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CDC releases new guidance on diagnosing, managing concussions :

September 10, 2018

Children who have suffered mild traumatic brain injury (mTBI) should start gradually returning to physical and cognitive activity after a few days of rest, according to federal health authorities.

The Centers for Disease Control and Prevention (CDC) has created new clinical recommendations and educational tools to guide health care providers as they diagnose and manage children with mTBI.

“As clinicians, we care for this vulnerable group of patients, and it is our duty to implement evidence-based care to deliver effective management of mild traumatic brain injury in children and to continue to advance the science of clinical care,” said lead author Angela Lumba-Brown, M.D., FAAP, co-director of the Stanford Concussion and Brain Performance Center and a member of the AAP Section on Emergency Medicine.

Each year, U.S. emergency departments treat more than 800,000 children for TBI, according to the CDC. While the Academy and other groups have guidelines for managing sports-related head injuries, the U.S. did not have evidence-based, broad guidelines that encompassed young children or the many possible causes of multiple traumatic brain injury, such as car accidents and falls.

The CDC convened a group of experts, including emergency medicine physicians, pediatricians, neurologists and physical therapists, who reviewed 25 years of research to create more comprehensive guidelines. They produced 19 sets of recommendations that are aimed at a providers in primary care, inpatient, outpatient and emergency settings.

The group noted the term mild traumatic brain injury is preferable to concussions as it denotes the seriousness of the injury. Imaging should not be routine in diagnosing mTBI as it exposes children to unnecessary radiation, according to the guidance.

“CT imaging should be used when there’s a clinical suspicion based on validated decision rules to look for severe brain injuries but not used in the identification of mild traumatic brain injury,” Dr. Lumba-Brown said.

The new guidelines call for using validated, age-appropriate symptom scales to diagnose children and assess their recovery.

Children who have experienced mTBI should rest for a few days, then return gradually to physical and cognitive activities except for those that could lead to re-injury, according to the CDC.

“We do want children to get back out and … walk, run, safely play, interact cognitively because those things are going to be beneficial, likely reducing the duration and severity of their self-reported symptoms,” Dr. Lumba-Brown said.

While the science is not definitive on why reintegration helps recovery, Dr. Lumba-Brown said that possibly stimulating blood flow and a sense of well-being from participating in enjoyable activities could play a role.

The guidelines also cover areas like cognitive testing, risk factor assessment, return to school and family education.

We have heard from healthcare providers that they want and need consistent, current, and evidence-based guidance for diagnosing and managing mTBI. And this guideline can help,” CDC National Center for Injury Prevention and Control Director Deb Houry, M.D., M.P.H., said in a news release. “However, we also designed the guideline so it can help inform efforts aimed at supporting families, sports coaches, and schools — who are all integral to keeping children safe and healthy.”

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