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A Pediatrician’s Guide to Concussion Management

  • Kenneth R. Perrine
  • Emilie A. George
  • Katie Shayna Davis
Chapter

Abstract

Concussions are one of the most common injury-related diagnoses in childhood and account for 65 % of adolescent emergency department visits. It is important for the pediatrician to understand the mechanisms of concussion, the expected time course of concussion resolution, and the circumstances involved in post-concussion syndrome recognized as symptoms beyond the typical remission period of several weeks. Pediatricians should also be cognizant of the special considerations in the pediatric population, especially among adolescent athletes. This chapter provides the necessary background for understanding the mechanisms and resolution pattern of concussion and also provides a comprehensive review of specific factors required in a history taken in an office visit for a child with a concussion. We will review aspects of the physical and neurologic exam specific to concussion, how to give feedback and make rational recommendations for the recovery period, how to manage persisting post-concussion syndrome, and when to make a referral to a specialist. Several case examples are provided to help the clinician understand the diversity of presentations and management of pediatric concussion.

Keywords

Concussion Mild traumatic brain injury Pediatric Post-concussion syndrome 

References

  1. 1.
    Child SCAT3. Br J Sports Med 2013; 47(5): 263.Google Scholar
  2. 2.
    SCAT3. Br J Sports Med 2013; 47(5): 259.Google Scholar
  3. 3.
    Bakhos LL, Lockhart GR, Myers R, Linakis JG. Emergency department visits for concussion in young child athletes. Pediatrics. 2010;126(3): e550–6.CrossRefPubMedGoogle Scholar
  4. 4.
    Bleiberg J, Cernich AN, Cameron K, Sun W, Peck K, Ecklund PJ, Reeves D, Uhorchak J, Sparling MB, Warden DL. Duration of cognitive impairment after sports concussion. Neurosurgery. 2004;54(5):1073–8. discussion 1078-1080.CrossRefPubMedGoogle Scholar
  5. 5.
    Bodin DY, Yeates KO, Klamar K. Definition and classification of concussion. In: Handbook of pediatric concussion. New York, NY: Guilford Press; 2011.Google Scholar
  6. 6.
    Cantu RC. Second-impact syndrome. Clin Sports Med. 1998;17(1):37–44.CrossRefPubMedGoogle Scholar
  7. 7.
    Ferguson RJ, Mittenberg W, Barone DF, Schneider B. Postconcussion syndrome following sports-related head injury: expectation as etiology. Neuropsychology. 1999;13(4):582–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Field M, Collins MW, Lovell MR, Maroon J. Does age play a role in recovery from sports-related concussion? A comparison of high school and collegiate athletes. J Pediatr. 2003;142(5):546–53.CrossRefPubMedGoogle Scholar
  9. 9.
    Frommer LJ, Gurka KK, Cross KM, Ingersoll CD, Comstock RD, Saliba SA. Sex differences in concussion symptoms of high school athletes. J Athl Train. 2011;46(1):76.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Gilchrist J, Thomas K, Xu L, McGuire L, Coronado V. Nonfatal sports and recreation related traumatic brain injuries among children and adolescents treated in emergency departments in the United States, 2001-2009. MMWR Morb Mortal Wkly Rep. 2011;60(39): 1337–42.Google Scholar
  11. 11.
    Giza CC, Hovda DA. The neurometabolic cascade of concussion. J Athl Train. 2001;36(3):228.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Gomez JE, Hergenroeder AC. New guidelines for management of concussion in sport: special concern for youth. J Adolesc Health. 2013;53(3):311–3.CrossRefPubMedGoogle Scholar
  13. 13.
    Grace MT. Concussion in the Pediatric Patient. J Pediatr Health Care. 2013;27(5):377–84.CrossRefPubMedGoogle Scholar
  14. 14.
    Guskiewicz KM. Assessment of postural stability following sport-related concussion. Curr Sports Med Rep. 2003;2(1):24–30.CrossRefPubMedGoogle Scholar
  15. 15.
    Guskiewicz KM, McCrea M, Marshall SW, Cantu RC, Randolph C, Barr W, Onate JA, Kelly JP. Cumulative effects associated with recurrent concussion in collegiate football players. JAMA. 2003;290(19):2549–55.CrossRefPubMedGoogle Scholar
  16. 16.
    Hessen E, Nestvold K, Anderson V. Neuropsychological function 23 years after mild traumatic brain injury: a comparison of outcome after paediatric and adult head injuries. Brain Inj. 2007;21(9):963–79.CrossRefPubMedGoogle Scholar
  17. 17.
    Kelly JP. Traumatic brain injury and concussion in sports. JAMA. 1999;282(10):989–91.CrossRefPubMedGoogle Scholar
  18. 18.
    McCrea M. Standardized mental status assessment of sports concussion. Clin J Sport Med. 2001;11(3):176–81.CrossRefPubMedGoogle Scholar
  19. 19.
    McCrea M, American Academy of Clinical Neuropsychology. Mild traumatic brain injury and postconcussion syndrome: the new evidence base for diagnosis and treatment. Oxford, NY: Oxford University Press; 2008.Google Scholar
  20. 20.
    McCrory P. Does second impact syndrome exist? Clin J Sport Med. 2001;11(3):144–9.Google Scholar
  21. 21.
    McCrory P, Meeuwisse WH, Aubry M, Cantu RC, Dvorak J, Echemendia RJ, Engebretsen L, Johnston K, Kutcher JS, Raftery M, Sills A, Benson BW, Davis GA, Ellenbogen R, Guskiewicz KM, Herring SA, Iverson GL, Jordan BD, Kissick J, McCrea M, McIntosh AS, Maddocks D, Makdissi M, Purcell L, Putukian M, Schneider K, Tator CH, Turner M. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport, Zurich, November 2012. J Athl Train. 2013;48(4): 554–75.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Silverberg ND, Lange RT, Millis SR, Rose A, Hopp G, Leach S, Iverson GL. Post-concussion symptom reporting after multiple mild traumatic brain injuries. J Neurotrauma. 2013;30(16):1398–404.CrossRefPubMedGoogle Scholar
  23. 23.
    Weinstein E, Turner M, Kuzma BB, Feuer H. Second impact syndrome in football: new imaging and insights into a rare and devastating condition: case report. J Neurosurg Pediatr. 2013; 11(3):331–4.CrossRefPubMedGoogle Scholar
  24. 24.
    Yeates KO. Mild traumatic brain injury and postconcussive symptoms in children and adolescents. J Int Neuropsychol Soc. 2010;16(6):953.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Kenneth R. Perrine
    • 1
  • Emilie A. George
    • 2
  • Katie Shayna Davis
    • 3
  1. 1.Department of Neurological SurgeryWeill Cornell Medical CollegeNew YorkUSA
  2. 2.Weill Cornell Medical CollegeNew YorkUSA
  3. 3.Division of Child and Adolescent PsychiatryNew York State Psychiatric InstituteNew YorkUSA

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