First-Ever Pediatric Concussion Guidelines: Real-Life Cases

Debra Houry, MD, MPH


November 15, 2018

Editorial Collaboration

Medscape &

Case 3: Imaging Studies After mTBI

A 16-year-old boy fell backwards and struck his head on the sidewalk after slipping on ice outside his home. Observers at the scene reported that he did not lose consciousness. However, they did report that he acted dazed and confused and initially did not respond to questions. After the first minute, he began responding to commands and was able to move all extremities. Emergency medical services arrived and took the patient to the local ED.

Examination of the patient in the ED demonstrated:

  • Glasgow coma scale score of 14;

  • Problems with memory (he could not remember three objects or say three numbers backwards);

  • Persisting confusion and disorientation (he was oriented to person and time but not place);

  • A small occipital cephalohematoma; and

  • Normal cranial nerve, motor sensory, and reflex exam with no focal neurologic signs. Patient did not report neck or head pain.

Figure 3. Head CT showing right temporal and frontal contusion.

The emergency physician ordered a head CT to assess for more severe brain injury. The patient and his family were counseled regarding the risks of CT. The CT scan showed a right temporal and frontal contusion.

Over the next 4 hours, the patient's cognitive function returned to normal and his neurologic exam remained normal. He was sent home with education and discharge instructions that covered the following information:

  • Warning signs indicating a more serious injury;

  • Expected course of symptoms and recovery;

  • Instructions for monitoring postconcussive symptoms;

  • Steps to prevent further injury;

  • Instructions regarding return to school and return to play or recreation; and

  • Instructions for when to follow up with a healthcare provider.