Head concussion in children has become a serious public health concern in recent years. From 2005 to 2009, there were more than 2 million outpatient visits and nearly 3 million ED visits by children for mild traumatic brain injury (mTBI), popularly called concussion. An mTBI can be associated with ongoing physical, cognitive, and psychological problems. Proper diagnosis and management are crucial to ensure optimal recovery.
Although guidelines have been available for treating adults with mTBI, the first broad evidence-based guidelines for diagnosis and management of pediatric patients was released only this fall by the Centers for Disease Control and Prevention. The guidelines are based on a comprehensive review of the literature published between 1990 and 2015.
Several recommended best practices merit highlighting.
Diagnosis. Computed tomography (CT) is the preferred imaging test for assessing severe injury, but it shouldn't be used routinely. The decision to obtain a CT scan must consider both the likelihood of serious head injury and the risks of CT, which include radiation exposure and the need for sedation in young children. Neurologic diagnostic tools, such as symptom scales and cognitive testing, should also be used to assist diagnosis.
Management. A child's physical and cognitive activity should be restricted for the first few days after mTBI, but rest shouldn't be prolonged. After several days, parents and families can allow the child to gradually resume activities; full activity can be resumed if the child is symptom-free at rest and with increased levels of physical exertion. The guidelines also address returning to school, ongoing headaches, and cognitive impairment.
Prognosis. Recovery time from mTBI generally ranges from one to three months. The presence of certain disorders or symptoms in the child prior to the injury as well as demographic and injury-related risk factors can delay recovery. Families should be informed about the impact of these factors and counseled that recovery time and trajectory are never completely predictable. Additional resources and tools are available at www.cdc.gov/HEADSUP.—Joan Zolot, PA
Lumba-Brown A, et al. JAMA Pediatr
2018 Sep 4 [Epub ahead of print].