Pediatric Mild Traumatic Brain Injury in the Acute Setting

Abstract

Pediatric mild traumatic brain injuries, most of which are concussions, are an increasingly common reason for presentation to emergency departments. The diagnosis of concussion has increased dramatically over the past decade, necessitating the acute care provider to have up-to-date knowledge of the definition, pathophysiology, signs and symptoms, physical examination findings, and acute management of pediatric concussion. This article also addresses populations most vulnerable to prolonged recovery from pediatric concussion and referral recommendations.

Figure 1

Biochemical cascade following concussion (Adapted from Grady MF, Master CL, Gioia GA. Concussion pathophysiology: rationale for physical and cognitive rest. Pediatr Ann. 2012; 41: 377–382; with the author’s permission)

Figure 2

Demonstration of saccadic and gaze stability testing in the vestibulo-ocular examination for concussion (a) To test horizontal saccades, the examiner’s fingers are placed shoulder-width apart (horizontal) or forehead-chin distance (vertical), and the patient is asked to look between them for 30 repetitions. (b) To test gaze stability, the patient fixes gaze on an object (or the examiner’s thumb) while nodding yes and then shaking head no side-to-side for 30 repetitions. (Adapted with permission, Plant G, Splaton D. Chapter 19: Neuro-ophthalmology. In: Spalton D, Hitchings R, Hunter P. Atlas of Clinical Ophthalmology, 3^rd Edition. Elsiever Limited. Oxford, Great Britain. 2005.)

Figure 2

Demonstration of saccadic and gaze stability testing in the vestibulo-ocular examination for concussion (a) To test horizontal saccades, the examiner’s fingers are placed shoulder-width apart (horizontal) or forehead-chin distance (vertical), and the patient is asked to look between them for 30 repetitions. (b) To test gaze stability, the patient fixes gaze on an object (or the examiner’s thumb) while nodding yes and then shaking head no side-to-side for 30 repetitions. (Adapted with permission, Plant G, Splaton D. Chapter 19: Neuro-ophthalmology. In: Spalton D, Hitchings R, Hunter P. Atlas of Clinical Ophthalmology, 3^rd Edition. Elsiever Limited. Oxford, Great Britain. 2005.)