Concussion and traumatic brain injury are ever-present topics among American parents and coaches of young athletes today. So the Centers for Disease Control and Prevention’s recent issuing of clinical concussion guidelines for pediatric professionals come…
Concussion and traumatic brain injury are ever-present topics among American parents and coaches of young athletes today. So the Centers for Disease Control and Prevention’s recent issuing of clinical concussion guidelines for pediatric professionals come at a crucial time in our collective conversation about how to protect kids from the experience and effects of concussion. Although the guidelines are written for medical professionals, there are takeaways that can help the public understand how we can keep our kids safe while they play the sports they love.
First, it should be noted that the CDC’s guidelines are extensive — 19 total recommendations in all, and each with an “assignment of obligation.” In essence, those guidelines that must be followed, those that should be followed and those that may be followed, all based on the confidence of the evidence reviewed and used to make the recommendations. Yet overall, the overwhelming theme of this list of recommendations is that concussion, or mild traumatic brain injury — also known as mTBI — is not “no big deal.” And such incidents require evaluation and follow-up for the health of our young people.
The new guidelines are evidence-based and represent a review of concussion literature spanning a significant period of time, from 1990 to 2015. That’s a tremendous task, considering that more than 37,000 articles were reviewed. However, there were a minimal number (only about 75 articles included in the final synthesis) that were of high enough quality to inform the final recommendations made.
What the data reveals is that information on the prognosis of concussion in children is far more represented in high-quality research than information that can be used to guide treatment and management of concussion in children. As such, there is a massive need for more high-quality research on treatment options and best practices for managing pediatric populations with concussion (both short- and long-term).
Also noteworthy among the CDC’s guidelines are the inclusion of recommendations based on more recent concussion research. This includes the advice of earlier reintroduction to regular activities that do not worsen concussion symptoms (light activity after two to three days), rather than eliminating physical or cognitive exertion until all symptoms have resolved — which was the previously-held belief and a widely-used practice among medical professionals.
Beyond the clinical/physiological aspects of concussion diagnosis and treatment, there’s the recommendation that school-related needs and academic accommodations should be addressed in collaboration with the medical professional, the child’s parents and school professionals. This is a multi-disciplinary approach to concussion management that brings multiple parties together for the best interest of the child.
For those of us in the neurological profession, it’s encouraging to note that the guidelines recommend that children who have experienced concussion and have symptoms that aren’t improving should be referred for specialty-level evaluation and treatment to address symptoms. Though it may not seem significant on its surface, this is a significant step toward getting children the care they need to best treat the concern. Just as orthopedic surgeons have specialty-level expertise to address issues of the musculoskeletal system, so too do neurological professionals have specialty-level expertise to evaluate and manage matters involving the brain and nervous system after concussion with prolonged or severe symptoms.
Whether we’re discussing children or adults, all concussions are not created equal. Some issues seem to be associated with prolonged symptoms and poor prognosis, such as lower socioeconomic status, preexisting neurological or psychiatric disorders that may have been present before a concussion occurred, learning disabilities and family or social stressors. These issues affect individuals physically, and especially in children, can negatively impact academic performance. Concentrated efforts to evaluate for and address these factors, how they contribute to clinical outcomes and what can be done to mitigate them should be a significant research priority going forward.