[Skip to Content]
[Skip to Content Landing]
Views 57,599
Citations 0
Special Communication
September 4, 2018

Centers for Disease Control and Prevention Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children

Author Affiliations
  • 1Stanford University School of Medicine, Stanford, California
  • 2University of Calgary, Calgary, Alberta, Canada
  • 3Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
  • 4Children’s National Health System, George Washington University School of Medicine, Washington, DC
  • 5Goodman Campbell Brain and Spine, Indianapolis, Indiana
  • 6Cleveland Clinic, Cleveland, Ohio
  • 7Kennedy Krieger Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 8The University of California, Los Angeles (UCLA) Steve Tisch BrainSPORT Program, UCLA Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles
  • 9University of Florida Health Science Center, Jacksonville
  • 10Center for Neuropsychological Services, Kaiser Permanente, Roseville, California
  • 11Emory University School of Medicine, Atlanta, Georgia
  • 12Icahn School of Medicine at Mount Sinai, New York, New York
  • 13Sports Concussion Center of New Jersey, Princeton
  • 14Rocky Mountain Hospital for Children, Denver, Colorado
  • 15Children’s Learning Institute, Department of Pediatrics, University of Texas (UT) Health Science Center at Houston
  • 16Massachusetts General Hospital, Harvard University, Boston
  • 17University Health Services, Princeton University, Princeton, New Jersey
  • 18Loma Linda University Health, Loma Linda, California
  • 19Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
  • 20University of Washington School of Medicine, Seattle
  • 21St Louis Children’s Hospital, St Louis, Missouri
  • 22University of Utah, Salt Lake City
  • 23Children's Hospital of Philadelphia, Raymond and Ruth Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • 24The University of North Carolina at Chapel Hill
  • 25John H. Stroger, Jr Hospital of Cook County (formerly Cook County Hospital), Chicago, Illinois
  • 26Vanderbilt University School of Medicine, Nashville, Tennessee
  • 27University of Pittsburgh Medical Center Sports Medicine Concussion Program, Pittsburgh, Pennsylvania
  • 28Nationwide Children’s Hospital Research Institute, Columbus, Ohio
  • 29Jameson Crane Sports Medicine Institute, School of Health and Rehabilitation Sciences, The Ohio State University Wexner Medical Center, Columbus
  • 30Children’s Hospital Colorado, Aurora
  • 31Nicklaus Children’s Hospital, University of Miami Miller School of Medicine, Miami, Florida
  • 32Department of Pediatric Neurosurgery, St Joseph’s Children’s Hospital, Tampa, Florida
  • 33University of California, San Diego
  • 34Vanguard Communications, Washington, DC
  • 35The National Association of State EMS Officials, Washington, Iowa
  • 36Social Marketing Group, ICF, Rockville, Maryland
  • 37American Academy of Neurology, Minneapolis, Minnesota
  • 38University of Kansas Medical Center, Kansas City
  • 39University of Virginia School of Medicine, Charlottesville
  • 40Penn State University Milton S. Hershey Medical Center, Hershey, Pennsylvania
JAMA Pediatr. Published online September 4, 2018. doi:10.1001/jamapediatrics.2018.2853
Key Points

Question  Based on current evidence, what are best practices for diagnosis, prognosis, and management/treatment of pediatric mild traumatic brain injury (mTBI)?

Findings  Based on a previous systematic review of the literature, this guideline includes 19 sets of recommendations on diagnosis, prognosis, and management/treatment of pediatric mTBI. Each recommendation was assigned a level of obligation (ie, must, should, or may) based on confidence in the evidence.

Meaning  Clinical guidance for health care professionals is critical to improving health and safety of this vulnerable population; the recommendations represent current best practices and comprise the first evidence-based clinical guideline to date for diagnosing and managing pediatric mTBI in the United States.

Abstract

Importance  Mild traumatic brain injury (mTBI), or concussion, in children is a rapidly growing public health concern because epidemiologic data indicate a marked increase in the number of emergency department visits for mTBI over the past decade. However, no evidence-based clinical guidelines have been developed to date for diagnosing and managing pediatric mTBI in the United States.

Objective  To provide a guideline based on a previous systematic review of the literature to obtain and assess evidence toward developing clinical recommendations for health care professionals related to the diagnosis, prognosis, and management/treatment of pediatric mTBI.

Evidence Review  The Centers for Disease Control and Prevention (CDC) National Center for Injury Prevention and Control Board of Scientific Counselors, a federal advisory committee, established the Pediatric Mild Traumatic Brain Injury Guideline Workgroup. The workgroup drafted recommendations based on the evidence that was obtained and assessed within the systematic review, as well as related evidence, scientific principles, and expert inference. This information includes selected studies published since the evidence review was conducted that were deemed by the workgroup to be relevant to the recommendations. The dates of the initial literature search were January 1, 1990, to November 30, 2012, and the dates of the updated literature search were December 1, 2012, to July 31, 2015.

Findings  The CDC guideline includes 19 sets of recommendations on the diagnosis, prognosis, and management/treatment of pediatric mTBI that were assigned a level of obligation (ie, must, should, or may) based on confidence in the evidence. Recommendations address imaging, symptom scales, cognitive testing, and standardized assessment for diagnosis; history and risk factor assessment, monitoring, and counseling for prognosis; and patient/family education, rest, support, return to school, and symptom management for treatment.

Conclusions and Relevance  This guideline identifies the best practices for mTBI based on the current evidence; updates should be made as the body of evidence grows. In addition to the development of the guideline, CDC has created user-friendly guideline implementation materials that are concise and actionable. Evaluation of the guideline and implementation materials is crucial in understanding the influence of the recommendations.

×