What the CDC's New Concussion Guidelines Mean for Kids
CONCUSSION AND traumatic brain injury are ever-present topics among American
parents and coaches of young athletes today. So the Centers for Disease
Control and Prevention's recent issuing of clinical concussion guidelines
for pediatric professionals come at a crucial time in our collective conversation
about how to protect kids from the experience and
effects of concussion. Although the guidelines are written for medical professionals, there
are takeaways that can help the public understand how we can keep our
kids safe while they play the sports they love.
First, it should be noted that the CDC's guidelines are extensive –
19 total recommendations in all, and each with an "assignment of
obligation." In essence, those guidelines that must be followed,
those that should be followed and those that may be followed, all based
on the confidence of the evidence reviewed and used to make the recommendations.
Yet overall, the overwhelming theme of this list of recommendations is that
concussion, or mild traumatic brain injury – also known as
mTBI – is not "no big deal." And such incidents require evaluation
and follow-up for the health of our young people.
The new guidelines are evidence-based and represent a review of concussion
literature spanning a significant period of time, from 1990 to 2015. That's
a tremendous task, considering that more than 37,000 articles were reviewed.
However, there were a minimal number (only about 75 articles included
in the final synthesis) that were of high enough quality to inform the
final recommendations made.
What the data reveals is that information on the
prognosis of concussion in children is far more represented in high-quality research than information that
can be used to guide treatment and management of concussion in children.
As such, there is a massive need for more high-quality research on treatment
options and best practices for managing pediatric populations with concussion
(both short- and long-term).
Also noteworthy among the CDC's guidelines are the inclusion of recommendations
based on more recent concussion research. This includes the advice of
earlier reintroduction to regular activities that do not worsen concussion
symptoms (light activity after two to three days), rather than eliminating
physical or cognitive exertion until all symptoms have resolved –
which was the previously-held belief and a widely-used practice among
medical professionals.
Beyond the clinical/physiological aspects of concussion diagnosis and treatment,
there's the recommendation that school-related needs and academic
accommodations should be addressed in collaboration with the medical professional,
the child's parents and school professionals. This is a multi-disciplinary
approach to concussion management that brings multiple parties together
for the best interest of the child.
For those of us in the neurological profession, it's encouraging to
note that the guidelines recommend that
children who have experienced concussion and have symptoms that aren't improving should be referred for specialty-level
evaluation and treatment to address symptoms. Though it may not seem significant
on its surface, this is a significant step toward getting children the
care they need to best treat the concern. Just as orthopedic surgeons
have specialty-level expertise to address issues of the musculoskeletal
system, so too do neurological professionals have specialty-level expertise
to evaluate and manage matters involving the brain and nervous system
after concussion with prolonged or severe symptoms.