Background/ Why Is This Important?
Concussion and mild traumatic brain injury (mTBI) — used synonymously in the literature — have received enormous attention in recent years, both in the media as well as the scientific literature. A concussion can occur to anyone from a variety of causes, can occur with or without loss of consciousness, and symptoms can be subtle and may not appear for several hours or even days. BC Children's Hospital alone sees well over 1,000 children per year with minor brain injuries, and it is believed that this is a fraction of children and youth who are assessed in general emergency departments and community physician offices throughout the province of British Columbia.
Although concussion has not been recognized as a potentially life threatening condition, evidence exists that children and adolescents take longer than adults to recover following a concussion. While the majority of individuals who suffer a concussion (85%) will have symptoms that resolve with no long-term consequences if diagnosed accurately and if given the correct treatment protocol, approximately 10 - 15% of people who suffer concussions will have prolonged symptoms and require specialized services. Therefore, concussion management and appropriate return to activity and school is crucial, particularly in the pediatric and adolescent populations.
Concussions impact the lives of children and youth at all levels and therefore having a provincial system of care in place with immediate access is crucial to their quality of life and future outcomes.
What Actions Have Already Been Taken?
Where did this work start? Child Health BC identified injury prevention and more specifically concussions as a priority area to focus on. Through a partnership with the BC Injury Prevention and Research Unit (BCIRPU) some foundational work was completed to support a provincial approach. These include an online concussion training tool and the completion of two reports on the burden of concussion in BC and a supplemental report outlining the burden of concussion among children and youth in BC.
The Concussion Awareness Training Toolkit (CATT), led by Dr. Shelina Babul, Associate Director/Sports Injury Specialist with the BC Injury Research and Prevention Unit, is to support standardize concussion recognition, diagnosis, treatment and management. The online tool has 3 components: CATT for Health Practitioners; CATT for Parents, Players and Coaches; and, CATT for Educators. CATT for Health Practitioners (HP) was developed by a team of injury prevention researchers and Emergency Department physicians with extensive provincial and national review. CATT HP features a learner-directed online training module supplemented with diagnostic tools (both adult and child SCAT3) and links to clinical resources, patient handouts, journal articles, related websites and concussion videos. CATT for Parents, Players and Coaches provides up-to-date educational training on the recognition, management and prevention of concussions. CATT for Educators, which will be launched Spring 2015, provides educators the necessary resources for supporting a concussed student in his/her integration back to school.
Child Health BC commissioned the BC Injury Prevention and Research Unit to develop two evidenced-based reports: Concussion in BC (October 2012); and a supplemental report, Burden of Concussion Among Children and Youth in BC (April 2013). The purpose of these reports was to highlight the significant issue of concussions in the province and to provide details on the burden of concussion among children and youth in BC. The reports are targeted to Health Authorities, health care providers and community stakeholders to be used to facilitate discussion of the need for standardized concussion prevention, diagnosis and management in BC.
In January 2015, Child Health BC (CHBC) organized a collaborative process with province-wide participation to review the newly released Guidelines for Diagnosing and Management of Pediatric Concussions. Using the Tiers of Service Framework, provincial stakeholders articulated the evidence-based assessments and interventions that are required at each Tier to support the diagnosis, management and treatment of pediatric concussion and post-concussive syndrome. The information generated from this provincial meeting will be used to inform policy and practice deliberations to support the establishment of a provincial approach to address pediatric concussions and post-concussive syndrome in an effort to improve health outcomes for children and youth in BC.
Where Are We Now?
The provincial concussion report is being completed and Health Authority concussion data packages have been developed. The report along with the data packages will be used to engage health authority leadership in determining a provincial approach for pediatric concussion. This will include community-based practitioners to specialized acute care services.