The evaluation and management of acute concussion differs in young children
Gavin A Davis1, Laura K Purcell
1Department of Neurosurgery, Cabrini Health, Austin Health and Murdoch Childrens Research Institute, , Melbourne, Victoria, Australia.
Insights
Pediatric concussion management requires age-specific tools for sideline assessment and recovery. The priority is return to learn, followed by a graduated return to play, acknowledging developmental differences in children.
Area of Science:
- Pediatric Neurology
- Sports Medicine
- Developmental Pediatrics
Background:
- Concussion management differs significantly between children and adults due to developmental variations.
- Existing guidelines, like the Zurich (2008) recommendations, have limitations regarding the 5-10 year age group.
- There's a need for age-specific approaches to pediatric concussion.
Purpose of the Study:
- To review current literature on concussion assessment in children aged 5-15 years.
- To examine sideline and recovery-stage assessment tools for pediatric concussion.
- To review the management strategies for concussion in children and adolescents.
Main Methods:
- A comprehensive literature review was conducted using the MEDLINE database.
- Articles focusing on the evaluation and/or management of concussion in children aged 5-15 years were selected.
Main Results:
- No validated sideline concussion assessment tools currently exist for the 5-15 age group.
- Several symptom scales are validated for follow-up assessments, but no single tool covers sideline to recovery.
- Management involves immediate withdrawal from play, cognitive/physical rest, prioritizing return to learn with potential accommodations.
Conclusions:
- Children require distinct diagnostic and management tools for concussion compared to adults.
- Validated, age-specific diagnostic tools are essential for accurate pediatric concussion assessment.
- Prioritizing return to learn is crucial in pediatric concussion management before considering return to play.
Background:
There are many reasons why concussion in children needs to be considered different from adults. The Zurich (2008) recommendations on the management of concussion in children are restricted to children less than to 10 years of age. It does not include recommendations for children aged 5-10 years. The aim of this study is to review the current literature on (1) concussion assessment at the sideline and during recovery stages, especially in the age group 5-15 years, and (2) the management of concussion in children and adolescents.
Methods:
A literature review using the MEDLINE database was undertaken. Articles were selected that included evaluation and/or management in children aged 5-15 years.
Results:
There are no sideline assessment tools validated for use in this age group. There are a number of different symptom scales that have been validated during different stages of the follow-up assessment in children. No single paediatric concussion assessment tool has been validated for use from sideline through to all stages of recovery. Reliability studies have been published on Balance Error Scoring System in children, but validity studies in this age group have not been published. The management of concussion includes withdrawal from play on the day and cognitive and physical rest. The priority of concussion management in children is to return to learn; while this is usually rapid, there are some children in whom a graduated return to school is required, which should include a number of accommodations.
Conclusions:
A young child is physically, cognitively and emotionally very different from adults, and requires the use of a different set of tools for the diagnosis, recovery-assessment and management of concussion. Age-specific, validated diagnostic tools are required, and management of concussion in children should focus attention on return to learn before considering return to play.
