Symptoms and Care Provided to Concussion Patients Who Have 72 Hour Emergency Department Revisits: A Retrospective Cohort Study (P3.335)

Objective: To characterize the symptoms and care provided to concussion patients who have 72 hour ED revisits.Background: There is limited data on ED patients with concussion.Design/Methods: We conducted a retrospective cohort study of adults evaluated in an urban academic ED from May 2014-June 2015 following concussion. We searched for patients with 72-hour ED revisits with either a chief complaint or discharge diagnosis on either visit concerning for concussion. Patients’ records were examined for selected variables relevant to ED care of concussion.Results: There were 67,862 visits and 2,151 72-hour revisits to our ED. Concussion search criteria were met by 195 patients. Chart review confirmed diagnosis in 19 patients with concussion who revisited the ED within 72 hours for related symptoms. Concussion characteristics at the initial visit included headache 68[percnt], nausea/vomiting 26[percnt], and cognitive changes 21[percnt]. At the revisit, patients reported headache 58[percnt], nausea/vomiting 42[percnt], and cognitive changes 5[percnt]. 89[percnt] had imaging during at least one visit. During the first ED visit, 63[percnt] underwent imaging. 74[percnt] reported moderate- severe pain, and 58[percnt] received an analgesic, most commonly acetaminophen (42[percnt]) and ibuprofen (21[percnt]). 16[percnt] were administered an anti-emetic. 17[percnt] were given a prescription (acetaminophen or ibuprofen) on the initial discharge (17[percnt]). At the revisit, 36[percnt] received a prescription on discharge. 53[percnt] received concussion-specific instructions on initial visit only, 21[percnt] received them on the second visit. A concussion center referral was given to 37[percnt] during initial ED discharge, and to 47[percnt] during the second visit.Conclusions: This is the first snapshot of concussion patients who revisit the ED. Most received neuroimaging at the initial encounter. While most were in pain and given medication during the visit, few were prescribed medication. Only half received concussion specific discharge instructions. These findings suggest target areas for improvement of ED care for patients with concussion. Disclosure: Dr. Minen has nothing to disclose. Dr. Shome has nothing to disclose. Dr. Balcer has received personal compensation for activities with Biogen Idec and Genzyme as a consultant. Dr. Grudzen has nothing to disclose. Dr. Gavin has nothing to disclose.