Does new research address persistent questions since the publication of the CDC's 2018 pediatric mTBI guideline
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Published on: August 16, 2019
Rebecca Dann1, Ankita Das1, Alexandria Naftchi1
1New York Medical College, Valhalla, NY, USA.
Insights
Recent research on pediatric mild traumatic brain injury (mTBI) has improved concussion diagnosis and prognosis, but high-quality studies on treatment and outcomes are still needed. This review assesses research addressing gaps in the 2018 CDC guideline for pediatric concussion management.
Area of Science:
- Pediatric neurology
- Clinical epidemiology
- Evidence-based medicine
Background:
- The 2018 CDC Guideline for pediatric mild traumatic brain injury (mTBI) identified knowledge gaps impacting clinical recommendations.
- Pediatric mTBI can lead to debilitating sequelae, necessitating evidence-based management strategies.
Purpose of the Study:
- To evaluate if research published since the 2018 CDC guideline has addressed identified clinical knowledge gaps.
- To assess the impact of recent research on pediatric mTBI diagnosis and management recommendations.
Main Methods:
- A comprehensive literature review was conducted using PubMed, focusing on studies published between July 2015 and January 2021.
- Keywords were derived from the CDC mTBI guidelines, and articles were screened for relevance to pediatric populations (<18 years) and mTBI.
Main Results:
- Out of 531 identified articles, 49% focused on diagnosis, 17% on prognosis, and 34% on treatment.
- The most common research topics included neuropsychological tools (28%), risk factors for intracranial injury (11%), cognitive/physical rest (11%), and return to school (10%).
- Prospective studies constituted 43% of the reviewed literature.
Conclusions:
- Recent research has primarily focused on improving the diagnosis and prognosis of pediatric mTBI, particularly through the use of neuropsychological tools.
- While progress has been made in addressing some CDC-identified gaps, there is a significant need for high-quality research on pediatric concussion treatment and long-term outcomes.
Background And Objective:
Due to the potential debilitating sequelae following pediatric mTBI, the CDC published the Guideline on the Diagnosis and Management of mTBI Among Children in 2018. However, the guideline identified several key gaps in our clinical knowledge to support several clinical recommendations. The objective of this review is to evaluate if subsequent research has addressed these gaps in clinical practice recommendations.
Methods:
A literature review was conducted in PubMed using keywords from the CDC guidelines for the years of July 2015-January 2021. Articles were screened by title and abstract so only studies with children < 18 years of age and those focusing on mTBI were included.
Results:
A total of 531 articles were identified after screening. Forty-three percent was prospective; 24% were case reports, literature reviews, comments, or protocols; 19% were retrospective, 7% were cross-sectional, 4% were RCTs, and 4% were systematic reviews/meta-analyses. Forty-nine percent focused on diagnosis, 17% on prognosis, and 34% on treatment. The four most published topics were neuropsychological tools (28%), risk factors for intracranial injury and computed tomography (11%), cognitive/physical rest (11%), and return to school (10%).
Conclusion:
Since the release of the 2018 CDC guidelines, the majority of publications addressing pediatric mTBI have been prospective studies evaluating the clinical application of neuropsychological tools in concussion management. While these studies do address several of the clinical gaps noted by the CDC regarding the diagnosis and prognosis of pediatric mTBI, there remains a lack of high-quality studies focused on improving pediatric concussion treatment and outcomes.
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