What are the risk factors for serious intracranial injury? When can patients return to normal activity? Answers here.
Recently, the CDC recently released the first US evidence-based guidelines on pediatric mild traumatic brain injury (mTBI).1 A summary of the practice-changing recommendations is available on our website.
What are the risk factors for serious intracranial injury? When can patients return to normal activity? Take this 5-question quiz to find out.
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Discussion: The CDC advises against routine imaging for pediatric patients to diagnose acute mTBI. Clinical decision rules are more accurate for identifying patients and should be used instead. In addition, skull radiographs cannot detect intracranial injuries, such as hemorrhage, and they expose children to radiation.1
Discussion: Nonfrontal scalp hematoma is listed in the guidelines as a risk factor for serious injury. Other risk factors are patient age <2 years, vomiting, loss of consciousness, severe mechanism of injury, severe/worsening headache, amnesia, a Glasgow Coma Scale score of <15, and clinical suspicion of skull fracture.1
Discussion: Lower socioeconomic status is a risk factor for prolonged recovery from mTBI, as are older age/adolescence, Hispanic ethnicity, history of mTBI or other brain injury, more severe presentation, more acute postconcussion symptoms, personal characteristics (eg, learning difficulties, psychiatric disorders), and family history (social stressors). Validated prediction rules may be used to provide prognostic counseling to patients and family.1
Discussion: Research suggests that early rest for 3 days after the injury may be beneficial. However, rest beyond 3 days may worsen symptoms.1
Discussion: Patients and caregivers should receive customized instructions on returning to normal activities. Advise a gradual increase in activity that does not increase symptoms, with close monitoring. If that is successful, recommend progressive reintroduction of noncontact aerobic activity that does not increase symptoms, with close monitoring. Also, advise patients to return to full activity when back to baseline and symptom-free at rest, with increased exertion. Note that the optimal timing has not been established.1
1. 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;172:e182853.