Concussions and other mild traumatic brain injuries are a fairly common issue in pediatric practice. For the first time, the CDC is offering evidence-based guidance to standardize diagnosis and management.
The Centers for Disease Control and Prevention (CDC) has released its first guidelines on treating children with concussions in an effort to increase compliance with evidence-based recommendations.
Historically, guidelines on treating pediatric mild traumatic brain injuries (mTBI) such as concussions have been consensus based or have been focused on specific causes of injuries, for example, sports, according to Gabraelle Lane, a public health analyst for the CDC, Atlanta, Georgia.
“The CDC Pediatric mTBI Guideline1 aims to spark a paradigm shift toward evidence-based recommendations and covers all causes of mTBI among children,” Lane says. “Whereas the recommendations included within the guideline are expected to significantly impact the identification and treatment of mTBI within the pediatric population, of equal significance is the evidence review that was undertaken to inform this guideline process.”
Comprehensive and up-to-date
The review encompassed 25 years of research in this area, Lane says, including sports and non–sports-related injuries. The guideline offers 19 sets of recommendations based on practice area and includes a call to action for further research in this area, she says.
“In sum, this mTBI guideline represents the most comprehensive review of pediatric mTBI scientific evidence to date and provides evidence-based recommendations for healthcare providers caring for children,” Lane says. “In addition, the guideline also has applicability to a broader audience that includes patients, their caregivers, school professionals, and sports programs.”
Some of the major actions included in the guidelines are refraining from using routine imaging for diagnosing pediatric patients with mTBI and using validated, age-appropriate symptom scales to diagnose mTBI. Lane says the recommendations also urge pediatricians to assess for risk factors for prolonged recovery, including history of mTBI or other brain injury, severe symptom presentation immediately after the injury, and personal characteristics and family history (such as learning difficulties and family and social stressors). Clinicians are also urged to provide patients with instructions on when they can resume normal activities based on their symptoms, and to counsel patients and families to allow a gradual return to normal activities after no more than 2 to 3 days of rest.
Lane says a commentary on the guidelines can help pediatricians understand the new initiatives.2 The CDC has also created tools, such as patient discharge instructions and a symptom-based recovery tips handout, to help healthcare providers with implementing the recommendation in their day-to-day practice.3
“This guideline can help fill a critical information gap. Our hope is that the recommendations in the guideline will improve the care and health outcomes from mTBI among this vulnerable population,” Lane says.
New standardized clinical practice
Mark R. Zonfrillo, MD, MSCE, a pediatric emergency medicine physician and injury researcher at Hasbro Children’s Hospital and the Warren Alpert Medical School of Brown University, Providence, Rhode Island, offered his take on the new guidelines, and says the comprehensive review is a cumulation of more than a decade’s worth of new research in this area.
“The recommendations address diagnosis (including radiographic imaging, symptom scales, cognitive testing, and standardized assessment), treatment (including patient/family education, rest, support, return to school, and symptom management), and prognosis (including history and risk factor assessment, monitoring, and counseling),” Zonfrillo says. “These guidelines will help standardize clinical practice in an evidence-based manner in order to maximize proper diagnosis and treatment of this very common but very treatable mild traumatic brain injury.”
1. Centers for Disease Control and Prevention. CDC pediatric mTBI guideline. Available at: https://www.cdc.gov/traumaticbraininjury/PediatricmTBIGuideline.html. Updated September 6, 2018. Accessed October 23, 2018.
2. Choe MC, Gregory AJ, Haegerich TM. What pediatricians need to know about the CDC guideline on the diagnosis and management of mTBI. Front Pediatr. 2018;6:249. Available at: https://www.frontiersin.org/articles/10.3389/fped.2018.00249/full?&utm_source=Email_to_authors_&utm_medium=Email&utm_content=T1_11.5e1_author&utm_campaign=Email_publication&field=&journalName=Frontiers_in_Pediatrics&id=415072. Accessed October 23, 2018.
3. Centers for Disease Control and Prevention. Heads up. Available at: https://www.cdc.gov/HEADSUP/. Updated June 22, 2017. Accessed October 23, 2018.