553 - Discordance between Documented and Patient Self-Reported Concussion Symptoms in the Pediatric Emergency Department
Monday, April 28, 2025
7:00am – 9:15am HST
Publication Number: 553.4114
Milisia Fam, Weill Cornell Medicine, New York, NY, United States; Will Simmons, Weill Cornell Medicine, New York, NY, United States; Steven Hicks, Pennsylvania State University College of Medicine, Hershey, PA, United States; Deborah A. Levine, Weill Cornell Medical College - New York, NY, Port Washington, NY, United States
Medical Student Weill Cornell Medicine New York, New York, United States
Background: Accurate identification of symptoms due to mild traumatic brain injury (mTBI) in children is challenging in the emergency department (ED). Under recognition of concussive symptoms may lead to inadequate anticipatory guidance, prolonged symptomatology, repeat ED visits, and possible long-term sequelae. Objective: Our objective was to compare the documentation of concussive symptoms in the ED chart compared to adolescent patients’ self-reported symptoms on a standardized survey tool, the Post-Concussion Symptom Inventory (PCSI). Design/Methods: This is a secondary analysis of a larger study of enrolled patients, aged 13-18 years old, with mTBI and at least 3 concussive symptoms within 48 hours of injury who presented to the pediatric EDs affiliated with a quaternary urban academic medical center. As part of the study, patients completed an electronic PCSI survey on their mobile device that was recorded into a database after evaluation by a physician in the pediatric ED. We compared and analyzed for discordance between the documented (positive or negative) concussive symptoms in the electronic medical record (EMR) with the 22 symptoms self-reported on the PCSI using a 7-point Likert scale. Results: Nineteen adolescent patients’ data were analyzed (Table 1). The median age was 16 years (IQR: 14, 17 years), 53% identified as female. Out of the 22 symptoms found on the SCAT5, “headache” and “nausea/vomiting” were most often recorded somatic symptoms in the EMR (79% and 68%, respectively). However, cognitive symptoms such as difficulty with concentration and confusion were only documented in 5% of patients. Sleep and emotional symptoms such as irritability or sadness were not documented in any patient. Considering the three most common concussion-related symptoms noted in prior concussion research (headache, difficulty concentrating, sensitivity to light), at least one of these symptoms was undocumented in the EMR in 14 of 18 patients (78%) who had at least one of these self-reported symptoms (PCSI >0), and in 9 of 13 patients (69%) who had at least one of these symptoms identified as moderate or severe (PCSI ≥3). Higher levels of discordance between symptoms documented in the EMR and self-reported moderate to severe symptomatology were noted with neck pain (57%), balance problems (50%) and fatigue (67%).
Conclusion(s): We found disagreement between concussive symptoms documented in the EMR and those self-reported by patients on a standardized symptom survey tool. Incorporation of a symptom survey tool into the EMR may enhance assessment of concussive symptom burden to guide management and follow-up.
