What Pediatricians Need to Know About the CDC Guideline on the Diagnosis and Management of mTBI.

Meeryo C Choe,Tamara M Haegerich,Andrew J Gregory

doi:10.3389/fped.2018.00249

Abstract

Pediatric traumatic brain injury (TBI) is a growing health concern, with over half a million TBI-related emergency department (ED) visits annually. However, this is likely an underestimate of the true incidence, with many children presenting to their pediatrician. The Centers for Disease Control and Prevention (CDC) published a guideline on the diagnosis and management of pediatric mild traumatic brain injury (mTBI). We outline key points and a decision checklist for pediatricians based on this evidence-based guideline.

Highlights

Pediatric traumatic brain injury (TBI) is a growing public health concern
Many tools to assess mild traumatic brain injury (mTBI) symptoms, prognosis, and recovery exist, but few are validated in the pediatric population, and none should be used in isolation
Clinicians should use validated clinical decision rules to determine the need for imaging based on factors that increase risk for injury, and counsel the patient and family regarding the risks associated with imaging

Summary

BACKGROUND

In 2013, there were an estimated 641,935 TBI-related emergency department (ED) visits, 17,930 TBI-related hospitalizations, and 1,484 TBI-related deaths among children aged 0–14 years in the United States (1) These data underestimate the true burden as the majority of pediatric patients with a mild traumatic brain injury (mTBI), which includes concussion, may seek care from an outpatient clinic or not seek care at all. With legislation in all 50 states requiring evaluation or diagnosis prior to return to play after a sports-related mTBI in children and adolescents, pediatricians may see a growing number of children in their offices with such injuries. These statistics point to the necessity of evidence-based recommendations for pediatricians. While mTBI guidelines are available for use in the adult population, comprehensive evidence-based guidelines for the diagnosis and management of pediatric mTBI have not been developed in the United States (3)

THE CDC GUIDELINE ON DIAGNOSIS AND MANAGEMENT OF MTBI AMONG CHILDREN

Diagnosis and Management

When to Refer for Imaging

When to Refer for Further Treatment

CONCLUSION