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Published on: September 25, 2014
The Age Variable in Childhood Concussion Management: A Systematic Review
Rosemarie Scolaro Moser1, Gavin A Davis2, Philip Schatz3
1Sports Concussion Center of New Jersey, Princeton, NJ, USA.
Insights
Current sports concussion research lacks clear age-based guidelines for managing children and adolescents. More studies are needed to understand how concussion symptoms and diagnosis vary across developmental stages.
Area of Science:
- Pediatric Sports Medicine
- Neuroscience
- Public Health
Background:
- Sports-related concussion is a growing concern in young children globally.
- Existing research lacks specific age-based management protocols for pediatric concussion.
- This review addresses when to manage young children differently for concussion compared to older individuals.
Purpose of the Study:
- To review the existing literature on sports concussion in children and adolescents.
- To investigate age-related differences in concussion presentation and management.
- To identify gaps in current research regarding pediatric concussion management.
Main Methods:
- Systematic review adhering to PROSPERO and PRISMA guidelines.
- Included 37 original research studies on sports concussion examining age as a variable (5-18 years).
- Applied specific inclusion and exclusion criteria for study selection.
Main Results:
- No defined, evidence-based age groups exist for differential pediatric concussion management.
- Concussion presentation and symptom severity may vary across developmental stages.
- Adolescents may report more symptoms with increasing age; 12-13 years is a common age cutoff.
- Age has been classified variously (educational, developmental, continuous) in research.
- Common groupings include pre-puberty, early, and late adolescence.
Conclusions:
- Limited understanding of childhood concussion due to assessment challenges in younger children.
- Studies often lack clear rationales for age groupings or cutoffs.
- Further research is essential to understand developmental variations in concussion from preschool to late adolescence to inform diagnosis and management.
Background:
Sports-related concussion in young children has become a significant international public health issue. This paper reviews the research literature in an effort to shed light on the question, "At what age should young children be managed differently than adults or older adolescents?"
Method:
A systematic review, registered with PROSPERO and using PRISMA guidelines, was conducted rendering 37 sports concussion original research studies that examined age as a variable (5-18 years), and which met specific inclusion/exclusion criteria.
Findings:
There are no defined, evidence-based age groups for childhood concussion to substantiate differential management across the childhood and adolescent age span. There is evidence to support: (1) concussion may present differently across developmental stages; (2) with increasing age, adolescents may exhibit more symptoms from concussion; (3) the age range of 12-13 is the most frequently used cutoff point between younger and older children; (4) sports concussion research has classified the age variable in children in a number of manners: educational, developmental, sport level, or as a continuous variable, or matter of sample convenience; and (5) four general groupings of young versus pre-puberty child and early versus late adolescent are often utilized.
Conclusions:
Due to limited measures and challenges of assessing younger children, current research presents a limited understanding of childhood concussion. Studies in children often lack explained rationales or theories behind age groupings or cutoffs. There is a need for studies dedicated to the question of how concussion varies developmentally from preschool through late adolescence to guide diagnosis and management.
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