What is the difference in concussion management in children as compared with adults? A systematic review

Davis, Gavin A; Anderson, Vicki; Babl, Franz E; Gioia, Gérard A.; Giza, Christopher C.; Meehan, William P.; Moser, Rosemarie Scolaro; Purcell, Laura; Schatz, Philip; Schneider, Kathryn; Takagi, Michael; Yeates, Keith Owen; Zemek, Roger

doi:10.1136/bjsports-2016-097415

Cited by 316 publications

(230 citation statements)

References 119 publications

(16 reference statements)

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“…As such, neuropsychological testing was not used to supplement the diagnosis of SRC in these patients. Recent systematic reviews of outcomes following pediatric concussion suggested that the vast majority of pediatric concussion patients recovered within 1 month postinjury [8,17]. For the purpose of this study, PPCS was defined as persistent symptoms lasting greater than 4 weeks postinjury compared with baseline.…”

Section: Methodsmentioning

confidence: 99%

Academic outcomes and accommodations following adolescent sport-related concussion: a pilot study

et al. 2017

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Aim:The purpose of this study was to examine academic achievement, absenteeism and school accommodations following adolescent sport-related concussion (SRC).Methods:A case-series was conducted among grade 8–12 students who suffered an SRC. The primary outcomes were change in pre- and post-concussion overall, core report card grade point average (GPA) and absenteeism due to concussion. The most helpful school accommodations were tabulated.Results:Pre- and post-concussion GPA was obtained from 33 students – 16 (48%) developed persistent post-concussion symptoms (symptoms lasting >4 weeks). There was no significant difference in pre- and post-concussion grades among students with a SRC for overall (p = 0.75) or core (p = 0.56) GPA. The median number of missed school days was 4 (interquartile range [IQR]: 2–8). Allowing for physical and cognitive rest was identified as the most helpful accommodation (30%).Conclusion:Larger studies should investigate the role that school accommodations and development of persistent post-concussion symptoms have on academic outcomes.

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Section: Methodsmentioning

confidence: 99%

Academic outcomes and accommodations following adolescent sport-related concussion: a pilot study

et al. 2017

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“…However, recent research has been unable to provide evidence to support the use of complete rest in the management of concussion beyond the acute phase following injury 3 , 14 , 15 . Three systematic reviews concluded that physical and cognitive rest may only be of use in the acute phase after concussion; however, they all found the evidence to be low level and inconclusive 3 , 14 , 15 . One review, focused on children, found that rest beyond the acute period may prolong symptoms 14 .…”

Section: Boxmentioning

confidence: 99%

“…Evidence does not support that rest beyond this period improves recovery; in children, prolonged rest may prolong symptoms 3,14,15 New recommendation: light intensity activity beyond initial period until the resolution of symptoms Consensus statement supports early introduction of symptom-limited physical activity if appropriate, although the evidence is not strong 3 the past 4 years. 2 Previously, consensus opinion recommended complete rest until the resolution of symptoms as the cornerstone of concussion management.…”

mentioning

confidence: 99%

“…3,14,15 Three systematic reviews concluded that physical and cognitive rest may only be of use in the acute phase after concussion; however, they all found the evidence to be low level and inconclusive. 3,14,15 One review, focused on children, found that rest beyond the acute period may prolong symptoms. 14 Accordingly, the new consensus supports light intensity physical and cognitive activity beyond the initial 24e48-hour rest period.…”

mentioning

confidence: 99%

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An update to the AIS–AMA position statement on concussion in sport

Elkington¹,

Manzanero

Hughes

2018

Medical Journal of Australia

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“…26 Of crucial importance in prognosis is the rapid increase in reactive stressors that heighten the metabolic demand on the brain. 27 Concussion induces inflammatory sensory stimulus that is preferentially transmitted to brainstem and specific hypothalamic nuclei which have direct connection to the hypothalamic paraventricular nucleus. Specifically, activation of the inflammatory cascade, increased protein catabolism and altered energy metabolism have been well-established as inducing long-term adverse effects on the developing brain via altered neuroendocrine and physiologic processes.…”

Section: Casazza K Et Al: Nutrition In Sports-related Concussionmentioning

confidence: 99%

Nutrition as Medicine to Improve Outcomes in Adolescents Sustaining a Sports-related Concussion

Casazza¹,

Swanson²

2017

Exploratory Research and Hypothesis in Medicine

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Recognition and diagnosis of sports-related concussion (SRC) among adolescents has significantly increased. In, fact, among high school adolescents, SRC incidence has more than doubled from 2007 to 2014, with recent estimates at approximately 2 per 100 athletes. SRC-related research has also increased; recognition of symptoms that may prolong recovery have been examined, potential biomarkers have been scrutinized, return-to-learn and return-to-play protocols have been developed and honed. However, to date, clinicians and researchers have struggled to find effective interventions to mitigate the significant symptoms after SRC and shorten recovery times. Despite the understood role of the brain as the primary regulator of metabolism, and the well-established metabolic impairments evoked after a concussion, nutrition is often ignored as a core complement to the recovery and rehabilitation process. In this article, we will identify deficiencies and/or inadequacies in nutrients post-concussion and provide support for potential exacerbation of injury and delayed recovery due to inadequate intake of nutrients prior to sustaining an SRC. Additionally, we will discuss the effect of derangement of the metabolic cascade post-concussion, and identify key nutrients, that if supplemented immediately post-injury, could increase neuroprotection, and improve recovery outcomes. Animal and cell culture studies have provided substantial evidence for not only the interrelationship of nutrient adequacy and the adaptation in the metabolic cascade post-concussion on neuroprotection, but also key nutrients that if supplemented immediately post-injury could enhance standard of care with minimal risk.

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What is the difference in concussion management in children as compared with adults? A systematic review

Abstract: PROSPERO 2016:CRD42016039184.

Cited by 316 publications

References 119 publications

Academic outcomes and accommodations following adolescent sport-related concussion: a pilot study

Academic outcomes and accommodations following adolescent sport-related concussion: a pilot study

An update to the AIS–AMA position statement on concussion in sport

Nutrition as Medicine to Improve Outcomes in Adolescents Sustaining a Sports-related Concussion

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