Back to Search
Start Over
Concussion diagnoses among adults presenting to three Canadian emergency departments: Missed opportunities
- Source :
- The American Journal of Emergency Medicine. 36:2144-2151
- Publication Year :
- 2018
- Publisher :
- Elsevier BV, 2018.
-
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 >17 years 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.
- Subjects :
- Adult
Male
Canada
medicine.medical_specialty
Multivariate analysis
Adult population
Signs and symptoms
Logistic regression
Young Adult
03 medical and health sciences
0302 clinical medicine
Concussion
medicine
Humans
Diagnostic Errors
Medical diagnosis
Brain Concussion
Chi-Square Distribution
business.industry
030208 emergency & critical care medicine
General Medicine
Emergency department
Length of Stay
Middle Aged
medicine.disease
3. Good health
Logistic Models
Multivariate Analysis
Emergency medicine
Emergency Medicine
Wounds and Injuries
Female
Emergency Service, Hospital
business
030217 neurology & neurosurgery
Sports
Motor vehicle crash
Subjects
Details
- ISSN :
- 07356757
- Volume :
- 36
- Database :
- OpenAIRE
- Journal :
- The American Journal of Emergency Medicine
- Accession number :
- edsair.doi.dedup.....0372bc7f6109f70bd084ae687087273f