EC Paediatrics

Background: Concussions are one of the most prevalent types of head injuries among children. Children’s concussions represent a significant proportion of emergency department visits. Most children’s concussions resolve within a month without secondary complications. However, early management should be performed to avoid further complications and consequences. Therefore, parents should have sufficient knowledge regarding children’s concussions when caring for children, and pediatric emergency physicians should adequately understand the diagnosis and management of children’s concussions to ensure better outcomes.

Aim: This study aimed to assess the prevalence of children’s concussions, as well as the knowledge among parents and pediatric emergency physicians of children’s concussions, by reviewing previous original studies on this subject.

Methods: For this systematic review, we searched PubMed, Elsevier, Science Direct, and Google Scholar databases for studies related to the current subject. The keywords used in this search process included “pediatric”, “physicians”, “emergency”, “prevalence”, “knowledge”, “parents”, “prevalence”, and “awareness.” The study’s inclusion criteria were original, English-language articles that focused on the examined topic whose full text was available.

Results: In total, 11 articles were eligible for inclusion, and they involved a total of 26,046 participants. The majority of these studies were focused on parents’ knowledge, followed by the prevalence of children’s concussions and then pediatric emergency physicians’ knowledge.

Conclusion: The prevalence of children’s concussions in the reviewed studies was similar to that found in previous reports, and parents’ knowledge was good; however, pediatric emergency physicians’ knowledge contained many gaps that can be improved by the establishment of educational programs.

Keywords: Brain Concussion; Concussion; Parents; Pediatric Emergency Physicians; Pediatrics; Knowledge; Prevalence

1. National Center for Injury Prevention and Control. What is a concussion? (2021).
2. Dizon Janine Margarita R. “Pediatric concussion epidemiology and incidence in general aspects of life”. Journal of Sports Medicine and Doping Studies 5 (2022): 258.
3. McCrory P., et al. “Consensus statement on concussion in sport-the 5^th international conference on concussion in sport held in Berlin, October 2016”. British Journal of Sports Medicine 11 (2017): 838-847.
4. BlueCross BlueShield. The Health of America Report. The Steep Rise in Concussion Diagnosis in the U.S. Blue Health Intelligence (2017): 1-8.
5. Black AM., et al. “Association between concussion education and concussion knowledge, beliefs and behaviours among youth ice hockey parents and coaches: a cross-sectional study”. BMJ Open8 (2020): e038166.
6. McCrory P., et al. “Consensus statement on concussion in sport: the Fourth International Conference on Concussion in Sport held in Zurich, November 2012 [Consensus Development Conference]”. British Journal of Sports Medicine 5 (2013): 250-258.
7. Boutis K., et al. “The diagnosis of concussion in a pediatric emergency department”. The Journal of Pediatrics5 (2015): 1214-1220.
8. Centers for Disease Control and Prevention. “Nonfatal traumatic brain injuries related to sports and recreation activities among persons aged #19 years-United States, 2001-2009”. Morbidity and Mortality Weekly Report 39 (2011): 1337-1342.
9. National Center for Injury Prevention: Report to Congress on mild traumatic brain injury in the United States: steps to prevent a serious public health problem. Atlanta, GA: National Center (2003).
10. Concannon LG. “Effects of legislation on sports-related concussion”. Physical Medicine and Rehabilitation Clinics of North America 2 (2016): 513-527.
11. Sirisena D., et al. “Pilot single-centre cross-sectional study to determine emergency physicians’ knowledge and management of sports concussion: an experience from Singapore”. Singapore Medical Journal6 (2018): 322.
12. , et al. “The PRISMA 2020 statement: an updated guideline for reporting systematic reviews”. Systematic Reviews 10: 89.
13. Beidler E., et al. “Factors associated with parent and youth athlete concussion knowledge”. Journal of Safety Research 80 (2022): 190-197.
14. Haarbauer-Krupa JK., et al. “Factors associated with concussion symptom knowledge and attitudes towards concussion care-seeking among parents of children aged 5-10 years”. Journal of Safety Research 78 (2021): 203-209.
15. Roberts SD., et al. “Parent knowledge of and attitudes towards youth sport-related concussion and associations with child and parent factors”. Concussion4 (2021): CNC93.
16. Cook NE and Iverson GL. “Concussion among children in the United States general population: incidence and risk factors”. Frontiers in Neurology 12 (2021): 773927.
17. Dufour SC., et al. “Prevalence and correlates of concussion in children: Data from the Adolescent Brain Cognitive Development study”. Cortex 131 (2020): 237-250.
18. Yaramothu C., et al. “Epidemiology and incidence of pediatric concussions in general aspects of life”. Brain Sciences10 (2019): 257.
19. Rice T and Curtis R. “Parental knowledge of concussion: Evaluation of the CDC's “Heads up to parents” educational initiative”. Journal of Safety Research 69 (2019): 85-93.
20. Rieger B., et al. “Parent knowledge and perceptions of concussion related to youth football”. Cureus3 (2018): e2268.
21. Lin AC., et al. “Assessment of parental knowledge and attitudes toward pediatric sports-related concussions”. Sports Health2 (2015): 124-129.
22. Zemek R., et al. “Canadian pediatric emergency physician knowledge of concussion diagnosis and initial management”. Canadian Journal of Emergency Medicine2 (2015): 115-122.
23. Zonfrillo MR., et al. “Pediatric providers’ self-reported knowledge, practices, and attitudes about concussion”. Pediatrics6 (2012): 1120-1125.
24. Haarbauer-Krupa J., et al. “Comparing prevalence estimates of concussion/head injury in U.S. children and adolescents in national surveys”. Annals of Epidemiology 54 (2021): 11-20.
25. Black L and Zablotsky B. “Concussions and brain injuries in children: United States, 2020”. NCHS Data Brief 423 (2021): 1-8.
26. Nanos KN., et al. “Youth sport-related concussions: perceived and measured baseline knowledge of concussions among community coaches, athletes, and parents”. Mayo Clinic Proceedings12 (2017): 1782-1790.
27. Sullivan SJ., et al. “Understanding of sport concussion by the parents of young rugby players: a pilot study”. Clinical Journal of Sport Medicine 3 (2009): 228-230.
28. Weerdenburg K., et al. “Concussion and its management: What do parents know?” Paediatrics and Child Health3 (2016): e22-e26.
29. Kay MC., et al. “Parents’ and child’s concussion history as predictors of parental attitudes and knowledge of concussion recognition and response”. Orthopaedic Journal of Sports Medicine12 (2017): 2325967117742370.
30. Feiss R., et al. “A systematic review of the effectiveness of concussion education programs for coaches and parents of youth athletes”. International Journal of Environmental Research and Public Health 8 (2020): 2665.
31. Mannix R and Bazarian JJ. “Managing pediatric concussion in the emergency department”. Annals of Emergency Medicine6 (2020): 762-766.
32. Boutis K., et al. “The diagnosis of concussion in pediatric emergency departments: a prospective multicenter study”. The Journal of Emergency Medicine6 (2018): 757-765.
33. Mitchell SH., et al. “Emergency physicians' knowledge of sports-related concussion, referral patterns, and use of return to play guidelines”. Athletic Training and Sports Health Care5 (2016): 209-215.
34. Carson JD., et al. “Are Canadian clinicians providing consistent sport-related concussion management advice?” Canadian Family Physician6 (2016): 494-500.