Do you know what to do when your child has a concussion?
As awareness and understanding of the potential dangers of concussions rise, so has the demand for new and improved care and protocols for those affected by them.
According to the CDC, more than 800,000 children seek care for a traumatic brain injury in U.S. emergency departments each year, with no evidence-based guidelines on pediatric cases to plan paths to recovery.
The goal of the guidelines, including a set of 19 clinical recommendations and five “key practice-changing recommendations” was two-fold, according to the CDC. First, there was a desire to arm health care providers with consistent, current and evidence-based guidance for diagnosing and managing mild traumatic brain injuries, (mTBI). Second, the CDC wanted to inform and support families, sports coaches and schools who were entrusted with the on-the-ground care of children.
The five key recommendations are:
- Do not routinely image pediatric patients to diagnose mTBI.
- Use validated, age-appropriate symptom scales to diagnose mTBI.
- Assess for risk factors for prolonged recovery, including history of mTBI or other brain injury, severe symptom presentation immediately after the injury and personal characteristics and family history (such as learning difficulties and family and social stressors).
- Provide patients and their parents/caregivers with instructions on returning to activity customized to their symptoms.
- Counsel patients and their parents/caregivers to return gradually to non-sports activities after no more than two to three days of rest.
The CDC also included additional tools and materials, including screening forms, discharge instructions and recovery tips.
Dr. Marc Hilgers, an Advocate Medical Group sports medicine physician in Downers Grove, Ill., with extensive clinical experience in treating patients with concussions and forming new policy around concussion patient care, says the guidelines are a huge step forward.
“I feel these new guidelines will be very powerful,” he says. “Many physicians and caregivers did not know about these strategies and best-practices – now, with the CDC bringing them to the public, the information will reach that much further.”
Dr. Hilgers, who has partnered with local school districts to implement concussion protocols for their student-athletes and served as team doctors for several professional sports teams, says the guidelines only represent the minimal requirements for care. As the recommendations suggest, most concussion cases are very individualized, depending on the extent of the injury, the patient age and history and more.
Still, they represent tremendous progress. Particularly, Dr. Hilgers calls attention to the recommendation of an earlier return activity than the previous “cocooning” of patients.
“Newer research has shown early reactivation and physical activity and only gradual return to mental activity promotes a faster return to preinjury function,” he says. “That doesn’t mean a return to sports, as that can lead to early re-exposure to injury. Instead, encourage light aerobic activities at an as-tolerated level.”
He also notes the recommendation against routinely imaging pediatric patients to diagnose a concussion. CT scans are often used to check for intracranial bleeds in such cases. However, recent studies show radiation exposure to an injured, developing brain can have detrimental long-term effects.
“Therefore, a good balance between risks and benefits has to be found,” Dr. Hilgers says. “By using CT scans only in cases where there is clear indication for intracranial bleed, it will significantly decrease pediatric exposure to radiation.”
Dr. Hilgers recommends anyone exhibiting the signs and symptoms of a concussion should seek medical attention immediately and call 911 if the patient experiences a loss of consciousness.
Specially trained physicians like Dr. Hilgers now have various ways to accurately diagnose and effectively treat concussions. He recommends people work with their primary care physician to identify a specialist who can assist with possible concussions and their after-effects.
About the Author
Nathan Lurz, health enews contributor, is a public affairs coordinator at Advocate Good Samaritan Hospital. He has nearly a decade of professional news experience as a reporter and editor, and a lifetime of experience as an enthusiastic learner. On the side, he enjoys writing even more, tabletop games, reading, running and explaining that his dog is actually the cutest dog, not yours, sorry.