Diagnosis of Concussion in the Pediatric Emergency Department

Area of Science:

• Pediatric Emergency Medicine
• Neurology
• Sports Medicine

Background:

• Pediatric concussion evaluations in the Emergency Department (ED) are frequent and increasing.
• Concussion symptoms in children can be subtle and easily missed by ED clinicians.
• Initial assessment must prioritize ruling out emergent conditions like intracranial hemorrhage or cervical spine injury.

Purpose of the Study:

• To outline the essential components of pediatric concussion evaluation and management within the ED setting.
• To emphasize the diagnostic limitations of imaging and laboratory studies for concussion.
• To provide guidance on initial symptom management and discharge recommendations for pediatric concussion.

Main Methods:

• Clinical assessment focusing on ruling out serious intracranial or spinal injuries.
• Physical examination to identify potential concussion signs, acknowledging that it may be normal.
• Exclusion of imaging and laboratory studies for routine concussion diagnosis.

Main Results:

• Concussion diagnosis relies on clinical evaluation, not imaging or lab tests.
• Symptom management may involve trigger avoidance and medications like NSAIDs or antiemetics.
• Initial management includes brief rest followed by outpatient follow-up for return-to-activity decisions.

Conclusions:

• ED evaluation of pediatric concussion requires careful assessment for severe injuries.
• Imaging and laboratory studies are not indicated for concussion diagnosis in the ED.
• Effective management involves symptom control and a structured approach to rest and recovery, coordinated with primary care providers.