return to Activity for Youth After Concussion? Maybe We Don't Have to Choose

Objectives: Return to School (RTS) and Return to Activity/Play (RTA) protocols are important in concussion management. Minimal evidence exists as to sequence and whether progression can occur simultaneously. Experts recommend that children/youth fully return to school before beginning RTA protocols. This study investigates recovery trajectories of children/youth while following RTA and RTS protocols simultaneously, with the following objectives: (1) to compare rates and patterns of progression through the stages of both protocols; (2) to evaluate symptom trajectories of youth post-concussion while progressing through stages of RTS and RTA; and (3) to propose a new model for concussion management in youth that involves the integration of Return to Activity and Return to School protocols. Methods: In a 3-year prospective-cohort study of 139 children/youth aged 5-18 years with concussive injury, self-reported symptoms using PCSS and stage of protocols were evaluated every 48 h using electronic surveys until full return to school and activity/sport were attained. Information regarding school accommodation and achievement was collected. Results: Sample mean age is 13 years, 46% male. Youth are returning to school with accommodations significantly quicker than RTA (p = 0.001). Significant negative correlations between total PCSS score and stage of RTS protocol were found at: 1-week (r = -0.376, p < 0.0001; r = -0.317, p = 0.0003), 1-month (r = -0.483, p < 0.0001; r = -0.555, p < 0.0001), and 3-months (r = -0.598, p < 0.0001; r = -0.617, p < 0.0001); indicating lower symptom scores correlated with higher guideline stages. Median full return to school time is 35 days with 21% of youth symptomatic at full return. Median return time to full sport competition is 38 days with 15% still symptomatic. Sixty-four percent of youth reported experiencing school problems during recovery and 30% at symptom resolution, with 31% reporting a drop in their grades during recovery and 18% at study completion. Conclusions: Children/youth return to school faster than they return to play in spite of the self-reported, school-related symptoms they experience while moving through the protocols. Youth can progress simultaneously through the RTS and RTA protocols during stages 1-3. Considering the numbers of youth having school difficulties post-concussion, full contact sport, stage 6, of RTA, should be delayed until full and successful reintegration back to school has been achieved. In light of the huge variability in recovery, determining how to resume participation in activities despite ongoing symptoms is still the challenge for each individual child. There is much to be learned with further research needed in this area.

The ups and downs of trampolines: Injuries associated with backyard trampolines and trampoline parks

Objective

To compare characteristics associated with backyard trampoline injuries (BTI) and trampoline park injuries (TPI) using records from the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP).

Methods

eCHIRPP records for trampoline injuries (2012 to 2016) were extracted using variable codes and narratives, and injuries were examined among individuals 17 years and younger. Descriptive estimates for BTI and TPI, as well as age and sex adjusted odds ratios (OR) for the mechanism, source, body part and type of injury associated with TPIs relative to BTIs, are presented.

Results

Trampoline injuries are increasing in Canada (P<0.01). Patients with TPIs were older than those with BTIs. Relative to BTIs, TPIs were more associated with impact as the mechanism (OR 2.6, 95% CI: 2.2 to 3.1), trampoline beds as the source (OR 1.7, 95% CI: 1.4 to 2.1), lower extremity as the body part (OR 3.7, 95% CI: 3.0 to 4.4) and sprains as the type of injury (OR 2.0, 95% CI: 1.6 to 2.4). In contrast, another jumper (OR 0.5, 95% CI: 0.4 to 0.6) or fall (OR 0.4, 95% CI: 0.4 to 0.6) as the mechanism, surface (OR 0.7, 95% CI: 0.5 to 0.9) or another jumper (OR 0.5, 95% CI: 0.4 to 0.7) as the source, face or neck (OR 0.6, 95% CI: 0.4 to 0.7) as the body part, and lacerations (OR 0.6, 95% CI: 0.3 to 0.9) or soft tissue injury (OR 0.7, 95% CI: 0.6 to 0.9) as the type of injury were more associated with BTIs relative to TPIs.

Conclusion

Trampoline parks result in injuries different than those from backyard trampolines. This examination into the distinct injury characteristics can help to inform future prevention measures.

The lows of getting high: sentinel surveillance of injuries associated with cannabis and other substance use

OBJECTIVES

Cannabis is a widely used illicit substance that has been associated with acute injuries. This study seeks to provide near real-time injury estimates related to cannabis and other substance use from the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP) database.

METHODS

Data from the eCHIRPP database, years 2011 to 2016, were analyzed via data mining, descriptive, logistic regression, and sensitivity analyses. Drug use trends over time for cannabis and/or other substances (alcohol, illicit drugs, and medications) were assessed. Descriptive statistics (intent, external cause, and nature of injury) and proportionate injury ratios (PIR) associated with cannabis use are presented.

RESULTS

Cannabis use was observed in 184 cases/100,000 eCHIRPP cases, and related injuries were mostly identified as unintentional (66.8%). Poisoning (68.5%) and intoxication (69.4%) were the external cause and nature of injury most associated with these events, and hospitalization was recorded for 14.3% of cases. Per 100,000 eCHIRPP cases, cannabis was used alone in 72.4 cases, and in combination with alcohol, illicit drugs, or medications in 74.6 cases, 11.3 cases, and 7.9 cases, respectively. Relative to non-use, the PIR of hospitalization was not significant for cannabis-only users of either sex (males: PIR 1.0, 95% CI 0.6-1.7, females: PIR 0.9, 95% CI: 0.5-1.7).

CONCLUSION

Cannabis use injuries are rare, but can occur when cannabis is used with or without other substances. As Canada considers legislative changes, our finding of cases related to unintentional injury, poisoning, and intoxication suggests areas that might benefit from health literacy efforts.

Status report - The Canadian Hospitals Injury Reporting and Prevention Program: a dynamic and innovative injury surveillance system

This status report on the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), an emergency department-based injury and poisoning surveillance system, describes the result of migrating from a centralized data entry and coding process to a decentralized process, the web-based eCHIRPP system, in 2011. This secure system is improving the CHIRPP's overall flexibility and timeliness, which are key attributes of an effective surveillance system. The integrated eCHIRPP platform enables near real-time data entry and access, has user-friendly data management and analysis tools, and allows for easier communication and connectivity across the CHIRPP network through an online collaboration centre. Current pilot testing of automated data monitoring and trend analysis tools-designed to monitor and flag incoming data according to predefined criteria (for example, a new consumer product)-is revealing eCHIRPP's potential for providing early warnings of new hazards, issues and trends.