Research Article
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Published Online: 23 September 2019

Practice Patterns in Pharmacological and Non-Pharmacological Therapies for Children with Mild Traumatic Brain Injury: A Survey of 15 Canadian and United States Centers

Publication: Journal of Neurotrauma
Volume 36, Issue Number 20

Abstract

Given the lack of evidence regarding effective pharmacological and non-pharmacological interventions for pediatric mild traumatic brain injury (mTBI) and the resultant lack of treatment recommendations reflected in consensus guidelines, variation in the management of pediatric mTBI is to be expected. We therefore surveyed practitioners across 15 centers in the United States and Canada who care for children with pediatric mTBI to evaluate common-practice variation in the management of pediatric mTBI. The survey, developed by a panel of pediatric mTBI experts, consisted of a 10-item survey instrument regarding providers' perception of common pediatric mTBI symptoms and mTBI interventions. Surveys were distributed electronically to a convenience sample of local experts at each center. Frequencies and percentages (with confidence intervals [CI]) were determined for survey responses. One hundred and seven respondents (71% response rate) included specialists in pediatric Emergency Medicine, Sports Medicine, Neurology, Neurosurgery, Neuropsychology, Neuropsychiatry, Physical and Occupational Therapy, Physiatry/Rehabilitation, and General Pediatrics. Respondents rated headache as the most prevalently reported symptom after pediatric mTBI, followed by cognitive problems, dizziness, and irritability. Of the 65 (61%; [95% CI: 51,70]) respondents able to prescribe medications, non-steroidal anti-inflammatory medications (55%; [95% CI: 42,68]) and acetaminophen (59%; [95% CI: 46,71]) were most commonly recommended. One in five respondents reported prescribing amitriptyline for headache management after pediatric mTBI, whereas topiramate (8%; [95% CI: 3,17]) was less commonly reported. For cognitive problems, methylphenidate (11%; [95% CI: 4,21]) was used more commonly than amantadine (2%; [95% CI: 0,8]). The most common non-pharmacological interventions were rest (“always” or “often” recommended by 83% [95% CI: 63,92] of the 107 respondents), exercise (59%; [95%CI: 49,69]), vestibular therapy (42% [95%CI: 33,53]) and cervical spine exercises (29% [95%CI: 21,39]). Self-reported utilization for common pediatric mTBI interventions varied widely across our Canadian and United States consortium. Future effectiveness studies for pediatric mTBI are urgently needed to advance the evidence-based care.

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cover image Journal of Neurotrauma
Journal of Neurotrauma
Volume 36Issue Number 20October 15, 2019
Pages: 2886 - 2894
PubMed: 31025612

History

Published in print: October 15, 2019
Published online: 23 September 2019
Published ahead of print: 17 June 2019
Published ahead of production: 26 April 2019

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Rebekah Mannix [email protected]
Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts.
Roger Zemek
Departments of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Keith Owen Yeates
Department of Psychology, Faculty of Kinesiology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
Kristy Arbogast
Division of Emergency Medicine, Sports Medicine and Performance Center, Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Shireen Atabaki
Division of Emergency Medicine, Children's National Health System, Washington, District of Columbia.
Mohammed Badawy
Department of Pediatrics, University of Texas Southwestern Medical School, Dallas, Texas.
Miriam H. Beauchamp
Department of Psychology, University of Montréal and Ste-Justine Research Center, Montréal, Canada.
Darcy Beer
Section of Pediatric Emergency Medicine, University of Manitoba, Children's Hospital of Winnipeg, Winnipeg, Manitoba, Canada.
Steven Bin
UCSF School of Medicine, Division of Pediatric Emergency Medicine, San Francisco, California.
Brett Burstein
Division of Pediatric Emergency Medicine, Department of Pediatrics, Montréal Children's Hospital, McGill University Health Centre, Montréal, Quebec, Canada.
William Craig
Department of Pediatrics, University of Alberta and Stollery Children's Hospital, Edmonton, Alberta, Canada.
Dan Corwin
Division of Emergency Medicine, Sports Medicine and Performance Center, Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Quynh Doan
Children's Research Institute, Division of Emergency Medicine, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
Michael Ellis
Department of Surgery and Pediatrics, Section of Neurosurgery, University of Manitoba, Pan Am Concussion Program, Winnipeg, Manitoba, Canada.
Stephen B. Freedman
Stephen B. Freedman Sections of Pediatric Emergency Medicine and Gastroenterology, Department of Pediatrics, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Isabelle Gagnon
School of Physical and Occupational Therapy, McGill University; Trauma Programs, Montréal Children's Hospital, McGill University Health Center, Montréal, Quebec, Canada.
Jocelyn Gravel
Division of Emergency Medicine, University of Montréal and Ste-Justine Research Center, Montréal, Canada.
John Leddy
UBMD Department of Orthopaedics and Sports Medicine, State University of New York at Buffalo, Buffalo, New York.
Angela Lumba-Brown
Departments of Emergency Medicine and Pediatrics, Concussion and Brain Performance Center, Stanford University, Stanford, California.
Christina Master
Division of Orthopaedics, Sports Medicine and Performance Center, Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Andrew R. Mayer
The Mind Research Network/LBERI and Departments of Psychology, Neurology, and Psychiatry, University of New Mexico, Albuquerque, New Mexico.
Grace Park
Department of Emergency Medicine, University of New Mexico Hospital, Albuquerque, New Mexico.
Michelle Penque
Pediatrics Division of Emergency Medicine, and Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York.
Tara Rhine
Department of Pediatrics, University of Cincinnati College of Medicine, Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Kelly Russell
Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital of Winnipeg, Winnipeg, Manitoba, Canada.
Kathryn Schneider
Sport Injury Prevention Research Centre, Faculty of Kinesiology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
Michael Bell*
Department of Pediatrics and Critical Care Medicine, Children's National Medical Center, Washington, District of Columbia.
Stephen Wisniewski*
Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.

Notes

*
These authors contributed equally to this article.
Address correspondence to: Rebekah Mannix, MD, MPH, Division of Emergency Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115 [email protected]

Author Disclosure Statement

No competing financial interests exist.

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