Children with concussion may not look injured but may experience attention and memory deficits, become clumsy and accident prone, and experience social withdrawal for weeks or even months after injury, according to the first comprehensive guidelines on the diagnosis and management of pediatric concussion.
Published by the Ontario Neurotrauma Foundation, with involvement of the American Academy of Neurology, the guidelines recommend that clinicians use validated tools such as the Postconcussion Symptom Inventory, and work closely with the child and his or her family and school to implement an individualized plan for both physical and cognitive rest. The guidelines are free and available here and here.
The guidelines recommended the practice of "if in doubt, sit them out" when unsure about whether concussion had occurred, and cited strong evidence in favor of both verbal information and printed handouts for patients and parents.
They also suggested clinicians consider baseline neurocognitive testing but only if the child or adolescent plays high-risk sports.
"Our hope is that these guidelines will lead to significant improvements in the current management, since our survey has demonstrated that the current management is suboptimal," said guidelines chair Dr. Roger Zemek, director of pediatric emergency research at the Children’s Hospital of Eastern Ontario, Ottawa.
"The literature examining pediatric concussion has seen exponential growth over the past decade, and the latest evidence points to different diagnostic and management approaches than 10 years (or even just 5 years) ago."
The guidelines’ 32-member panel involved pediatric neurologists, sports medicine physicians, and neuropsychologists, and doctors of rehabilitation medicine, emergency medicine, family medicine, pediatric neurosurgery, and speech and language pathology. The panelists also included health professionals in physical and occupational therapy, rehabilitation nursing, and child and youth health system planning, as well as a pediatric brain injury outreach program school liaison and a patient advocacy group adviser.
There were no relevant conflicts of interest declared.