First-Ever Pediatric Concussion Guidelines: Real-Life Cases

Debra Houry, MD, MPH


November 15, 2018

Editorial Collaboration

Medscape &

Assessing Impact and Force

A concussion can occur as a result of an external force to the head or body that causes the brain to accelerate and decelerate with translational, rotational, and/or angular forces. Brain injuries can result on the side of the force (coup) or on the side opposite the force (contrecoup).

The symptoms of concussion can vary with different biomechanics, previous injury (including subconcussive impacts), and location of the impact. Question the patient and document the type of force and location where the force was received. The magnitude of that force may dictate how much damage is occurring inside the brain tissue. However, a relatively minor force can also lead to significant symptoms. This may be the consequence of an athlete having increased vulnerability to concussion or other physical or psychological factors that are exacerbating symptoms. Some experts believe that short-term, cumulative, subconcussive head impacts can increase vulnerability to concussion. Therefore, a clinical TBI doesn't always correlate with the magnitude of a hit or blow recorded by helmet sensors.

These case studies provide an overview of selected medical issues that are important to healthcare professionals who are responsible for pediatric patients with mTBI. They are not intended as a standard of care and should not be interpreted as such. These case studies are only examples or teaching tools, and as such, are of a general nature, consistent with the reasonable, objective practice of the healthcare professional. Individual treatment will depend on the specific facts and circumstances presented to the healthcare professional.