CDC releases new guideline for managing pediatric concussions
The Centers for Disease Control and Prevention (CDC) has released their first-ever evidence-based clinical guideline for diagnosing and managing concussions in US children.
The report includes 19 specific recommendations for every stage of TBI, including prevention, diagnosis, and treatment.
While the CDC has released several guidelines or recommendations on concussions in the past, they have been consensus-based, rather than evidence-based, and typically only focused on concussions in adults or athletes.
Some of the recommendations are significant shifts from past guidelines. Most significantly, the CDC is urging parents and medical professionals to limit the number of days following an injury. Instead, they should “gradually return to nonsports activities after no more than 2 to 3 days of rest,” as co-author Matthew J. Breiding, Ph.D., told Medscape Medical News.
In the past, TBI patients have been encouraged to rest until symptoms have almost entirely subsided. Over the past few years, however, increasing research has indicated a gradual return to activity not long after injury may be more beneficial than prolonged rest.
“While some scientific findings indicate that rest or reduction in cognitive and physical activity is beneficial immediately following mTBI, there is also evidence to suggest that limiting cognitive and physical activity beyond several days can worsen symptoms,” Breiding said.
The new guideline comes after calls from Congress to better outline how to manage and respond to concussions in younger individuals and was based on a systematic review of more than 25 years of research.
Breiding says the guideline “represents the most comprehensive review of pediatric mTBI scientific evidence to date and provides evidence-based recommendations for healthcare professionals caring for children.”
The co-author says the guidelines can also be helpful for parents, caregivers, patients, school administration, and sports organizations.
Breiding also highlighted several recommendations he believes are most important:
- Refrain from routinely imaging children to diagnose mTBI. Clinical evaluation of the child with possible mTBI should weigh multiple risk factors for further injury against the risks associated with radiation exposure and possible sedation, according to the guidelines.
- Use validated, age-appropriate symptom scales in diagnosis. For instance, the Standardized Assessment of Concussion should not be the only one used to diagnose mTBI for children aged 6 to 18 years.
- Assess risks for sustained recovery, including history of mTBI or other brain injury, severe symptoms immediately after the injury, and personal characteristics and family history, such as learning difficulties and family and social stressors.
- Provide instructions about returning to activity appropriate for patients’ symptoms. For example, providers should advise patients to resume full activity “when they return to premorbid performance if they have remained symptom-free at rest and with increasing levels of physical exertion,” the guideline states.