Updates in the General Approach to Pediatric Head Trauma and Concussion

Atabaki, Shireen M.

doi:10.1016/j.pcl.2013.06.001

Cited by 5 publications

(5 citation statements)

References 56 publications

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“…44,45 However, empiric data supporting the use of cognitive rest in concussion is conflicting. One study showed no association between recommendation of cognitive rest and length of symptoms, 46 and another showed improved performance on cognitive testing and decreased symptom reporting with any cognitive rest.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of Prolonged Concussion Recovery in a Pediatric Subspecialty Referral Population

Corwin

Zonfrillo

Master

et al. 2014

The Journal of Pediatrics

205

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Objective To identify pre-existing characteristics associated with prolonged recovery from concussion in a sample of patients referred to a pediatric sports medicine clinic. Study design This was a retrospective, exploratory cohort study of 247 patients age 5-18 years old with concussion referred to a tertiary pediatric hospital-affiliated sports medicine clinic from July 1, 2010, through December 31, 2011. A random sample of all eligible patient visits (3740) was chosen for further review and abstraction. Statistical comparisons between subsets of patients were conducted using exact chi-square tests, logistic regression, quantile regression, and Kaplan Meier survival curves. Results The median time until returning to school part-time was 12 days (interquartile range (IQR) 6-21); until returning to school full-time without accommodations was 35 days (IQR 11-105); until becoming symptom-free was 64 days (IQR 18-119); and until being fully cleared to return to sports was 75 days (IQR 30-153). 73% of all patients were symptomatic for >4 weeks, 73% were prescribed some form of school accommodation, and 61% reported a decline in grades. Characteristics associated with a prolonged recovery included a history of depression or anxiety; an initial complaint of dizziness; abnormal convergence or symptom provocation following oculomotor examination on physical examination; and history of prior concussion. Conclusion Pediatric and adolescent patients with concussion may experience cognitive and emotional morbidity that can last for several months following injury. Clinicians should consider specific pre-existing characteristics and presenting symptoms that may be associated with a more complicated recovery for concussion patients.

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Section: Discussionmentioning

confidence: 99%

Characteristics of Prolonged Concussion Recovery in a Pediatric Subspecialty Referral Population

Corwin

Zonfrillo

Master

et al. 2014

The Journal of Pediatrics

205

View full text Add to dashboard Cite

show abstract

“…To maintain cerebral perfusion, patients often need intravenous fluids and sometimes might require initiation of vasopressor agents. In patients with a severe TBI defined as a GCS ≤ 8, the optimal evaluation would ideally include a head computed tomography (CT) to visualize any skull fractures and intracranial pathology ( 44 , 45 ). In many LMICs, CT scanners are often not available or are out of the financial reach of most of the general population.…”

Section: Evaluation and Management Of Specific System-based Injuriesmentioning

confidence: 99%

“…In many LMICs, CT scanners are often not available or are out of the financial reach of most of the general population. In such situations, there may be some utility to skull x-rays which can at least identify fractures but do not reveal intracranial injuries ( 45 , 46 ). In situations where clinical examination or, when available, intracranial pressure monitoring, reveals increased intracranial pressure and evidence for cerebral edema, hyperosmolar therapy is initiated ( 41 , 43 ).…”

Section: Evaluation and Management Of Specific System-based Injuriesmentioning

confidence: 99%

Pediatric Trauma Care in Low Resource Settings: Challenges, Opportunities, and Solutions

et al. 2018

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Trauma constitutes a significant cause of death and disability globally. The vast majority -about 95%, of the 5.8 million deaths each year, occur in low-and-middle-income countries (LMICs) 3–6. This includes almost 1 million children. The resource-adapted introduction of trauma care protocols, regionalized care and the growth specialized centers for trauma care within each LMIC are key to improved outcomes and the lowering of trauma-related morbidity and mortality globally. Resource limitations in LMICs make it necessary to develop injury prevention strategies and optimize the use of locally available resources when injury prevention measures fail. This will lead to the achievement of the best possible outcomes for critically ill and injured children. A commitment by the governments in LMICs working alone or in collaboration with international non-governmental organizations (NGOs) to provide adequate healthcare to their citizens is also crucial to improved survival after major trauma. The increase in global conflicts also has significantly deleterious effects on children, and governments and international organizations like the United Nations have a significant role to play in reducing these. This review details the evaluation and management of traumatic injuries in pediatric patients and gives some recommendations for improvements to trauma care in LMICs.

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“…Radiographic evaluation of patients with severe TBI (GCS < 8) is ideally accomplished with cranial computed tomography (CT) to evaluate for fracture and intracranial pathology. 23,24 CT scanners are not always available and less sensitive skull radiographs are used to determine if a fracture is present. 24,25 Unfortunately, radiographs do not reveal intracranial lesions, but may aid in deciding where to drill a burr hole if necessary.…”

Section: System-based Injury Evaluation and Management Traumatic Braimentioning

confidence: 99%

“…23,24 CT scanners are not always available and less sensitive skull radiographs are used to determine if a fracture is present. 24,25 Unfortunately, radiographs do not reveal intracranial lesions, but may aid in deciding where to drill a burr hole if necessary. When increased ICP or cerebral edema are present, osmolar therapy with hypertonic saline or mannitol is initiated.…”

Section: System-based Injury Evaluation and Management Traumatic Braimentioning

confidence: 99%

Pediatric Trauma Care in Low- and Middle-Income Countries: A Brief Review of the Current State and Recommendations for Management and a Way Forward

Kiragu

Dunlop

Wachira

et al. 2016

J Pediatr Intensive Care

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Traumatic injuries are a significant cause of death and disability worldwide. The vast majority of these injuries occur in low- and middle-income countries (LMICs). Attention to protocolized care and adaptations to treatments based on availability of resources, regionalization of care, and the development of centers of excellence within each LMIC are crucial to improving outcomes and lowering trauma-related morbidity and mortality worldwide. Given limitations in the availability of the resources necessary to provide the levels of care found in high-income countries, strategies to prevent trauma and make the best use of available resources when prevention fails, and thus achieve the best possible outcomes for injured and critically ill children, are vital. Overall, a commitment on the part of governments in LMICs to the provision of adequate health care services to their populations will improve the outcomes of injured children. This review details the evaluation and management of traumatic injuries in pediatric patients and gives some recommendations for improvements to trauma care in LMICs.

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Updates in the General Approach to Pediatric Head Trauma and Concussion

Cited by 5 publications

References 56 publications

Characteristics of Prolonged Concussion Recovery in a Pediatric Subspecialty Referral Population

Characteristics of Prolonged Concussion Recovery in a Pediatric Subspecialty Referral Population

Pediatric Trauma Care in Low Resource Settings: Challenges, Opportunities, and Solutions

Pediatric Trauma Care in Low- and Middle-Income Countries: A Brief Review of the Current State and Recommendations for Management and a Way Forward

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