Service Delivery Models for the Management of Pediatric and Adolescent Concussion: A Systematic Review.
Jacqueline Purtzki, Haley M Chizuk, Aaiush Jain and 6 others
PMID 36545517WHAT IT FOUND
Most concussion studies measure provider habits or costs, not patient recovery.
Specialists deliver active exercise and multidisciplinary care, while generalists often lack standardized tools. Telemedicine improves access for rural families but cannot replace in-person neurologic exams.
Key findings
01The review identified three service models: generalist-based, specialist-based, and web/telemedicine-based, but found few articles thoroughly described these models or evaluated their effectiveness.
02Specialist-based services frequently utilized active interventions like aerobic exercise, which were associated with faster recovery and reduced persistent symptoms in adolescents, contrasting with the passive rest or medication approaches often used by generalists.
03Telemedicine models increased accessibility and reduced costs for remote communities, with high patient preference, but could not provide in-person neurologic examinations.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
Most included studies did not thoroughly describe the service delivery model or evaluate its effectiveness on patient outcomes. The review excluded adult populations, moderate-to-severe traumatic brain injuries, and emergency department-based research, limiting generalizability to acute or severe cases. Cost studies were limited to North American contexts and commercially insured patients, excluding uninsured populations and indirect costs like travel or time off work. The classification system is broad and simplistic due to the heterogeneity and lack of detail in the included articles.
Declared interests
The paper does not explicitly state funding sources or conflicts of interest in the provided text, but notes that the search was assisted by a health sciences librarian.
The easy way to misread this
Do not assume that telemedicine is a complete substitute for in-person care. The review explicitly states that in-person neurologic examinations cannot be performed via telemedicine, and web-based models are limited by technology access and potential symptom triggers like screen time.