Cincinnati Children’s Psychologist Helps Write New National Concussion Guidelines Released by CDC

Tuesday, September 04, 2018

A Cincinnati Children’s psychologist helped write a guideline on mild traumatic brain injury, often referred to as concussion, among children to be published Sept. 4 in the journal JAMA Pediatrics.

The Pediatric mTBI Guideline, released by the Centers for Disease Control and Prevention (CDC), is intended to safeguard the health of children and teens.

Shari Wade, PhD, director of research in the Division of Rehabilitation Medicine at Cincinnati Children’s, worked with the CDC to develop 19 clinical recommendations that cover diagnosis, prognosis, and management and treatment. The recommendations are based on a rigorous review of the science, and on feedback from experts and the public.

“Concussion affects millions of children in the U.S. every year, and our understanding of how best to diagnose and treat concussion is continually evolving,” says Wade. “This evidence-based guideline can help both consumers and physicians identify risk factors that might contribute to slower recovery, avoid expensive and unnecessary neuroimaging, and optimize recovery by getting kids back to non-sports activities within days, rather than weeks, of injury.”

The recommendations include specific actions that healthcare providers can take to improve outcomes for children with concussion. Five key, practice-changing takeaways are:

• Do not routinely image patients to diagnose a concussion.
• Use validated, age-appropriate symptom scales to diagnose a concussion.
• Assess for risk factors for prolonged recovery.
• Provide patients with instructions on returning to activity customized to their symptoms.
• Counsel patients to return gradually to non-sports activities after no more than 2 to 3 days of rest.

The CDC recommendations recognize that health outcomes can be optimized through patient education and behavior modification. The evidence suggests that rest, or reduction in cognitive and physical activity, is beneficial immediately following a concussion. Rest should be followed shortly after the injury with a gradual return to activity within 2 to 3 days.

Concussions can lead to short- or long-term problems that affect how children think, act, learn, and feel. The CDC followed a rigorous process guided by the American Academy of Neurology, and the 2010 National Academy of Sciences’ methodologies for developing evidence-based guidelines. The Pediatric mTBI Guideline authors reviewed 25 years of scientific research.

Angela Lumba-Brown, MD, a pediatric emergency medicine physician at Stanford University, is the lead author of the guideline.

For more information, visit HEADS UP on the CDC website.