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CDC Guideline on Mild Traumatic Brain Injury in Children

Important Practice Takeaways for Sports Medicine Providers

Sarmiento, Kelly, MPH*; Waltzman, Dana, PhD*; Lumba-Brown, Angela, MD; Yeates, Keith O., PhD; Putukian, Margot, MD, FACSM§; Herring, Stanley, MD

doi: 10.1097/JSM.0000000000000704
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Objectives: The Centers for Disease Control and Prevention (CDC) published an evidence-based guideline on the diagnosis and management of pediatric mild traumatic brain injury (mTBI) in 2018. This commentary provides key practice takeaways for sports medicine providers outlined in the Guideline recommendations.

Data Sources: The CDC Pediatric mTBI Guideline was developed through a rigorous scientific process using a modified Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology. A systematic review of the scientific literature published over a 25-year period for all causes of pediatric mTBI formed the basis of the Guideline.

Main Results: The key practice takeaways for sports medicine providers focus on preseason evaluations, neuroimaging, symptom-based assessment, managing recovery, monitoring for persistent symptoms, and return to activity, including sport and school.

Conclusions: Sports medicine providers play an integral part in the implementation of evidence-based practices that promote appropriate diagnosis and management of mTBI in children. This commentary highlights key practice takeaways that sports medicine providers can implement.

*Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA;

Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California;

Department of Psychology, University of Calgary, Calgary, Alberta, Canada;

§Department of Athletic Medicine, University Health Services, Princeton University, Princeton, New Jersey; and

Departments of Rehabilitation Medicine, Orthopaedics and Sports Medicine, and Neurological Surgery, University of Washington School of Medicine, Seattle, Washington.

Corresponding Author: Kelly Sarmiento, MPH, Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mail Stop F62, Atlanta, GA 30341 (KSarmiento@cdc.gov).

No funding supported the development of this commentary. K. O. Yates is the President of the International Neuropsychological Society. He receives speaker honorarium and book royalties from Guilford Press and Cambridge University Press. He also discloses his research grant support from the National Institutes of Health, Brain Canada, Alberta Health Services, and the Canadian Institutes of Health Research, and his research support from the Research Institute at Nationwide Children's Hospital in Columbus, Ohio. M. Putukian works as a consultant to the USA Football Medical Advisory Committee, National Football League Head Neck and Spine Committee, US Lacrosse Sports Science & Safety Committee, National Collegiate Athletics Association Concussion Task Force, the US Soccer Medical Advisory Committee, and serves as a medical consultant for Major League Soccer. She also reports receiving a research grant support from the National Collegiate Athletics Association–Department of Defense Grand Alliance and the National Operating Committee on Standards for Athletic Equipment. S. Herring reports stock options from VICIS, a helmet manufacturer. The remaining authors report no conflicts of interest.

The findings and conclusions in this manuscript are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Received August 29, 2018

Accepted October 25, 2018

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