Category: Pediatrics
Keywords: Concussion, minor head injury, traumatic brain injury, mTBI (PubMed Search)
Posted: 9/14/2018 by Mimi Lu, MD
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The Centers for Disease Control and Prevention recently released guidelines on the diagnosis and management of mild traumatic brain injury (mTBI**) among children. From 2005-2009, children made almost 3 million ED visits for mTBI. Based on a systemic review of the literature, the guideline includes 19 sets of recommendations on the diagnosis, prognosis, and management/treatment of pediatric mTBI.
Key Recommendations:
1. Do not routinely image patients to diagnose mTBI (utilize clinical decision rules to identify children at low risk and high risk for intracranial injury (ICI), e.g. PECARN)
2. Use validated, age-appropriate symptoms scales to diagnose mTBI
3. Assess evidence-based risk factors for prolonged recovery. No single factor is strongly predictive of outcome.
4. Provide patients with instructions on return to activity customized with their symptoms (see CDC Resources below)
5. Counsel patients to return gradually to non-sports activities after no more than 2-3 days of rest.
A wealth for information and tools for provder and families can be found at:
www.cdc.gov/HEADSUP (including evaluation forms and care plans for providers)
www.cdc.gov/traumaticbraininjury/PediatricmTBIGuideline.html
**Although concussion, minor head injury, and mBI are frequently used interchangeably, they have different connotations which allows for misinterpretation and confusion. The guideline recommends the clinical use of the single term mild traumatic brain injury. This is defined as "an acute brain injury resulting from mechanical injury to the head from external physical forces including: (1) 1 or more of the following: Confusion or disorientation, loss of consciousness for 30 minutes or less, posttraumatic amnesia for less than 24 hours, and/or other transient neurologic abnormality such as focal signs, symptoms, or seizure; (2) Glasgow Coma Scale score of 13-15 after 30 minutes post injury or later upon presentation for healthcare
Diagnosis and management of mild traumatic brain injury in children: A systemic review. Lumba-Brown A, Yeates KO, Sarmiento K, Breiding MJ, Haegerich TM, Gioia GA, Turner M, Benzel EC, Suskuer SJ, Giza CC, Joseph M,Broomand C, Weissa B, Gordon W Wright DW, Moser RS, McAvoy K, Ewing-Cobbs L, Duaime AC, Putukian M, Holhouse B, Paulk D, Wade SL, Herig SA, HalsteadM, Keenan H, Choe M, Christia CW, Gusiewic K, Raksin PB, Gregory A, Mucha A, Taylor HG, Callahan JM, DeWtt J, Collins MW, Kirkwood MW, Ragheb J, Ellenbogen RG, Spinks TJ, Ganiats TG, Sabelhaus LJ, Altenhofen K, Hoffman , Getchius T, Gronseh G,Donnell Z, O'Connor RE, Timmons SD JAMA Pediatr 2018 Sept 4.
