Cognitive rest and school-based recommendations following pediatric concussion: the need for primary care support tools

Abstract

Objectives: (1) Assess pediatric primary care providers' understanding of cognitive rest for concussion and (2) describe their concussion management practices.

Methods: This study included (1) a survey of general pediatric providers and (2) an electronic medical record (EMR) review of children 5 to 18 years old treated for concussion from September 1, 2010, to May 31, 2011. The survey asked about treatment recommendations for concussion, and results were coded to identify cognitive rest recommendations. The EMR review included the following: injury details, medical evaluation, and recommendations for resuming school and sports/recreation.

Results: In all, 89 of 201 providers responded to the survey, and 52 of the 84 clinicians who included comments about concussion management mentioned cognitive rest (62%, 95% confidence interval [CI] = 51%-72%). Of the 91 EMRs reviewed for patients' first visits following the concussion, only 10 (11%, 95% CI = 6%-19%) included written cognitive rest recommendations.

Conclusions: Although the majority of pediatric providers identified cognitive rest as important in pediatric concussion management, few provided written recommendations in the EMR.

Keywords: cognitive rest; concussion; mild traumatic brain injury; primary care; school.