CDC Releases Guideline for Youth Concussion

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This is the first evidence-based guidance for treating concussion in children

In September 2018, the Centers for Disease Control and Prevention released clinical recommendations for health care providers treating children with concussion. The CDC Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children was published in JAMA Pediatrics, and is based on a comprehensive review of pediatric mTBI.

The guideline, which includes 19 sets of recommendations on the diagnosis, treatment and management of mTBI, is the first of its kind and seeks to improve the way parents, coaches and doctors care for a vulnerable population. According to CDC Director Deb Houry, MD, MPH, more than 800,000 children seek treatment for TBI every year. The CDC developed the new guideline in response to health care providers’ need for consistent, evidence-based guidance for diagnosing and managing mTBI in their young patients.

“The guideline couldn’t have come sooner,” said International Concussion Society President John Leddy, MD, FACSM, FACP. “The concussion community is looking forward to seeing how it will inform diagnosis and treatment, as well as help children get back to their normal lives.”

The CDC guideline featured several practice-changing recommendations. Most notably, it recommends against routine imaging tests to diagnose concussion. X-rays and CT scans are not effective for determining youth concussions, and children should not be unnecessarily exposed to radiation. The guideline also encourages health care providers to “use validated, age-appropriate symptom scales to diagnose mTBI.”

The CDC guidelines include some practice-changing recommendations related to post-concussion care as well. Within the first few days after a concussion diagnosis, children should refrain from physical and mental activities, including school and sports, before gradually returning to their regular activities. Rest is recommended for only the first three days because inactivity beyond that may worsen symptoms. The CDC reassures parents that most children’s symptoms clear up within one to three months of injury.

In cases where a patient’s recovery is prolonged, the guideline also outlines symptoms that warrant further medical attention. These include changes in personal characteristics, such as learning difficulties, as well as severe physical symptoms like worsening headaches, dizziness, sensitivity to light or noise, and sleep problems.

To help health care providers implement the recommendations, the CDC developed supporting tools and materials. The resources can be downloaded on the CDC website and include screening forms to assess young patients, discharge instructions and recovery tips for parents.

The International Concussion Society is optimistic that these guidelines will inform and support health care providers, parents and coaches looking to keep children safe and healthy.