Scope: Using this Guideline

Guideline Target Audience

This guideline was developed to help inform the concussion care practices of healthcare professionals across a wide variety of settings.

  • Family or emergency department physicians working in large centres and rural areas, whose patients have ready access to specialized care;
  • Physicians and healthcare professionals working in remote regions who have access to the internet and whose patients have access to specialized care through telemedicine or other means;
  • Healthcare and rehabilitation professionals who manage and rehabilitate children and adolescents with concussion and prolonged symptoms.

Stakeholder Groups

Resources for parents, caregivers, schools, and community sports organizations/centres related to identifying symptoms of a potential concussion and managing recovery following concussion are on the Living Guideline for Diagnosing and Managing Pediatric Concussion  website and can be accessed by following this link: www.braininjuryguidelines.org. This guideline does not address concussion prevention.

Target Population for Clinical Care

The target population is every child/adolescent 5-18 years who has or may have sustained a concussion. There are limited well-validated measures to diagnose concussion in children 0-5 years old, however, concussion occurs in infants, toddlers, and preschoolers and may have adverse consequences. Diagnosing and managing concussion in children 0-5 years old is challenging because it relies heavily on the child’s ability to communicate and the parent’s ability to recognize post-concussive symptoms. Established concussion procedures and measures may not be validated in pre-school aged children.

Key Messages and  General Directions for Clinical Use

Children and adolescents with a suspected concussion should be assessed by a physician or nurse practitioner to perform a comprehensive medical assessment to exclude more severe injuries, consider a full differential diagnosis, and confirm the diagnosis of concussion.  Evidence-based recommendations for initial management and follow-up visits are provided in the guideline. Children who are at high-risk for prolonged symptoms or those whose post-concussion symptoms do not gradually resolve by 4 weeks should be referred to specialized care with an interdisciplinary concussion team. Guideline algorithms and tools guide further assessment and management of ongoing prolonged symptoms.

Therapies or treatment approaches that are marketed as effective for post-concussion recovery that are not specifically mentioned in this guideline were not included because there is not sufficient evidence to support their use.

Purpose

Need for a Guideline on Pediatric Concussion

Concussion is recognized as an important health issue in children and adolescents. While most children and adolescents recover within 4 weeks post-injury, some have ongoing symptoms that can last for months. Prolonged post-concussive symptoms can disrupt daily living, affect quality of life, and reduce participation in school, sports, and other activities.

There are inconsistencies related to how healthcare professionals manage pediatric concussion. Implementation of the Living Guideline for Diagnosing and Managing Pediatric Concussion has the potential to standardize and guide clinical practice based on the best available evidence and mitigate the impact of prolonged symptoms.

Rationale

In 2014, the Ontario Neurotrauma Foundation (ONF) published the first edition of Guidelines for Diagnosing and Managing Pediatric Concussion, a guide to help healthcare professionals diagnose and manage pediatric concussion specifically. Given the rapid increase in new literature since 2014, the evidence has evolved and changed for many of the previous recommendations thus requiring an updated version.

Health Clinical Questions

  • How should children and adolescents return to physical activity following concussion?
  • Which children are at risk for prolonged symptoms post-concussion?
  • When should primary care providers consult an interdisciplinary concussion team?
  • How can providers better recognize and manage vestibular and visual impairments post-concussion?

Overall Objectives

To develop high quality, evidence-based recommendations that:

  • standardize the diagnosis and management of pediatric concussion;
  • are relevant and useful for healthcare professionals;
  • improve the care of children/adolescents who have sustained a concussion;
  • reduce the impact of concussion on the mental health, social engagement, and academic participation of children/adolescents during their formative years;
  • identify knowledge gaps in the literature that require more research.