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Practice Guideline
. 2018 Nov 1;172(11):e182853.
doi: 10.1001/jamapediatrics.2018.2853. Epub 2018 Nov 5.

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

Angela Lumba-Brown  1 , Keith Owen Yeates  2 , Kelly Sarmiento  3 , Matthew J Breiding  3 , Tamara M Haegerich  3 , Gerard A Gioia  4 , Michael Turner  5 , Edward C Benzel  6 , Stacy J Suskauer  7 , Christopher C Giza  8 , Madeline Joseph  9 , Catherine Broomand  10 , Barbara Weissman  11 , Wayne Gordon  12 , David W Wright  11 , Rosemarie Scolaro Moser  13 , Karen McAvoy  14 , Linda Ewing-Cobbs  15 , Ann-Christine Duhaime  16 , Margot Putukian  17 , Barbara Holshouser  18 , David Paulk, Shari L Wade  19 , Stanley A Herring  20 , Mark Halstead  21 , Heather T Keenan  22 , Meeryo Choe  8 , Cindy W Christian  23 , Kevin Guskiewicz  24 , P B Raksin  25 , Andrew Gregory  26 , Anne Mucha  27 , H Gerry Taylor  28 , James M Callahan  23 , John DeWitt  29 , Michael W Collins  27 , Michael W Kirkwood  30 , John Ragheb  31 , Richard G Ellenbogen  20 , Theodore J Spinks  32 , Theodore G Ganiats  33 , Linda J Sabelhaus  34 , Katrina Altenhofen  35 , Rosanne Hoffman  36 , Tom Getchius  37 , Gary Gronseth  38 , Zoe Donnell  36 , Robert E O'Connor  39 , Shelly D Timmons  40
Affiliations
Practice Guideline

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

Angela Lumba-Brown et al. JAMA Pediatr. .

Erratum in

  • Updated Additional Contributions.
    [No authors listed] [No authors listed] JAMA Pediatr. 2018 Nov 1;172(11):1104. doi: 10.1001/jamapediatrics.2018.3868. JAMA Pediatr. 2018. PMID: 30398576 Free PMC article. No abstract available.

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.

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References

    1. Mannix R, O’Brien MJ, Meehan WP III. The epidemiology of outpatient visits for minor head injury: 2005 to 2009. Neurosurgery. 2013; 73(1):129–134. doi: 10.1227/01.neu.0000429846.14579.41 - DOI - PubMed
    1. Babcock L, Byczkowski T, Wade SL, Ho M, Mookerjee S, Bazarian JJ. Predicting postconcussion syndrome after mild traumatic brain injury in children and adolescents who present to the emergency department. JAMA Pediatr. 2013;167(2):156–161. doi: 10.1001/jamapediatrics.2013.434 - DOI - PMC - PubMed
    1. Lee H, Wintermark M, Gean AD, Ghajar J, Manley GT, Mukherjee P. Focal lesions in acute mild traumatic brain injury and neurocognitive outcome: CT versus 3T MRI. J Neurotrauma. 2008;25(9): 1049–1056. doi: 10.1089/neu.2008.0566 - DOI - PubMed
    1. Hessen E, Nestvold K. Indicators of complicated mild TBI predict MMPI-2 scores after 23 years. Brain Inj. 2009;23(3):234–242. doi: 10.1080/02699050902748349 - DOI - PubMed
    1. Dikmen S, Machamer J, Fann JR, Temkin NR. Rates of symptom reporting following traumatic brain injury. J Int Neuropsychol Soc. 2010;16(3): 401–411. doi: 10.1017/S1355617710000196 - DOI - PubMed

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