Epidemiological data indicate a market increase in the number of emergency department (ED) visits for pediatric mild traumatic brain injury (mTBI) over the past decade, yet there are no evidence-based guidelines for diagnosing and managing these concussions. To address this, the Centers for Disease Control and Prevention (CDC) has now established the Pediatric Mild Traumatic Brain Injury Guideline Workgroup.
Children made nearly 3 million visits to the ED and more than 2 million outpatient visits for mTBI from 2005 to 2009. Because many patients seek treatment at a variety of settings, including in their schools, the actual number of mild TBIs cases in children is difficult to assess.
Research suggests that the number of mild TBIs among kids is increasing — there were 461,000 ED visits for TBI among children aged 14 and younger in 2007, and the number had risen to 642,000 ED visits by 2013.
With input from the American College of Emergency Physicians (ACEP) and others, the CDC has issued evidence-based guidelines for the broad range of health providers that may be responsible for detecting and managing cases of mTBI in children.
Published in an Annals of Emergency Medicine editorial, the CDC recommendations span the diagnosis, prognosis, management, and treatment of pediatric TIBs in a number of clinical settings.
"The experts in emergency departments are often the first care providers to evaluate a child's head injury," said lead author Angela Lumba-Brown, MD, in a press release. "These guidelines standardize a framework for recognizing, treating and managing a child's recovery from mild traumatic brain injury — encouraging appropriate use of diagnostic imaging, safe prescribing, and making sure each child, family or caretaker is equipped with the information they need for a quick and safe recovery."
Brown is a pediatric emergency physician and Clinical Assistant Professor of Emergency Medicine at Stanford University.
Key Recommendations
The CDC lays out 19 sets of clinical recommendations for healthcare providers in inpatient, emergency, primary, and outpatient care settings that may provide diagnosis, prognosis, and management and treatment of pediatric mTBI.
In their recommendations, the CDC suggests that providers:
- Not routinely image patients to diagnose concussion
- Use age-appropriate validated symptom scales to diagnose mild TBI
- Assess the patient’s evidence-based risk factors for prolonged recovery
- Provide patients with instructions regarding return to activity, customized to the symptoms the patient experiences
- Counsel patients to return gradually to non-sports activities after resting for no more than two to three days
Specifically, the CDC says that a patient with mTBI does not require imaging in an acute care setting. Providers should consider computed tomography (CT) imaging only when the practitioner suspects a more severe form of injury. Clinicians should screen for risk factors, as recovery varies by the patient’s individual characteristics. ED physicians should prescribe non-opioid pain relievers, along with counseling about the risks of overuse.
The child and family should receive education about the warning signs of more severe injury. The patient and family should be advised about the expected course of recovery. Lastly, providers should describe various strategies, such as healthy sleep habits, that can help facilitate recovery from mTBI.
The CDC offers a number of new tools to help medical professionals implement the guidelines. These tools include a diagnosis and management checklist, patient discharge instructions, recovery tips for parents, and a letter to the schools that healthcare providers can simply fill in.
