Brian H Rowe1, Leeor Eliyahu2, Justin Lowes3, Lindsay A Gaudet3, Jeremy Beach4, Martin Mrazik5, Garnet Cummings3, Donald Voaklander6. 1. School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada. Electronic address: brian.rowe@ualberta.ca. 2. School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada. 3. Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada. 4. School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Division of Preventive Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; College of Physicians and Surgeons of Alberta, Edmonton, Alberta, Canada. 5. Department of Educational Psychology, Faculty of Education, University of Alberta, Edmonton, Alberta, Canada. 6. School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
Abstract
OBJECTIVES: Patients with concussion commonly present to the emergency department (ED) for assessment. Misdiagnosis of concussion has been documented in children and likely impacts treatment and discharge instructions. This study aimed to examine diagnosis of concussion in a general adult population. METHODS: Patients >17years old presenting meeting the World Health Organization's definition of concussion were recruited in one academic (Hospital 1) and two community (Hospitals 2 and 3) EDs in a Canadian city. A physician questionnaire and patient interviews documented recommendations given by emergency physicians. Bi-variable comparisons are reported using chi-square tests, t-tests or Mann-Whitney tests, as appropriate. Multivariate analyses were performed using logistic regression methods. RESULTS: Overall, the study enrolled 250 patients. The median age was 35 (IQR: 23 to 49) and 52% were female. A variety of concussion causes were documented. Forty-one (16%) patients were not diagnosed with a concussion despite meeting criteria. Concussion diagnosis was less likely with a longer ED length of stay (OR=0.71; 95% CI: 0.60 to 0.83), presenting to the non-academic centers (Hospital 2: OR=0.21, 95% CI: 0.08 to 0.58; Hospital 3: OR=0.07, 95% CI: 0.02 to 0.24), or involvement in a motor vehicle collision (OR=0.11; 95% CI: 0.03 to 0.46). CONCLUSION: One in six patients with concussion signs and symptoms were misdiagnosed in the ED. Misdiagnosis was related to injury mechanism, length of stay, and enrolment site. Closer examination of institutional factors is needed to identify effective strategies to promote accurate diagnosis of concussion.
OBJECTIVES:Patients with concussion commonly present to the emergency department (ED) for assessment. Misdiagnosis of concussion has been documented in children and likely impacts treatment and discharge instructions. This study aimed to examine diagnosis of concussion in a general adult population. METHODS:Patients >17years old presenting meeting the World Health Organization's definition of concussion were recruited in one academic (Hospital 1) and two community (Hospitals 2 and 3) EDs in a Canadian city. A physician questionnaire and patient interviews documented recommendations given by emergency physicians. Bi-variable comparisons are reported using chi-square tests, t-tests or Mann-Whitney tests, as appropriate. Multivariate analyses were performed using logistic regression methods. RESULTS: Overall, the study enrolled 250 patients. The median age was 35 (IQR: 23 to 49) and 52% were female. A variety of concussion causes were documented. Forty-one (16%) patients were not diagnosed with a concussion despite meeting criteria. Concussion diagnosis was less likely with a longer ED length of stay (OR=0.71; 95% CI: 0.60 to 0.83), presenting to the non-academic centers (Hospital 2: OR=0.21, 95% CI: 0.08 to 0.58; Hospital 3: OR=0.07, 95% CI: 0.02 to 0.24), or involvement in a motor vehicle collision (OR=0.11; 95% CI: 0.03 to 0.46). CONCLUSION: One in six patients with concussion signs and symptoms were misdiagnosed in the ED. Misdiagnosis was related to injury mechanism, length of stay, and enrolment site. Closer examination of institutional factors is needed to identify effective strategies to promote accurate diagnosis of concussion.
Authors: Guido I Guberman; Marie-Pier Robitaille; Peter Larm; Alain Ptito; Frank Vitaro; Richard E Tremblay; Sheilagh Hodgins Journal: Can J Psychiatry Date: 2019-10-17 Impact factor: 4.356
Authors: Ilaria Pozzato; Susanne Meares; Annette Kifley; Ashley Craig; Mark Gillett; Kim Van Vu; Anthony Liang; Ian Cameron; Bamini Gopinath Journal: BMJ Open Date: 2020-02-03 Impact factor: 2.692