Sport-Related Concussion in Children and Adolescents

Halstead, Mark; Moffatt, Kody

doi:10.1542/9781610024310-part08-ch25

Cited by 14 publications

(34 citation statements)

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“…As described in Management, although initial return-toactivity guidance can and should be provided by the acute care provider, follow-up through recovery is a critical element of pediatric concussion care. Consensus guidelines recommend that follow-up primarily occur through the primary care provider 30,31 ; however, there is a role for referral to concussion specialists from the acute setting, particularly for patients already experiencing prolonged symptoms from their current injury. These specialists can help coordinate educational resources and facilitate referral to specialized physical therapists for rehabilitation.…”

Section: Follow-up and Referralmentioning

confidence: 99%

“…24,25 Consensus recommendations for the management of pediatric concussion, including from the American Academy of Pediatrics (AAP) Council on Sports Medicine and Fitness and the Centers for Disease Control and Prevention (CDC), recommend assessing concussion symptoms in a standardized manner. 30,31 Although multiple symptom-based tools are available, 32 regardless of the tool used, systematic evaluation of symptoms has the potential to improve diagnostic accuracy and avoid diagnostic delays. 33 In addition, during history-taking, it is important to assess comorbidities that may impact concussion recovery.…”

Section: Acute History: Signs and Symptoms Of Concussionmentioning

confidence: 99%

“…Consensus statements recommend assessment of visiovestibular function as part of standard concussion assessment. 1,30,31 Several visiovestibular batteries have been developed, building on the Vestibular/Oculomotor Screening (VOMS) assessment. 18 One version of vestibular testing, the VisioVestibular Examination for Concussion (VVE), is described in Table 2 and Figure 2, and includes 9 test elements: (1) smooth pursuit, (2) horizontal and (3) vertical saccades; (4) horizontal and (5) vertical gaze stability (the angular vestibuloocular reflex), ( 6) near-point of convergence, (7) right and (8) left monocular accommodation; and (9) complex tandem gait.…”

Section: Physical Examinationmentioning

confidence: 99%

“…Consensus statements from the AAP, CDC, and International Concussion in Sport Group agree that standard imaging available in the ED setting, via either computed tomography (CT) scan or magnetic resonance imaging (MRI) of the head, does not currently contribute to the diagnosis of concussion. 1,30,31 When the clinician has suspicion for a gross structural intracranial process (such as hemorrhage), there exist multiple decision models to assist decision-making with regard to neuroimaging, with the largest and most widely utilized published by Kuppermann et al 43 in 2009 from the Pediatric Emergency Care Applied Research Network.…”

Section: Neuroimaging and Laboratory Testingmentioning

confidence: 99%

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Evaluation and Management of Pediatric Concussion in the Acute Setting

et al. 2021

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Concussion, a type of mild traumatic brain injury, is a common injury encountered by providers caring for pediatric patients in the emergency department (ED) setting. Our understanding of the pathophysiologic basis for symptom and recovery trajectories for pediatric concussion continues to rapidly evolve. As this understanding changes, so do recommendations for optimal management of concussed youth. As more and more children present to EDs across the country for concussion, it is imperative that providers caring for children in these settings remain up-to-date with diagnostic recommendations and management techniques. This article will review the definition, epidemiology, pathophysiology, diagnosis, and management of pediatric concussion in the ED setting.

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Section: Follow-up and Referralmentioning

confidence: 99%

Section: Acute History: Signs and Symptoms Of Concussionmentioning

confidence: 99%

Section: Physical Examinationmentioning

confidence: 99%

Section: Neuroimaging and Laboratory Testingmentioning

confidence: 99%

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Evaluation and Management of Pediatric Concussion in the Acute Setting

et al. 2021

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“…A cervical spine injury must be assumed for an unconscious athlete. [36][37][38] While advancements in technology are helping to shape the future of concussion diagnostics, the clinical utility of many of the tools is still under investigation. The technological advancements thus far primarily fall into 3 categories: emerging tools for sideline assessment, imaging, and blood biomarkers.…”

Section: Recognition and Diagnosismentioning

confidence: 99%

Leadership Lessons in Concussion Management for Team Physicians

Ross

Cameron²,

Colsant³

et al. 2021

Sports Medicine and Arthroscopy Review

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Over the last decade, with emphasis on concussion awareness and potential long-term deficits, concussions have become a public health concern. Although common, concussions are complex in nature and often require a collaborative treatment approach across multiple disciplines. In an athletic setting, the Team Physician plays a critical leadership role in the organization, management, and provision of care for concussed athletes. However, leadership strategies for the provision of concussion care utilized by the Team Physician have not been adequately described. This manuscript intends to describe advanced planning for concussion management and highlight best practices for the provision of care for the concussed athlete, to assist the Team Physician in coordinating optimal care. Specific emphasis will be placed on outlining a concussion management protocol aligned with evidencebased best practices.

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Visio-Vestibular Deficits in Healthy Child and Adolescent Athletes

Corwin

McDonald

Arbogast

et al. 2021

Clinical Journal of Sport Medicine

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Objective: To determine the relationship between patient characteristics and performance on the visio-vestibular examination (VVE) in a cohort of healthy youth athletes and explore the potential association between the VVE and other standardized concussion batteries. Design: Cross-sectional. Setting: Suburban middle and high school. Patients: One hundred ninety subjects age 11 to 18 enrolled before their respective scholastic sport season between August 2017 and March 2020. Assessment of Independent Variables: Patient age, sex, concussion history, comorbidities, hours of weekly exercise, Sport Concussion Assessment Tool, 5th edition (SCAT-5), King-Devick (K-D), Postconcussion Symptom Inventory (PCSI). Main Outcome Measures: Visio-vestibular examination abnormalities (smooth pursuit, horizontal and vertical saccades, horizontal and vertical gaze stability, convergence, right and left monocular accommodation, complex tandem gait). Results: Overall, 29.5% of subjects had at least one of 9 VVE elements abnormal, 7.9% at least 2, and 3.2% at least 3. None of 72 comparisons of the VVE elements, when stratified by age, sex, concussion history, history of headaches, attention deficit hyperactivity disorder, learning issues, psychiatric problems, motion sickness, or weekly hours of exercise, reached significance using the Benjamini-Hochberg procedure at a false discovery rate of 5%. There were no significant associations between VVE elements and the SCAT-5, K-D, or PCSI. Conclusions: The VVE is robust across multiple patient characteristics. Although healthy subjects may have one abnormal element, multiple abnormal elements are a less common feature, making multiple abnormal elements more indicative of concussion, highlighting the use of this assessment in the setting of injury. The VVE tests unique domains when compared with the PCSI, SCAT-5, and K-D.

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Sport-Related Concussion in Children and Adolescents

Cited by 14 publications

References 0 publications

Evaluation and Management of Pediatric Concussion in the Acute Setting

Evaluation and Management of Pediatric Concussion in the Acute Setting

Leadership Lessons in Concussion Management for Team Physicians

Visio-Vestibular Deficits in Healthy Child and Adolescent Athletes

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