Pediatric concussion

The symptoms can typically be included in four major categories: physical, cognitive, emotional, and sleep-related changes. Depending on the age group of the patient, the display of symptoms and signs may vary.

A pediatric concussion can lead to an immediate or delayed onset of symptoms.{{cite journal | vauthors = Rose SC, Weber KD, Collen JB, Heyer GL | title = The Diagnosis and Management of Concussion in Children and Adolescents | language = English | journal = Pediatric Neurology | volume = 53 | issue = 2 | pages = 108–118 | date = August 2015 | pmid = 26088839 | doi = 10.1016/j.pediatrneurol.2015.04.003 }} Immediate onset of symptoms includes physical impacts, such as dizziness, headache, anterograde or retrograde amnesia, loss of consciousness, vomiting and more. Delayed onset of symptoms may occur a few hours or days after the injury. The delayed symptoms involve all the physical, emotional and cognitive changes.

The symptoms of pediatric concussion can differ between babies, toddlers and older children. Babies, aged from birth to one-year-old, are usually unable to communicate their pain or emotions verbally. Therefore, more physical symptoms of pediatric concussion will be administered. This includes excessive crying when slightly moving the baby's head, different portrayal of irritability such as persistent crying, fever, or poor appetite, distinctive changes in the baby's sleeping habits, vomiting, or a visible physical injury on the baby's head.{{Cite web|title=Babies' Warning Signs|url=https://www.nationwidechildrens.org/family-resources-education/family-resources-library/babies-warning-signs|access-date=2021-03-27|website=www.nationwidechildrens.org|language=en}}

Toddlers, aged from 12 to 36 months, might be able to communicate vocally about symptoms. Symptoms will potentially include a headache, nausea, vomiting as physical symptoms. The portrayal of behavioral changes, such as a sudden change in sleeping patterns or excessive crying, and a loss of interest, such as hobbies, may also be seen.

In older children, aged two or more, a pediatric concussion may lead to detectable modifications in the patients' cognition and behavior. Similar to toddlers, they may be vocal about symptoms. This includes feelings of dizziness, problems balancing, having blurry vision, increased sensitivity to light and noise, trouble paying attention, difficulty in memory, various mood changes, fatigue, and irregular sleep patterns.

All children and adolescents with suspected concussion require a medical assessment from a physician or nurse practitioner to accurately diagnose concussion and ensure that the child or adolescent does not have a more severe form of brain injury (TBI), an injury to their cervical spine, or other mental health or neurological conditions that may have similar symptoms to concussion. There is no single physical or physiological test, imaging technique, or bodily fluids test to directly diagnose a pediatric concussion.{{Cite web|title=CEArticlePrint|url=https://nursingcenter.com/interiormaster/ce-pages/cearticle/ce_articleprint|access-date=2021-04-11|website=nursingcenter.com}}

The Glasgow coma scale (GCS) is a clinical scale utilized to measure the severity of the concussion.{{Cite web|title=Diagnosis and Management of Pediatric Concussions in the ED|url=https://www.reliasmedia.com/articles/137049-diagnosis-and-management-of-pediatric-concussions-in-the-ed?v=preview|access-date=2021-03-27|website=www.reliasmedia.com|language=en}} The normal GCS can be used for children above the age of two, and a pediatric GCS has also been developed to assess the symptoms for children under the age of two.{{Cite web|title=Clinical Practice Guidelines : Head injury|url=https://www.rch.org.au/clinicalguide/guideline_index/Head_injury/|access-date=2021-04-13|website=www.rch.org.au}}{{cite journal | vauthors = Borgialli DA, Mahajan P, Hoyle JD, Powell EC, Nadel FM, Tunik MG, Foerster A, Dong L, Miskin M, Dayan PS, Holmes JF, Kuppermann N | display-authors = 6 | title = Performance of the Pediatric Glasgow Coma Scale Score in the Evaluation of Children With Blunt Head Trauma | journal = Academic Emergency Medicine | volume = 23 | issue = 8 | pages = 878–884 | date = August 2016 | pmid = 27197686 | doi = 10.1111/acem.13014 | hdl-access = free | hdl = 2027.42/133544 }}

Both the normal and pediatric GCS aims to test the eye, verbal and motor responses. For each test, the scale value ranges from not testable (NT) to six, increasing in severity with higher numbers. Each of the values recorded is indicative of the person's best response provided during the examination. If the sum of the GCS is below eight or nine, the brain injury, such as concussion, is classified as severe, such as being in a coma. If the sum of the GCS is above or same as thirteen, it is classified to be a minor brain injury. Any value of GCS between nine and thirteen will be classified as moderate injury.{{Cite web|date=2018-02-13|title=What Is the Glasgow Coma Scale?|url=https://www.brainline.org/article/what-glasgow-coma-scale|access-date=2021-04-11|website=BrainLine|language=en}}

Sideline testing is one of the physical assessments that can be made immediately, which usually utilized for a sports-related injury.{{Cite book| vauthors = Graham R, Rivara FP, Ford MA, Spicer CM, ((Youth Board on Children)), ((Institute of Medicine)), ((National Research Council)) |url=https://www.ncbi.nlm.nih.gov/books/NBK185340/|title=Concussion Recognition, Diagnosis, and Acute Management | collaboration = Committee on Sports-Related Concussions in Youth|date=2014-02-04|publisher=National Academies Press (US)|language=en}} There are various examples of sideline testing, including Sideline Concussion Assessment Tool (SCAT5), Child Sideline Concussion Assessment Tool (ChildSCAT5), Balance Error Score System, Test of Individual Stability, King-Devick Test (KD), and Test of Visual–Motor function.

The Sideline Concussion Assessment Tool 6 has two major categories of carrying out an on-field assessment and off-field assessment.{{Cite journal |last=Medicine |first=BMJ Publishing Group Ltd and British Association of Sport and Exercise |date=2023-06-01 |title=Sport Concussion Assessment Tool 6 (SCAT6) |url=https://bjsm.bmj.com/content/57/11/622 |journal=British Journal of Sports Medicine |language=en |volume=57 |issue=11 |pages=622–631 |doi=10.1136/bjsports-2023-107036 |issn=0306-3674 |pmid=37316203|url-access=subscription }} For the on-field, immediate assessment, several different physical examinations such as noting observable concussion signs, memory tests and observation of the level of consciousness using GCS as well as a cervical spine assessment can be done. For off-field assessments, it can be carried out in a clinical setting, with assessments such as careful evaluation of the symptoms, and the utilization of a neurological screen. The SCAT6 test is used for children above age thirteen. ChildSCAT6 is similar to the use of SCAT6, however, it is only used to evaluate children from age five to thirteen.{{Cite journal |last=Medicine |first=BMJ Publishing Group Ltd and British Association of Sport and Exercise |date=2023-06-01 |title=Child SCAT6 |url=https://bjsm.bmj.com/content/57/11/636 |journal=British Journal of Sports Medicine |language=en |volume=57 |issue=11 |pages=636–647 |doi=10.1136/bjsports-2023-106982 |issn=0306-3674 |pmid=37316212|url-access=subscription }}

The Balance Error Score System (BESS) examination measures postural stability which can be affected with the occurrence of a concussion. BESS aims to demonstrate the individual's stability by testing the balancing ability of the individual for three different positions on firm and foam surfaces.

The King-Devick test is to assess the visual–motor function of the individual.{{cite journal | vauthors = Dhawan PS, Leong D, Tapsell L, Starling AJ, Galetta SL, Balcer LJ, Overall TL, Adler JS, Halker-Singh RB, Vargas BB, Dodick D | display-authors = 6 | title = King-Devick Test identifies real-time concussion and asymptomatic concussion in youth athletes | journal = Neurology. Clinical Practice | volume = 7 | issue = 6 | pages = 464–473 | date = December 2017 | pmid = 29431168 | pmc = 5800721 | doi = 10.1212/CPJ.0000000000000381 }} Different sets of test cards are provided to the individuals, with different form of lines that have numbers in the middle. The individual is told to read the numbers of the card from the top-left corner to the bottom-right corner, as fast as possible and as accurately as possible. The time taken to complete this is measured, and any symptoms that occurred during the test is noted.{{cite journal | vauthors = Galetta KM, Barrett J, Allen M, Madda F, Delicata D, Tennant AT, Branas CC, Maguire MG, Messner LV, Devick S, Galetta SL, Balcer LJ | display-authors = 6 | title = The King-Devick test as a determinant of head trauma and concussion in boxers and MMA fighters | journal = Neurology | volume = 76 | issue = 17 | pages = 1456–1462 | date = April 2011 | pmid = 21288984 | pmc = 3087467 | doi = 10.1212/WNL.0b013e31821184c9 }} The test assists the evaluation of impairment in the eye movements, language abilities as well as attention,{{Cite web|title=Sideline Assessment – King-Devick technologies, Inc.|url=https://kingdevicktest.com/products/sideline-concussion-screening/|access-date=2021-04-11|language=en-US}} which is important to assess, as such factors can be affected by a concussion.

The office evaluation is conducted to confirm that the individual has a sustained concussion. To do this, it requires a comprehensive concussion evaluation, including detailed records of the injury, symptomatic scale, neurological exam, evaluation of the behavior and cognition, visual–motor function evaluation, balancing tests, and assessment for risk factors for slower recovery.

It is critical to record down details of the initial injury, such as whether the symptoms of concussion were present immediately, how the injury occurred, or the severity of the symptoms presented. These records may be necessary and helpful for medical professionals to accurately identify the significance of the injury, as well as predict the recommended duration of recovery.

Symptom scales can be varied among various age groups, and it can be provided to help health care providers to assess. Different checklists can be used to measure the symptoms of concussion, such as the Graded Symptom Checklist (GSC), Post-Concussion Symptoms Survey (PCSS), and Rivermead Post-Concussion Symptom Questionnaire (RPCSQ). The GSC rates the symptoms based on severity, and it can be self-reported for individual ages 13 and over.{{Cite book | vauthors = Graham R, Rivara FP, Ford MA, Spicer CM, ((Youth Board on Children)), ((Institute of Medicine)), ((National Research Council)) |url= https://www.ncbi.nlm.nih.gov/books/NBK185341/|title=Clinical Evaluation Tools | collaboration = Committee on Sports-Related Concussions in Youth|date=2014-02-04|publisher=National Academies Press (US)|language=en}} The PCSS is also a self-report that measures the severity of symptoms; however, it has not been yet tested in individuals under the age of eleven. RPCSQ asks individuals to report the comparisons of the severity of symptoms prior to the injury and after the injury. These questionnaires can be self-reported or be reported by the parent or guardian.

File:Ophthalmoscopy.JPG, which consists of the retina, optic disc, and blood vessels. This examination can detect any eye problems, such as glaucoma, optic nerve problems or macular degeneration.{{Cite web|date=2011-02-02|title=Funduscopy|url=https://www.cancer.gov/publications/dictionaries/cancer-terms/def/funduscopy|access-date=2021-04-13|website=National Cancer Institute|language=en}} It can be useful when recognizing any eye injuries caused by a concussion.]]

Various neurological examinations can be initiated to indicate areas affected by pediatric concussion.{{Cite web|title=Concussion Diagnostic Exams {{!}} Neurological Tests at Beaumont {{!}} Beaumont Health|url=https://www.beaumont.org/conditions/concussion/diagnostic-exams?related=page|access-date=2021-04-13|website=www.beaumont.org}} This includes the examination of the mental status, fundoscopic (ophthalmoscopy) exam to assess eye coordination, cranial nerve testing to evaluate the brain, strength, sensory analysis, reflexes and coordination, and walking.

The vestibular–ocular evaluation is the screening of visual–motor functions.{{Cite web|title=Vestibular Ocular Motor Screening (VOMS) {{!}} Concussion Diagnosis|url=https://www.upmc.com/services/sports-medicine/services/concussion/symptoms-diagnosis/voms|access-date=2021-04-13|website=UPMC Sports Medicine|language=en}}{{cite journal | vauthors = Mucha A, Collins MW, Elbin RJ, Furman JM, Troutman-Enseki C, DeWolf RM, Marchetti G, Kontos AP | display-authors = 6 | title = A Brief Vestibular/Ocular Motor Screening (VOMS) assessment to evaluate concussions: preliminary findings | journal = The American Journal of Sports Medicine | volume = 42 | issue = 10 | pages = 2479–2486 | date = October 2014 | pmid = 25106780 | pmc = 4209316 | doi = 10.1177/0363546514543775 }} Visual–motor screening evaluates the cognitive control of the eye movement which utilizes several pathways of the brain. These pathways, such as the frontoparietal circuits and subcortical nuclei, are susceptible to injuries in concussion. Therefore, the evaluation of the visual–motor function, the King-Devick Test as an example, can indicate the severity of the concussion, which can then be associated with the duration needed for recovery.

The balance assessment is useful in observing the abnormalities in balancing abilities, which is a commonly reported symptom of concussed individuals.{{cite journal | vauthors = Ruhe A, Fejer R, Gänsslen A, Klein W | title = Assessing postural stability in the concussed athlete: what to do, what to expect, and when | journal = Sports Health | volume = 6 | issue = 5 | pages = 427–433 | date = September 2014 | pmid = 25177420 | pmc = 4137680 | doi = 10.1177/1941738114541238 }} When conducting the balance test, it is important to focus on the footwear of the individual, as it may impact the results of the balance test.{{Cite web|date=2018-06-13|title=BESS Test for Balance Assessment|url=https://www.tekscan.com/blog/medical/bess-test-balance-assessment|access-date=2021-03-27|website=Tekscan|language=en}} Therefore, it is recommended to remove footwear prior to balance testing. Such balance assessments include SCAT5, and the BESS.

The Acute Concussion Evaluate (ACE) tool and the SCAT5 can be utilized to screen the cognitive status of the individual. These assessment tools can evaluate cognition, such as memory. Nonetheless, it lacks in its ability to judge attention, a factor that may be affected due to concussion. Poor performance in the cognitive screen testing can suggest slower recovery or even a referral to a neuropsychologist.

The neuropsychological evaluation facilitates the analysis of factors that may be affected by concussion such as learning, memory, efficacy, thinking process, reaction time, and attention.{{Citation| vauthors = Schaefer LA, Thakur T, Meager MR |title=Neuropsychological Assessment |date=2021 |url=http://www.ncbi.nlm.nih.gov/books/NBK513310/ |work=StatPearls|place=Treasure Island (FL)|publisher=StatPearls Publishing|pmid=30020682|access-date=2021-04-13}} This is achieved through different assessments such as the Performance Validity Test (PVTs) and Symptom Validity Tests (SVTs), which allows the interpretation of any injuries made by concussion. It can recognize the cognitive status of the patients as well as indicate the recommended duration of recovery based on the severity of the injury.

{{Main|Neuroimaging}}

File:MRI-Philips.JPG

There are various methods of neuroimaging, commonly including magnetic resonance imaging (MRI) and computed tomography (CT). Neuroimaging techniques can detect changes occurring in the brain through technology, further implying brain damage caused by a concussion.{{cite journal | vauthors = Churchill NW, Hutchison MG, Richards D, Leung G, Graham SJ, Schweizer TA | title = Neuroimaging of sport concussion: persistent alterations in brain structure and function at medical clearance | journal = Scientific Reports | volume = 7 | issue = 1 | pages = 8297 | date = August 2017 | pmid = 28839132 | pmc = 5571165 | doi = 10.1038/s41598-017-07742-3 | bibcode = 2017NatSR...7.8297C }} Neuroimaging is a less common technique utilized for pediatrics, as there may be obstacles such as procedural difficulties or discomfort of a pediatric patient.{{cite journal | vauthors = Raschle N, Zuk J, Ortiz-Mantilla S, Sliva DD, Franceschi A, Grant PE, Benasich AA, Gaab N | display-authors = 6 | title = Pediatric neuroimaging in early childhood and infancy: challenges and practical guidelines | journal = Annals of the New York Academy of Sciences | volume = 1252 | pages = 43–50 | date = April 2012 | issue = 1 | pmid = 22524338 | pmc = 3499030 | doi = 10.1111/j.1749-6632.2012.06457.x | bibcode = 2012NYASA1252...43R }}

Infants, adolescents and children suspected of having a concussion are recommended to seek immediate medical attention.{{Cite web|title=Traumatic Brain Injury Information Page {{!}} National Institute of Neurological Disorders and Stroke|url=https://www.ninds.nih.gov/Disorders/All-Disorders/Traumatic-Brain-Injury-Information-Page|access-date=2021-03-27|website=www.ninds.nih.gov}} Those with red flag symptoms should go to the nearest emergency room or call an ambulance (emergency medical service transport). Treatments vary to provide recovery from the trauma; specific treatment depends on the severity and area of injury.{{Cite web|title=What are the treatments for traumatic brain injury (TBI)?|url=https://www.nichd.nih.gov/health/topics/tbi/conditioninfo/treatment|access-date=2021-03-27|website=National Institute of Health|date=24 November 2020 |language=en}} Medical clearance is not necessary to return to school for pediatric patients. However, observation is required to monitor return-to-school and activities. Re-injury should be avoided to prevent long-term consequences and permanent brain damage.{{Cite web|last=CDC|date=2020-10-02|title=Responding to a Concussion and Action Plan for Coaches|url=https://www.cdc.gov/headsup/basics/concussion_respondingto.html|access-date=2021-03-27|website=Centers for Disease Control and Prevention|language=en-us}}

Immediately after a person hits their head and concussion is suspected they must be removed from the activity and require a medical assessment before returning to play.{{Cite web |last=Society |first=Canadian Paediatric |title=Sport-related concussion and bodychecking in children and youth: Evaluation, management, and policy implications {{!}} Canadian Paediatric Society |url=https://cps.ca/en/documents/position/sport-related-concussion-and-bodychecking |access-date=2023-03-20 |website=cps.ca |language=en}} After an initial rest of 24 – 48 hours, activities should be gradually started again. Activities involving contact, collision or any risk of another hit to the body or head need to be completely avoided until medical clearance is granted.{{cite journal | vauthors = Gupta A, Summerville G, Senter C | title = Treatment of Acute Sports-Related Concussion | journal = Current Reviews in Musculoskeletal Medicine | volume = 12 | issue = 2 | pages = 117–123 | date = June 2019 | pmid = 30887284 | pmc = 6542872 | doi = 10.1007/s12178-019-09545-7 }}

After a brief 1–2 days of rest, school activities should be started.{{cite journal | vauthors = Zimmerman SD, Vernau BT, Meehan WP, Master CL | title = Sports-Related Concussions and the Pediatric Patient | journal = Clinics in Sports Medicine | volume = 40 | issue = 1 | pages = 147–158 | date = January 2021 | pmid = 33187605 | doi = 10.1016/j.csm.2020.08.010 | s2cid = 226947984 | doi-access = free }} Absences of more than 1 week are discouraged to avoid deterioration of the manifestations and are recommended to take an active rehabilitation instead.{{cite journal | vauthors = DeMatteo C, Bednar ED, Randall S, Falla K | title = Effectiveness of return to activity and return to school protocols for children postconcussion: a systematic review | journal = BMJ Open Sport & Exercise Medicine | volume = 6 | issue = 1 | pages = e000667 | date = 2020-02-24 | pmid = 32153982 | pmc = 7047486 | doi = 10.1136/bmjsem-2019-000667 }}

Pharmacologic treatment at the present stage has been shown to be unable to speed the recovery of pediatric concussion; nevertheless, the medication can be prescribed to alleviate signs and symptoms of sleep disturbances, headaches, cognitive and emotional inflictions, of the injury.{{cite journal | vauthors = Beauchamp K, Mutlak H, Smith WR, Shohami E, Stahel PF | title = Pharmacology of traumatic brain injury: where is the "golden bullet"? | journal = Molecular Medicine | volume = 14 | issue = 11–12 | pages = 731–740 | date = 2008-11-01 | pmid = 18769636 | pmc = 2527342 | doi = 10.2119/2008-00050.Beauchamp }} Melatonin can assist patients experiencing sleep disturbances.{{cite journal | vauthors = Meehan WP | title = Medical therapies for concussion | journal = Clinics in Sports Medicine | volume = 30 | issue = 1 | pages = 115–24, ix | date = January 2011 | pmid = 21074086 | pmc = 3359788 | doi = 10.1016/j.csm.2010.08.003 }} Medication utilized for headaches like naproxen, ibuprofen, acetaminophen, and oxaprozin can be applied to lessen symptoms in the short term; though, recent studies indicate patients improved in the ailment after discontinuation of the treatment.{{cite journal |display-authors=6 |vauthors=Polinder S, Cnossen MC, Real RG, Covic A, Gorbunova A, Voormolen DC, Master CL, Haagsma JA, Diaz-Arrastia R, von Steinbuechel N |date=2018-12-19 |title=A Multidimensional Approach to Post-concussion Symptoms in Mild Traumatic Brain Injury |journal=Frontiers in Neurology |volume=9 |pages=1113 |doi=10.3389/fneur.2018.01113 |pmc=6306025 |pmid=30619066 |doi-access=free}} However, medication and other forms of drugs are advised to not be administered unless prescribed by a doctor due to the potential detrimental implications on recovery.{{Cite web|title=Concussion in children and adolescents: Management|url=https://www.uptodate.com/contents/concussion-in-children-and-adolescents-management|access-date=2021-03-27|website=www.uptodate.com}}

The majority of pediatric patients recover completely from concussion; some may experience prolonged recuperation.{{cite journal | vauthors = Iverson GL, Gardner AJ, Terry DP, Ponsford JL, Sills AK, Broshek DK, Solomon GS | title = Predictors of clinical recovery from concussion: a systematic review | journal = British Journal of Sports Medicine | volume = 51 | issue = 12 | pages = 941–948 | date = June 2017 | pmid = 28566342 | pmc = 5466929 | doi = 10.1136/bjsports-2017-097729 }} Around 70-80% recover without difficulties after one to three months following the concussion. Each child's recovery follows a unique direction; an accurate prediction based on a single factor is unable to determine the outcome of the child.{{cite journal | vauthors = Babikian T, Satz P, Zaucha K, Light R, Lewis RS, Asarnow RF | title = The UCLA longitudinal study of neurocognitive outcomes following mild pediatric traumatic brain injury | journal = Journal of the International Neuropsychological Society | volume = 17 | issue = 5 | pages = 886–895 | date = September 2011 | pmid = 21813031 | pmc = 4579245 | doi = 10.1017/S1355617711000907 }}

Health care professionals may occasionally employ prognostic tools to provide assistance to determine a predictive outcome, such as validated symptoms scales, cognitive tests and balance testing. Although these tests are incapable of being a strong predictive tool for outcomes, they are able to assess recovery from the pediatric concussion.{{cite journal | vauthors = Zemek RL, Farion KJ, Sampson M, McGahern C | title = Prognosticators of persistent symptoms following pediatric concussion: a systematic review | journal = JAMA Pediatrics | volume = 167 | issue = 3 | pages = 259–265 | date = March 2013 | pmid = 23303474 | doi = 10.1001/2013.jamapediatrics.216 }} These tools display greater benefits towards older adolescents for determining predictions for prognosis.

In pediatric patients at risk for persisting symptoms, including factors such as premorbid history, demographics and injury characteristics, health care professionals may closely monitor these children and refer to interventions if indications do not resolve within four to six weeks. Children suspected of a threat for delayed recovery are highly likely for intervention and will assess prognostic risk factors for effectively counselling patients.

Presently, there is no test to accurately determine the recovery estimate of pediatric patients who had a concussion.{{cite journal | vauthors = Kamins J, Bigler E, Covassin T, Henry L, Kemp S, Leddy JJ, Mayer A, McCrea M, Prins M, Schneider KJ, Valovich McLeod TC, Zemek R, Giza CC | display-authors = 6 | title = What is the physiological time to recovery after concussion? A systematic review | journal = British Journal of Sports Medicine | volume = 51 | issue = 12 | pages = 935–940 | date = June 2017 | pmid = 28455363 | doi = 10.1136/bjsports-2016-097464 | doi-access = free }}

Concussions are one of the most common traumatic head injuries involved with sports or injuries; children under the age of eighteen having the highest rate among all age groups.{{cite journal | vauthors = Askow AT, Erickson JL, Jagim AR | title = Recent Trends in Youth Concussions: A Brief Report | journal = Journal of Primary Care & Community Health | volume = 11 | pages = 2150132720985058 | date = 2020-12-29 | pmid = 33372578 | pmc = 7780302 | doi = 10.1177/2150132720985058 }} Among various sports that were observed, soccer was found to have the highest number of concussions followed by football and basketball, respectively.{{cite journal | vauthors = Yaramothu C, Goodman AM, Alvarez TL | title = Epidemiology and Incidence of Pediatric Concussions in General Aspects of Life | journal = Brain Sciences | volume = 9 | issue = 10 | pages = 257 | date = September 2019 | pmid = 31569649 | pmc = 6827131 | doi = 10.3390/brainsci9100257 | doi-access = free }} Male pediatric patients had more incidence of concussions than females within sports-related concussion occurrences. Within different levels of schools (elementary, middle, and high school), the incidence of concussions was highest in high schoolers (43.1%) compared to elementary (25%) and middle schoolers (31.9%). Most of the concussions in a school setting were associated with Physical Education (PE) class being sports-related as well as opposed to during recess, walking in the hall, or in a classroom. Among children that were diagnosed with concussions, there was not a significant difference in rate of concussions between males and females.

Despite the pediatric population having the highest rate of concussions among all age groups, the pediatric population has the lowest rate of loss of consciousness accompanying the concussion among all age groups. Among children attending school following a pediatric concussion, 13.7% continued to be symptomatic 3 months afterwards; this could not be explained by trauma, family dysfunction, or psychological adjustment.{{cite journal |vauthors=Barlow KM, Crawford S, Stevenson A, Sandhu SS, Belanger F, Dewey D |date=August 2010 |title=Epidemiology of postconcussion syndrome in pediatric mild traumatic brain injury |journal=Pediatrics |volume=126 |issue=2 |pages=e374–e381 |doi=10.1542/peds.2009-0925 |pmid=20660554 |s2cid=36915304}}

The most recent estimated range of concussions among patients 18 years of age or younger is between 1.1 million to 1.9 million concussions annually.{{Citation |title=Sport-Related Concussion in Children and Adolescents |date=2018-05-01 |url=http://dx.doi.org/10.1542/9781610021494-part05-sport-related_concus |work=Pediatric Clinical Practice Guidelines & Policies |pages=1302 |publisher=American Academy of Pediatrics |doi=10.1542/9781610021494-part05-sport-related_concus |isbn=978-1-61002-149-4 |access-date=2022-11-21|url-access=subscription }} The estimate is a wide range due to the difficulty of accurately reporting because of differing definitions used, lack of surveillance systems, and possible underreporting of the condition. Also, there are differences on what type of patients are used as study subjects within studies to estimate the incidence. Many studies use emergency department visits as a proxy for the estimate; however, recently it was found that about 75% of 5–17 years old patients visited their primary care provider to be diagnosed with a concussion.

The rate of incidence of concussions, in general, decreases with age; the younger generation experience head traumas more often.{{cite journal |vauthors=Gordon KE, Dooley JM, Wood EP |date=May 2006 |title=Descriptive epidemiology of concussion |journal=Pediatric Neurology |volume=34 |issue=5 |pages=376–378 |doi=10.1016/j.pediatrneurol.2005.09.007 |pmid=16647998}} However, overall the number of pediatric patients diagnosed with a concussion has increased from 2013 to 2018. This increase of diagnoses could be related to increased frequency of injury, increased participation in sport activities, and more awareness around concussions. The awareness in turn has led to an increased production of policies and procedures dealing with detection, managing symptoms, and return-to-play protocols among sports organizations and schools.

• Concussion
• Pediatrics
• Prevention of concussions

{{reflist}}

• US CDC resources:
• [https://www.cdc.gov/traumatic-brain-injury/index.html Traumatic Brain Injury & Concussion] page
• [https://jamanetwork.com/journals/jamapediatrics/fullarticle/2698456 Guideline on MTBI in children] (2018)

Category:Neurotrauma

Category:Pediatrics