New evidence-based guidelines, developed by the Centers for Disease Control and Prevention (CDC) with input from the American College of Emergency Physicians (ACEP) and others put forward recommendations for a broad range of health care providers responsible for detection and management of pediatric mild traumatic brain injury, most of which are concussions.
The CDC recommendations are outlined in an Annals of Emergency Medicine editorial and span diagnosis, prognosis, management and treatment in a variety of clinical settings. From 2005-2009, there were almost 3 million emergency visits for pediatric mild traumatic brain injury, according to the CDC.
“The experts in emergency departments are often the first care providers to evaluate a child’s head injury,” said Angela Lumba-Brown, MD, pediatric emergency physician, lead author and Clinical Assistant Professor of Emergency Medicine at Stanford University. “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.”
Key recommendations include that mild traumatic brain injury does not require imaging in an acute care setting. Computed tomography (CT) imaging should be considered when there is suspicion of more severe forms of injury, the authors wrote. The CDC suggests that clinicians screen for risk factors because recovery will vary by individual characteristics. Non-opioid analgesics should be prescribed by the emergency department along with counseling about risks of overuse. The child and family should be educated before discharge about the warning signs for more serious injury and the expected course of recovery. And, the new recommendations call for providers to describe healthy sleep habits and other strategies to help facilitate recovery.
The CDC is offering new tools that can help health care providers with implementation of the guidelines, including a checklist for diagnosis and management; patient discharge instructions; recovery tips for parents to support their child; and a letter to schools to be filled in by healthcare providers.
Five questions: What parents should know about concussions
Angela Lumba-Brown et al, Emergency Department Implementation of the Centers for Disease Control and Prevention Pediatric Mild Traumatic Brain Injury Guideline Recommendations, Annals of Emergency Medicine (2018). DOI: 10.1016/j.annemergmed.2018.03.045