Citation

Thomas DG, Collins MW, Saladino RA, Frank V, Raab J, Zuckerbraun NS. Acad. Emerg. Med. 2011; 18(3): 246-254.

Affiliation

From the Department of Pediatrics, Emergency Medicine Division, University of Pittsburgh Medical Center (DGT, RAS, VF, JR, NSZ), Pittsburgh, PA; and the Department of Orthopedic Surgery, Sports Concussion Program, University of Pittsburgh Medical Center, Center for Sports Medicine (MWC), Pittsburgh, PA.

Copyright

(Copyright © 2011, Society for Academic Emergency Medicine, Publisher John Wiley and Sons)

DOI

10.1111/j.1553-2712.2011.01015.x

PMID

21401786

PMCID

PMC3076718

Abstract

Objectives:  This study of concussed adolescents sought to determine if a computer-based neurocognitive assessment (Immediate Postconcussion Assessment and Cognitive Test [ImPACT]) performed on patients who present to the emergency department (ED) immediately following head injury would correlate with assessments performed 3 to 10 days postinjury and if ED neurocognitive testing would detect differences in concussion severity that clinical grading scales could not. Methods:  A prospective cohort sample of patients 11 to 17 years of age presenting to the ED within 12 hours of a head injury were evaluated using two traditional concussion grading scales and neurocognitive testing. ED neurocognitive scores were compared to follow-up scores obtained at least 3 days postinjury. Postconcussive symptoms, outcomes, and complications were assessed via telephone follow-up for all subjects. Results:  Sixty patients completed phone follow-up. Thirty-six patients (60%) completed follow-up testing a median of 6 days postinjury. Traditional concussion grading did not correlate with neurocognitive deficits detected in the ED or at follow-up. For the neurocognitive domains of verbal memory, processing speed, and reaction time, there was a significant correlation between ED and follow-up scores trending toward clinical improvement. By 2 weeks postinjury, 23 patients (41%) had not returned to normal activity. At 6 weeks, six patients (10%) still had not returned to normal activity. Conclusions:  Immediate assessment in the ED can predict neurocognitive deficits seen in follow-up and may be potentially useful to individualize management or test therapeutic interventions. Neurocognitive assessment in the ED detected deficits that clinical grading could not and correlated with deficits at follow-up.

Language: en