Gold standard of care for concussion for children presenting to the emergency department

There are 1.7 million traumatic brain injuries in the United States each year. Mild traumatic brain injury or concussion, accounts for over 600,000 pediatric visits to Emergency Departments (EDs) annually. Children can suffer for up to two years with severe headaches, difficulty concentrating, depression, interrupted school attendance, and re-injury in sports when concussion is not diagnosed and managed appropriately. Recurrent concussion has been linked to long-term cognitive impairment, neurodegenerative disease and chronic traumatic encephalopathy. Children with concussion benefit from a graduated return to academics and sports with recovery. In a nationwide study, we documented the majority of children with concussion are discharged from the ED and returned to school with inadequate recommendations for management. Underserved urban patients are at increased risk of loss to follow-up and lack of information on the need for self and family symptom monitoring.  Health IT is emerging as an effective disease management tool in minority children and families. ED-initiated programs of symptom monitoring and management that allow the child, family school nurse and ED team to identify and monitor concussion symptoms as well as the graduated return to academics and sports, based on symptom and behavior monitoring, can guide recovery for underserved children.