Just the facts: diagnosis and acute management of pediatric concussion.

Abstract:Sport-related concussion (SRC) is a common injury in recreational and organized sport. Over the past 30 years, there has been significant progress in our scientific understanding of SRC, which in turn has driven the development of clinical guidelines for diagnosis, assessment, and managemen

Pediatric Concussion Management in the Emergency Department: A National Survey of Parents

ObjectiveThis study aimed to investigate knowledge of paediatric concussion amongst emergency medicine trainees, testing the hypothesis that emergency medicine trainees lack sufficient knowledge to competently assess, diagnose and manage sports-related paediatric concussion.Designcross-sectional questionnaire survey.SettingSecondary care emergency medicine departments.ParticipantsAll emergency medicine trainees in one geographical training region in the UK were invited to participate.Outcome measuresoccupational grade, years of experience, history of specific concussion training, awareness of head injury guidelines, perceived knowledge and confidence in concussion diagnosis and management.Main resultsSixty questionnaires were returned. Across all training grades, the mean correct response score on questions of diagnosis, assessment and management of concussion was 73.4%. Nearly 70% of trainees were not aware of any concussion guidelines, and only 10% had attended a course or received training regarding concussion. There was a negative correlation between awareness of guidelines and perceived confidence (r=−0.50 p<0.001), and knowledge in diagnosis and management of concussion (r=−0.51, p<0.001). The majority (91.7%) of the participants would like further education on concussion management, with an online learning module being the preferred format (71.7%).ConclusionsThe study revealed insufficient level of knowledge and confidence in the assessment, diagnosis and management of paediatric concussion among emergency medicine trainees. None of the variables studied statistically predicted knowledge score. Additional concussion-specific education would be beneficial to optimise trainees’ knowledge of paediatric concussion.Competing interestsNone.

This article reviews current issues and practices in the assessment and clinical management of sports-related concussion. An estimated 300,000 sports-related concussions occur annually in the United States. Much of what has been learned about concussion in the sports arena can be applied to the diagnosis and management of concussion in military settings. Current military guidelines for assessing and managing concussion in war zones incorporate information and methods developed through sports-concussion research. We discuss the incidence, definition, and diagnosis of concussion; concussion grading scales; sideline evaluation tools; neuropsychological assessment; return-to-action criteria; and complications of concussion.

Background: In recent years, sports leagues and sports medicine experts have developed guidelines for concussion management. The extent to which current clinical practice is consistent with guideline recommendations is unclear. At the collegiate level, there have been few examinations of concussion management practices and the extent to which meaningful differences across divisions of competition exist. Purpose: The purposes of this study were to (1) examine current practices in concussion diagnosis and management at National Collegiate Athletic Association (NCAA) member colleges, (2) explore the extent to which current practices reflect current recommendations for concussion diagnosis and management, and (3) determine whether there are differences in management patterns across divisions of competition. Design: Descriptive epidemiology study. Methods: An electronic questionnaire was sent to sports medicine clinicians at all NCAA member colleges during September and October 2013. Clinicians were asked about baseline assessments, diagnosis and management practices, return-to-play protocols, the perceived prevalence of underdiagnosis, and basic demographic information. Results: Approximately 30% (n = 866) of contacted clinicians, representing nearly 50% (n = 527) of NCAA member colleges, responded to the questionnaire. Preparticipation baseline examinations were administered at the majority of schools (95%), but most (87.5%) administered baseline assessments only to selected high-risk athletes. Computerized neurocognitive testing and balance assessments were most commonly used as preseason baseline and postinjury assessments. Multimodal examination in line with NCAA and other guidance was used only at a minority of institutions. Athletic trainers most commonly administered and interpreted the preseason baseline examination. Most clinicians reported that their institutions’ practices were in line with NCAA guidelines during the first 24 hours of an athlete’s concussion diagnosis, with exact percentages varying across measures. Differences across divisions of competition included shorter return-to-play time at Division I schools than Division III schools (9.13 vs 10.31 days, respectively) and more frequently referring concussed athletes to a physician within 24 hours of diagnosis at Division I schools. Conclusion: Concussion management at many colleges in the United States incorporates elements recommended by current guidelines; however, there is room to improve. Increasing the use of a multimodal baseline and postinjury examination will elevate the concussion care provided to college athletes and better align with best practice guidance.

An intervention to improve knowledge and increase comfort of concussion management among school medical staff

ObjectiveEvaluate knowledge on concussion management within the European Francophonie of the ReFORM group.DesignCross-sectional.Setting85 participants of an educational conference on concussion’s management given in Geneva, Luxembourg and Liege in September 2019.Participants38...

Heightened recognition of concussions and concerns about their sequelae in children has become an increasing community and public health concern. Biomarkers and clinical tests are being explored, but the diagnosis of concussion in the emergency department continues to be based on clinical signs and symptoms. While the majority of children go on to recover from post-concussive symptoms within 2 weeks, it is unclear which patients with concussion will go on to develop short- or long-term sequelae. A number of more or less evidence-based guidelines have become available which seek to guide clinicians on how to manage children post-concussion. In general, care after the emergency department is focused on reducing the risk of re-injury and rest until cerebral recovery with a graduated return to school and then play.

A Perfect Storm.

BackgroundThere are many reasons why concussion in children needs to be considered different from adults. The Zurich (2008) recommendations on the management of concussion in children are restricted to children...

Concussion, a type of mild traumatic brain injury, is a common injury encountered by providers caring for pediatric patients in the emergency department (ED) setting. Our understanding of the pathophysiologic basis for symptom and recovery trajectories for pediatric concussion continues to rapidly evolve. As this understanding changes, so do recommendations for optimal management of concussed youth. As more and more children present to EDs across the country for concussion, it is imperative that providers caring for children in these settings remain up-to-date with diagnostic recommendations and management techniques. This article will review the definition, epidemiology, pathophysiology, diagnosis, and management of pediatric concussion in the ED setting.

One of the National Football League’s (NFL) Head, Neck and Spine Committee’s principal goals is to create a ‘best practice’ protocol for concussion diagnosis and management for its players. The...

Evaluation and management of concussion in the child and adolescent requires a developmentally appropriate clinical model, emphasizing key factors relevant to the injury manifestation and needs of the child. This chapter presents a model for clinical evaluation and management of concussion in children and adolescents at the acute and postacute stages. Multiple methods and informants are incorporated with the evaluation guided by the specific goals and timing of the service in relation to the injury. Appropriate assessment and intervention tools are discussed for each stage, as well as reasons for referral for additional levels of care. The fundamental components of a pediatric concussion evaluation include the following: definition of injury characteristics; history of premorbid and postinjury risk factors; assessment of current neurocognitive functioning, postconcussion symptoms, and balance; and examination of social–emotional functioning. Different disciplines contribute to the evaluation and management of pediatric concussion. The concept of the concussion generalist and specialist service is introduced with suggested requisite training, skills, and knowledge to evaluate and manage the full range of complexity of pediatric concussion.

The Acute Symptoms of Sport-Related Concussion: Diagnosis and On-field Management

ContextThe Concussion Awareness Training Tool (CATT) is a series of online educational modules and resources with the goal of standardizing concussion recognition, diagnosis, treatment, and management. Based upon the established...