Recent Guideline Updates

Date Updated: November 2019 Update

Link: Publication selection process Dec 2017-November 2019

Domain

Recommendation

Update **

Evidence

%Consensus*

2- Initial Diagnosis and Management

2.1b: Note common modifiers that may delay recovery and use a clinical risk score to predict risk of prolonged symptoms. Minor Revision: Update the list of modifiers for a prolonged recovery to include: High symptom burden at initial presentation, clinical evidence of vestibular or oculomotor dysfunction, duration of recovery from a previous concussion. Zemek et al 2016, Beauchamp et al 2018, Ellis et al 2018, Fehr et al 2019, Guerriero et al 2018, Howell et al 2018, Howell et al 2018, Ledoux et al 2019Master et al 2018Yeates et al 2019 100%
2- Initial Diagnosis and Management 2.2: Provide verbal information and written (electronic) handouts regarding the course of recovery and when the child/adolescent can return to school/activity/sport/work. Minor Revision: Include a sentence sharing that the information that females aged 13-18 years have an increased risk of a prolonged recovery. Ledoux et al 2019 83%
7- Sleep Introduction Minor Revision: Update the 4th sentence of the introduction to include: “Medication use, headaches and mental health conditions (e.g. anxiety, depression) may also affect sleep. Poor sleep may be related to cognitive complaints and worse post-concussion symptoms. A repeat…”

Murdaugh et al 2018

Wiseman-Hakes et al 2019

100%
4- Medical Clearance 4.1: Child/adolescent has successfully returned to all school activities including writing exams without symptoms above their previous pre-injury level or requiring accommodations related to their concussion/post-concussion symptoms.

Minor revision:

Update level of evidence to

Dematteo et al 2019 100%
12- Return to School and Work 12.5: Return-to-school and return-to-sport strategies can be performed simultaneously. Recommend that the child/adolescent return-to-school full-time at a full academic load, including writing exams without accommodations related to their concussion/post-concussion symptoms, before returning to full-contact sport or high-risk activities.

Minor Revision: 

Update level of evidence to

Dematteo et al 2019 80%

* Consensus for minor revisions: Minimum three domain experts vote on minor revisions. 75% consensus is required to proceed with a minor revision. Please see the Methodology Living Guideline pdf for more information.

** Definitions of the A, B, C level of evidence can be found here: Levels of Evidence

Link: All Living Guideline PRISMA diagrams available for download