New research by Pediatric Emergency Medicine physician, Deborah Levine, M.D., and published in the Pediatric Emergency Care Journal, focuses on improving the diagnosis and management of traumatic brain injury (TBI) in early childhood patients, an age group particularly vulnerable to this type of injury.
“[Children under five are] probably the most underdiagnosed patient population when it comes to concussions, often due subtle post-concussive symptoms, to the reliance on parental reports and the non-verbal nature of these young patients,” says Dr. Levine.
TBI Research Identifies Three Areas for Improving Concussion Diagnosis
To conduct the research, Dr. Levine and her team gathered perspectives from pediatric emergency medicine physicians practicing in various settings across the country regarding diagnosis, management, and the types of information they provide to their patients.
From those discussions, the team was able to identify three key themes for improving diagnosis of and care for TBIs in the youngest patients:
- Role of Guidelines and Tools in Diagnostic Workup: Most participants relied on clinical prediction tools for neuroimaging but did not use clinical symptom scales. This indicates a reliance on established guidelines for imaging decisions while highlighting a gap in the use of symptom scales for diagnosis.
- Difficulties in Diagnosis: Diagnosing concussions in young children is fraught with challenges due to their young age, limited verbal skills, and the unreliability of examinations, underscoring the need for more reliable and age-appropriate diagnostic tools.
- Challenges in Discharge Counseling: Providing clear discharge instructions to parents proved difficult for many participants, potentially leading to exacerbated symptoms, prolonged recovery periods and developmental delays. There was a notable lack of counseling regarding activity restrictions and educational tasks, with many physicians allowing self-modulation instead.
"Our findings highlight the critical need for standardized diagnostic and management protocols tailored to the unique needs of young children,” says Dr. Levine, “By addressing these gaps, we can improve outcomes and provide better care for our youngest patients."
Why TBI Research in the Youngest Patients Matters
By identifying the gaps and inconsistencies in current practices, this work paves the way for the development of more effective diagnostic tools and management strategies which will both enhance the care provided to young children with TBIs and contribute to their long-term health and development.
Following up on the initial study, the team has already been working on a quality improvement project to standardize discharge instructions at Weill Cornell Medicine (WCM) and Lower Manhattan Hospital (LMH) to include guidance specifically for those aged 0-5 and 6 and over. A survey given to parents following an emergency room visit for TBI finds that providing standardized instructions is helpful in reducing anxiety and increasing understanding of post-hospital care.
Additionally, Dr. Levine’s team has been collaborating with researchers at the University of Montreal to utilize their symptom scoring tool created specifically for young children that aims to standardize the grading of symptoms and improve diagnostic accuracy.
Dr. Levine is also involved in a study with Steven Hicks, M.D., PhD, of Penn State University, that is exploring salivary MicroRNA as a potential biomarker for head injuries. This collaborative study aims to develop a signature for point-of-care efforts, potentially enhancing detection and diagnosis in high-risk patient populations.
These studies serve as a call to action for the medical community to develop and implement better concussion practices for the benefit of our youngest and most vulnerable patients.
“There’s a lot of work on the horizon. It’s an exciting area because it’s been a previously neglected group of children,” concludes Dr. Levine.
