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Original article
Concussion assessment in the emergency department: a preliminary study for a quality improvement project
  1. Dylan A Mistry1,
  2. Timothy H Rainer2
  1. 1 School of Medicine, Cardiff University, Cardiff, UK
  2. 2 Division of Population Medicine, School of Medicine, University Hospital of Wales, Cardiff University, Cardiff, UK
  1. Correspondence to Dr Timothy H Rainer; thrainer{at}cuhk.edu.hk

Abstract

Background In sport, concussion is assessed using the Sports Concussion Assessment Tool (SCAT) 5 and managed with return to play guidelines. Similar, user-friendly tools are rarely, if ever, used in the emergency department (ED).

Objectives To evaluate a modified concussion assessment tool designed for the ED (ED-CAT) in patients presenting with a head injury and to identify variables that predict 30-day reattendance.

Methods A preliminary, prospective, evaluation in a quality improvement project was conducted in one hospital in South Wales. Patients were recruited if they were over 13 years, and either did not have an ED-CT head scan or had a scan with no acute changes. The primary outcome was 30-day reattendance.

Results 40 patients were recruited, 18 of whom had a CT scan. 37 were discharged on the same day with advice, two discharged the next day and one was admitted. Three (7.5%) patients reattended the department. Predictors of reattendance were headache score (median 3.0 vs 5.0; p<0.05), pressure in head score (2.0 vs 5.0; p<0.05), nausea/vomiting score (1.0 vs 3.0; p<0.05), dizziness score (1.0 vs 4.0; p<0.05), blurred vision score (0 vs 4.0; p<0.01), balance problems score (0 vs 4.0; p<0.05), sensitivity to light and confusion score (0 vs 4.0; p<0.01), orientation score (1. 0 vs 0; p<0.05) and immediate memory score (5.0 vs 4.0; p<0.05).

Conclusions Key symptoms and signs predicted 30-day reattendance. The ED-CAT requires validation and refinement in a larger population to produce a short, practical, user-friendly, relevant tool for ED head injury assessment.

  • concussion
  • head
  • diagnosis
  • sporting injuries
  • study

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjsem-2018-000445

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    Footnotes

    • Contributors DAM contributed to the acquisition of data and manuscript writing. THR contributed to the supervision and advice. DAM and THR contributed to the study design, data analysis and interpretation, project administration and statistical analysis.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval Ethics was waived as this was part of a quality improvement project, which does not require consent in our institution. All patients were anonymised and no personal or telephone follow-up was employed.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement There are no unpublished data from this study. Only the authors have access to the data. To obtain the data please contact the corresponding author.