The first comprehensive pediatric concussion guidelines were launched by pediatric emergency medicine researchers at the Children’s Hospital of Eastern Ontario and the Ontario Neurotrauma Foundation. The guidelines provide healthcare providers with evidence-based recommendations to standardize the diagnosis and management of concussion in children aged 5 to 18 years old, from the initial assessment through to the period of recovery, which can last months.
Also included in the guidelines are numerous tools and instructions for all levels of user (eg, a pocket tool for coaches or parents to use at the sideline to recognize concussion, which also offers advice on when to remove kids from play and when to seek emergent medical attention).
Algorithms are provided for emergency department physicians to facilitate decisions on whether or not to obtain CT scans. Examples of written discharge handouts for patients and families are also included. For family physicians and nurse practitioners, the guidelines provide recommendations for ongoing symptom management and decision tools.
Key Recommendations from the Guideline:
♦ For children participating in high-risk sports (contact and collision sports), consider baseline neurocognitive testing.
♦ On initial presentation, assess and treat physical, cognitive, and other neurologic deficits:
– Manage acute symptoms, including identifying any so-called red flags and assessing need for emergent neuroimaging.
– Perform an acute concussion evaluation based on a standardized tool.
– Prescribe physical and cognitive rest.
♦ On discharge, provide education and a postconcussion care plan with explicit direction for teachers and school-based activities:
– Educate about the risks for persistent symptoms including managing sleep, headaches, and fatigue.
– Counsel patients on avoiding alcohol, recreational drugs, and driving during recovery.
– Instruct patients to have close primary care follow-up and referral to a specialist in concussion management if symptoms persist beyond 1 month.
♦ On interim assessment, have return-to-learn and return-to-play stepwise plans and refer children with multiple concussions to specialized care by a concussion expert.
♦ At 1 month, if symptoms persist, patients should undergo a more comprehensive health evaluation to:
– Look for underlying physical or mental health modifiers.
– Consider a program of sleep hygiene.
– Prescribe short-term medications as needed for sleep and headaches.
– Refer patients with neurocognitive or mental health needs to relevant specialists.
Source: Guidelines for Diagnosing and Managing Pediatric Concussion (free PDF)