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JAMA Pediatr. 2018 Nov 1;172(11):e182853. doi: 10.1001/jamapediatrics.2018.2853. Epub 2018 Nov 5.

Centers for Disease Control and Prevention Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children.

Author information

1
Stanford University School of Medicine, Stanford, California.
2
University of Calgary, Calgary, Alberta, Canada.
3
Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.
4
Children's National Health System, George Washington University School of Medicine, Washington, DC.
5
Goodman Campbell Brain and Spine, Indianapolis, Indiana.
6
Cleveland Clinic, Cleveland, Ohio.
7
Kennedy Krieger Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
8
The University of California, Los Angeles (UCLA) Steve Tisch BrainSPORT Program, UCLA Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles.
9
University of Florida Health Science Center, Jacksonville.
10
Center for Neuropsychological Services, Kaiser Permanente, Roseville, California.
11
Emory University School of Medicine, Atlanta, Georgia.
12
Icahn School of Medicine at Mount Sinai, New York, New York.
13
Sports Concussion Center of New Jersey, Princeton.
14
Rocky Mountain Hospital for Children, Denver, Colorado.
15
Children's Learning Institute, Department of Pediatrics, University of Texas (UT) Health Science Center at Houston.
16
Massachusetts General Hospital, Harvard University, Boston.
17
University Health Services, Princeton University, Princeton, New Jersey.
18
Loma Linda University Health, Loma Linda, California.
19
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
20
University of Washington School of Medicine, Seattle.
21
St Louis Children's Hospital, St Louis, Missouri.
22
University of Utah, Salt Lake City.
23
Children's Hospital of Philadelphia, Raymond and Ruth Perelman School of Medicine, University of Pennsylvania, Philadelphia.
24
The University of North Carolina at Chapel Hill.
25
John H. Stroger, Jr Hospital of Cook County (formerly Cook County Hospital), Chicago, Illinois.
26
Vanderbilt University School of Medicine, Nashville, Tennessee.
27
University of Pittsburgh Medical Center Sports Medicine Concussion Program, Pittsburgh, Pennsylvania.
28
Nationwide Children's Hospital Research Institute, Columbus, Ohio.
29
Jameson Crane Sports Medicine Institute, School of Health and Rehabilitation Sciences, The Ohio State University Wexner Medical Center, Columbus.
30
Children's Hospital Colorado, Aurora.
31
Nicklaus Children's Hospital, University of Miami Miller School of Medicine, Miami, Florida.
32
Department of Pediatric Neurosurgery, St Joseph's Children's Hospital, Tampa, Florida.
33
University of California, San Diego.
34
Vanguard Communications, Washington, DC.
35
The National Association of State EMS Officials, Washington, Iowa.
36
Social Marketing Group, ICF, Rockville, Maryland.
37
American Academy of Neurology, Minneapolis, Minnesota.
38
University of Kansas Medical Center, Kansas City.
39
University of Virginia School of Medicine, Charlottesville.
40
Penn State University Milton S. Hershey Medical Center, Hershey, Pennsylvania.

Abstract

Importance:

Mild traumatic brain injury (mTBI), or concussion, in children is a rapidly growing public health concern because epidemiologic data indicate a marked increase in the number of emergency department visits for mTBI over the past decade. However, no evidence-based clinical guidelines have been developed to date for diagnosing and managing pediatric mTBI in the United States.

Objective:

To provide a guideline based on a previous systematic review of the literature to obtain and assess evidence toward developing clinical recommendations for health care professionals related to the diagnosis, prognosis, and management/treatment of pediatric mTBI.

Evidence Review:

The Centers for Disease Control and Prevention (CDC) National Center for Injury Prevention and Control Board of Scientific Counselors, a federal advisory committee, established the Pediatric Mild Traumatic Brain Injury Guideline Workgroup. The workgroup drafted recommendations based on the evidence that was obtained and assessed within the systematic review, as well as related evidence, scientific principles, and expert inference. This information includes selected studies published since the evidence review was conducted that were deemed by the workgroup to be relevant to the recommendations. The dates of the initial literature search were January 1, 1990, to November 30, 2012, and the dates of the updated literature search were December 1, 2012, to July 31, 2015.

Findings:

The CDC guideline includes 19 sets of recommendations on the diagnosis, prognosis, and management/treatment of pediatric mTBI that were assigned a level of obligation (ie, must, should, or may) based on confidence in the evidence. Recommendations address imaging, symptom scales, cognitive testing, and standardized assessment for diagnosis; history and risk factor assessment, monitoring, and counseling for prognosis; and patient/family education, rest, support, return to school, and symptom management for treatment.

Conclusions and Relevance:

This guideline identifies the best practices for mTBI based on the current evidence; updates should be made as the body of evidence grows. In addition to the development of the guideline, CDC has created user-friendly guideline implementation materials that are concise and actionable. Evaluation of the guideline and implementation materials is crucial in understanding the influence of the recommendations.

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