First-Ever Pediatric Concussion Guidelines: Real-Life Cases

Debra Houry, MD, MPH


November 15, 2018

Editorial Collaboration

Medscape &

Pediatric Mild Traumatic Brain Injury

Mild traumatic brain injury (mTBI), also known as concussion, in children is a major cause of visits to the emergency department (ED). The diagnosis, management, and follow-up of children with mTBI have been inconsistent owing to a lack of consensus guidelines and limitations in the evidence base. Recently, this gap in clinical care has been addressed with the newly released US Centers for Disease Control and Prevention (CDC) Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children.[1]Based on the current state of the science, the guideline identifies best practices for clinicians who encounter children with mTBI in a variety of settings, from primary care to the ED.[1] CDC has prepared the following clinical cases to illustrate major points from the guidance document.

Case 1: Assessing and Managing Symptoms of mTBI

A 9-year-old girl was in a low-speed motor vehicle crash. She struck her head against the rear passenger side window. The airbags did not deploy, and there was minimal damage to the car. She complained of facial pain, headache, nausea, and amnesia, prompting her mother to drive her immediately to the closest ED. No loss of consciousness was reported. She had no known history of TBI.

Figure 1. Motor vehicle accidents are a leading cause of mTBI.

A review of the Pediatric Emergency Care Applied Research Network (PECARN) decision rule[2] for children age 2 and older determined that a head CT was not warranted. On the basis of a validated, age-appropriate, symptom-based assessment, the patient was diagnosed with mTBI. Before discharge from the ED, the patient's family was given verbal and written instructions on returning to non-sports activity within 2-3 days, and was counseled to follow up with the patient's primary care provider.

During the follow-up visit, the patient complained of continuing headaches but no other neurologic symptoms.