Tuesday, July 1, 2014

New Pediatric Concussion Guidelines

Watching the amazing players on the World Cup teams, we suspect that the high level of play and the drama of many of the games will help make soccer more popular here in the U.S., especially among young people. But we can't help but notice the frequent and often traumatic contact between the players' heads and the ball and the lack of any sort of protective headgear. Parents are understandably concerned about this.

We were particularly interested, therefore, when we learned of the release last week of the first comprehensive pediatric concussion guidelines from pediatric emergency medicine researchers at the Children's Hospital of Eastern Ontario (CHEO) together with the Ontario Neurotrauma Foundation (ONF). The guidelines were developed by an expert panel including over 30 members across Canada and the United States, and included representation from the full spectrum of pediatric health disciplines (emergency medicine, family practitioners, neurologists, rehabilitation professionals, etc.) which worked for over two years and reviewed more than 4,000 academic papers.

"These are the first comprehensive pediatric guidelines that we're aware of; they reflect the very best available evidence today," said Dr. Roger Zemek, who led the panel. "It was fascinating to see how recommendations have changed over time. Years ago, children were told to 'rest' after concussion, which means something entirely different today with the onset of technology – now, rest also includes a break from screen time."

The guidelines include numerous tools and instructions for parents, schools, physicians, and coaches. For example, the guidelines provide a pocket tool to be used by a coach or parent at the sideline to recognize concussion and offer advice on when to remove kids from play and when to seek emergent medical attention. For the emergency department physician, algorithms are provided to guide the decision whether or not to obtain CT scans, and examples of written discharge handouts for patients and families are included. For family physicians and nurse practitioners in the community, the guidelines provide recommendations for ongoing symptom management and decision tools to help navigate 'return-to-learn' and 'return-to-play'. For school boards, the guidelines provide an example of a policy statement regarding pediatric concussion.

We have long been concerned about the impact of concussions on learning  It is encouraging to see the expertise of so many researchers and clinical physicians come together to offer practical guidelines that reflect the best current knowledge. 

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