Paeds · neurology-neurodisability-and-neuromuscular
Concussion and mild traumatic brain injury
Also known as Sport-related concussion · Mild traumatic brain injury · Cerebral concussion · Minor head injury · Post-concussion syndrome
Fellowship guide to concussion and mild traumatic brain injury in children and adolescents. Covers the consensus definition of concussion as a traumatically induced functional brain injury with rapid-onset short-lived impairment, the distinction from moderate and severe traumatic brain injury by a Glasgow Coma Scale of 13 to 15, the PECARN and CATCH clinical decision rules that safely reduce computed tomography in minor head injury, the Amsterdam 2022 consensus pathway of 24 to 48 hours of relative rest followed by graduated return to learn before return to sport, the Child SCAT5 and Child SCAT6 multimodal assessment, the natural recovery trajectory with most children symptom-free within four weeks, the predictors of persistent post-concussion symptoms, and the active rehabilitation of the child whose symptoms do not resolve.
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Overview & Definition
A child who bumps the head on the playground, takes a knock in a football match, or falls off a bike is the everyday face of concussion. Concussion is a traumatically induced disturbance of brain function, and the job of the clinician is to recognise it, to rule out the structural brain injury that it is not, and to guide the child safely back to school and sport. The Amsterdam consensus, the product of the sixth International Conference on Concussion in Sport, defines concussion as a traumatic brain injury caused by a direct or indirect force to the head that produces a rapid onset of short-lived neurological impairment that resolves spontaneously, with no abnormality on standard structural neuroimaging. [5]
Mild traumatic brain injury is the broader medical term that brackets concussion, and it is defined operationally by the Glasgow Coma Scale. An injury with a Glasgow Coma Scale of 13 to 15 within 30 minutes of the event, with any period of loss of consciousness, amnesia, or neurological change, is a mild traumatic brain injury. The two terms overlap heavily, but concussion carries the added sense of a functional disturbance that imaging does not capture, while mild traumatic brain injury is the administrative and research envelope. The Centers for Disease Control and Prevention guideline synthesised the paediatric evidence into a set of recommendations that frame the modern approach. [3]
Three facts make this topic central to the paediatric exam. The diagnosis is clinical and depends on recognising the symptom cluster after a plausible mechanism, because no scan and no blood test confirms a concussion. The first decision is not treatment but triage, separating the child who needs a computed tomography from the very large majority who can be observed, and the PECARN and CATCH rules make that decision explicit. And the management is a graduated return to activity, in which prolonged rest is no longer the answer and the recovery of most children within four weeks is the benchmark against which persistent symptoms are detected. [4]
You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.
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- [1]Kuppermann N, Holmes JF, Dayan PS, et al Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet, 2009.PMID 19758692
- [2]Osmond MH, Klassen TP, Wells GA, et al CATCH: a clinical decision rule for the use of computed tomography in children with minor head injury. CMAJ, 2010.PMID 20142371
- [3]Lumba-Brown A, Yeates KO, Sarmiento K, et al. Centers for Disease Control and Prevention Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children. JAMA Pediatr, 2018.PMID 30193284
- [4]Lumba-Brown A, Yeates KO, Sarmiento K, et al. Diagnosis and Management of Mild Traumatic Brain Injury in Children: A Systematic Review. JAMA Pediatr, 2018.PMID 30193325
- [5]Patricios JS, Schneider KJ, Dvorak J, et al Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport, Amsterdam, October 2022. Br J Sports Med, 2023.PMID 37316210
- [6]Davis GA, Purcell LK, Guskiewicz KM, et al Child SCAT6. Br J Sports Med, 2023.PMID 37316212
- [7]Echemendia RJ, Meeuwisse W, McCrory P, et al. Sport Concussion Assessment Tool 5th Edition (SCAT5): Background and rationale. Br J Sports Med, 2017.PMID 28446453
- [8]Davis GA, Purcell L, Schneider KJ, et al The Child Sport Concussion Assessment Tool 5th Edition (Child SCAT5): Background and rationale. Br J Sports Med, 2017.PMID 28446452
- [9]Halstead ME, Walter KD, Moffatt K Sport-Related Concussion in Children and Adolescents. Pediatrics, 2018.PMID 30420472
- [10]Makdissi M, Schneider KJ, Feddermann-Demont N, et al. Approach to investigation and treatment of persistent symptoms following sport-related concussion: a systematic review. Br J Sports Med, 2017.PMID 28483928
- [11]Ledoux AA, Tang K, Yeates KO, et al Natural Progression of Symptom Change and Recovery From Concussion in a Pediatric Population. JAMA Pediatr, 2019.PMID 30398522
- [12]Howell DR, Zemek R, Brilliant AN, et al. Identifying Persistent Postconcussion Symptom Risk in a Pediatric Sports Medicine Clinic. Am J Sports Med, 2018.PMID 30265817