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Concussion is “a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces.” Concussion results from acceleration and deceleration forces which may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an 'impulsive' force transmitted to the head.

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Bottom Line Recommendations English (6) French (1) All (7)

Bottom Line Recommendations: Concussion

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Zemek R & TREKK Network

Bottom line recommendations for the treatment and management of concussion. Updated: August 2018.

Bottom Line: The Child Sport Concussion Assessment Tool 5th Edition (Child SCAT5)

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Davis GA, Purcell L, Schneider KJ, Yeates KO, Gioia GA, Anderson V, Ellenboge...

The Child SCAT5 is a standardized tool for evaluating concussions designed for use by physicians and licensed healthcare professionals. The Child SCAT5 is to be used for evaluating Children aged 5 to 12 years. For athletes aged 13 years and older, please use the SCAT5.

Bottom Line: The Sport Concussion Assessment Tool 5th Edition (SCAT5)

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Echemendia RJ, Meeuwisse W, McCrory P, Davis GA, Putukian M, Leddy J, Makdiss...

The SCAT5 is a standardized tool for evaluating concussions designed for use by physicians and licensed healthcare professionals. The SCAT5 is to be used for evaluating athletes aged 13 years and older. For children aged 12 years or younger, please use the Child SCAT5.

Bottom Line: Management of Acute Symptoms Algorithm

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Ontario Neurotrauma Foundation

This document is intended to guide health care professionals in diagnosing and managing pediatric concussion. See Page 48 of this document for the Management of Acute Symptoms Algorithm (Tool 2.1).

Emergency Medicine Cases Podcast: Pediatric head injury

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Dr. Rahim Valani and Dr. Jennifer Riley

Episode 3:Dr. Rahim Valani and Dr. Jennifer Riley discuss their approach to the workup and management of both minor and major Pediatric Head Injury. They review two recent landmark studies (Kupperman PECARN & CATCH studies) describing clinical decision rules for performing CT head in minor pediatric head injury, as well as practical tips on instructing parents regarding back to sport activities after discharge. In major pediatric head injury, they discuss key clinical pearls on managing blood pressure, the use of hypertonic saline and managing raised intracranial pressure in the treatment of major head injury. Published online: April 2010. 

Bottom Line: Acute Concussion Evaluation (ACE): Physician/Clinician Office Version

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Goia G, Collins M

The ACE is intended to provide an evidence-based clinical protocol to conduct an initial evaluation and diagnosis of patients (both children and adults) with known or suspected mild traumatic brain injury.

Recommandations de Base: Commotion cérébrale (TCC léger)

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Zemek R and TREKK Network

Bottom line recommendations for the treatment and management of concussion - en francais. Updated: August 2018.

Bottom Line Recommendations: Concussion

Download

Zemek R & TREKK Network

Bottom line recommendations for the treatment and management of concussion. Updated: August 2018.

Recommandations de Base: Commotion cérébrale (TCC léger)

Download

Zemek R and TREKK Network

Bottom line recommendations for the treatment and management of concussion - en francais. Updated: August 2018.

Bottom Line: The Child Sport Concussion Assessment Tool 5th Edition (Child SCAT5)

Visit

Davis GA, Purcell L, Schneider KJ, Yeates KO, Gioia GA, Anderson V, Ellenboge...

The Child SCAT5 is a standardized tool for evaluating concussions designed for use by physicians and licensed healthcare professionals. The Child SCAT5 is to be used for evaluating Children aged 5 to 12 years. For athletes aged 13 years and older, please use the SCAT5.

Bottom Line: The Sport Concussion Assessment Tool 5th Edition (SCAT5)

Visit

Echemendia RJ, Meeuwisse W, McCrory P, Davis GA, Putukian M, Leddy J, Makdiss...

The SCAT5 is a standardized tool for evaluating concussions designed for use by physicians and licensed healthcare professionals. The SCAT5 is to be used for evaluating athletes aged 13 years and older. For children aged 12 years or younger, please use the Child SCAT5.

Bottom Line: Management of Acute Symptoms Algorithm

Visit

Ontario Neurotrauma Foundation

This document is intended to guide health care professionals in diagnosing and managing pediatric concussion. See Page 48 of this document for the Management of Acute Symptoms Algorithm (Tool 2.1).

Emergency Medicine Cases Podcast: Pediatric head injury

Visit

Dr. Rahim Valani and Dr. Jennifer Riley

Episode 3:Dr. Rahim Valani and Dr. Jennifer Riley discuss their approach to the workup and management of both minor and major Pediatric Head Injury. They review two recent landmark studies (Kupperman PECARN & CATCH studies) describing clinical decision rules for performing CT head in minor pediatric head injury, as well as practical tips on instructing parents regarding back to sport activities after discharge. In major pediatric head injury, they discuss key clinical pearls on managing blood pressure, the use of hypertonic saline and managing raised intracranial pressure in the treatment of major head injury. Published online: April 2010. 

Bottom Line: Acute Concussion Evaluation (ACE): Physician/Clinician Office Version

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Goia G, Collins M

The ACE is intended to provide an evidence-based clinical protocol to conduct an initial evaluation and diagnosis of patients (both children and adults) with known or suspected mild traumatic brain injury.

Clinical guidelines English (3) French All (3)

Guidelines: Consensus statement on concussion in sport-the 5(th) international conference on concussion in sport held in Berlin, October 2016

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McCrory P, Meeuwisse W, Dvorak J, Aubry M, Bailes J, Broglio S, Cantu RC, Cas...

The 2017 Concussion in Sport Group (CISG) consensus statement is designed to build on the principles outlined in the previous statements and to develop further conceptual understanding of sport-related concussion (SRC) using an expert consensus-based approach.

Guidelines: Guidelines for Diagnosing and Managing Pediatric Concussion: Recommendations for Health Care Professionals

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Zemek R, Duval S, Dematteo C, Solomon B, Keightley M, Osmond M

This document is intended to guide health care professionals in diagnosing and managing pediatric concussion.

Guidelines: Care of the Patient with mild traumatic brain injury

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West TA, Bergman K, Biggins MS, French B, Galletly J, Hinkle JL, Morris J

The purpose of this document is to provide recommendations based on current evidence that will help registered nurses, advanced practice nurses, and institutions provide safe and effective care to injured patients with a mild traumatic brain injury.

Guidelines: Consensus statement on concussion in sport-the 5(th) international conference on concussion in sport held in Berlin, October 2016

Visit

McCrory P, Meeuwisse W, Dvorak J, Aubry M, Bailes J, Broglio S, Cantu RC, Cas...

The 2017 Concussion in Sport Group (CISG) consensus statement is designed to build on the principles outlined in the previous statements and to develop further conceptual understanding of sport-related concussion (SRC) using an expert consensus-based approach.

Guidelines: Guidelines for Diagnosing and Managing Pediatric Concussion: Recommendations for Health Care Professionals

Visit

Zemek R, Duval S, Dematteo C, Solomon B, Keightley M, Osmond M

This document is intended to guide health care professionals in diagnosing and managing pediatric concussion.

Guidelines: Care of the Patient with mild traumatic brain injury

Visit

West TA, Bergman K, Biggins MS, French B, Galletly J, Hinkle JL, Morris J

The purpose of this document is to provide recommendations based on current evidence that will help registered nurses, advanced practice nurses, and institutions provide safe and effective care to injured patients with a mild traumatic brain injury.

Overviews of systematic reviews English (1) French All (1)

Evidence Summary: Management of paediatric minor head injuries. Safe discharge?

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Hunter F

This summary answers the question: In paediatric patients with minor head injury, GCS (Glasgow Coma Score) 15 and no focal neurological deficit does a normal computed tomography brain scan allow safe discharge?

Evidence Summary: Management of paediatric minor head injuries. Safe discharge?

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Hunter F

This summary answers the question: In paediatric patients with minor head injury, GCS (Glasgow Coma Score) 15 and no focal neurological deficit does a normal computed tomography brain scan allow safe discharge?

Systematic reviews English (7) French All (7)

Systematic Review: Predictors of clinical recovery from concussion: a systematic review

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Iverson GL, Gardner AJ, Terry DP, Ponsford JL, Sills AK, Broshek DK, Solomon GS

This is a systematic review of factors that might be associated with, or influence, clinical recovery from sport-related concussion

Systematic Review: Rest and treatment/rehabilitation following sport-related concussion: a systematic review

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Schneider KJ, Leddy JJ, Guskiewicz KM, Seifert T, McCrea M, Silverberg ND, Fe...

The objective of this systematic review was to evaluate the evidence regarding rest and active treatment/rehabilitation following sport-related concussion (SRC).

Systematic Review: Psychosocial consequences of mild traumatic brain injury in children: results of a systematic review by the International Collaboration on Mild Traumatic Brain Injury Prognosis

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Keightley ML, Ct P, Rumney P, Hung R, Carroll LJ, Cancelliere C, Cassidy JD

Objective: To synthesize the best available evidence regarding psychosocial consequences of mild traumatic brain injury (MTBI) in children.

Systematic Review: Prognosticators of persistent symptoms following pediatric concussion: a systematic review

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Zemek RL, Farion KJ, Sampson M, McGahern C

Objective: To identify predictors of persistent concussion symptoms (PCS) in children following concussion.

Systematic Review: Interventions provided in the acute phase for mild traumatic brain injury: a systematic review

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Gravel J, D'Angelo A, Carrire B, Crevier L, Beauchamp MH, Chauny JM, Wassef M...

This systematic review investigated the effectiveness of interventions initiated in acute settings for patients who experience mild traumatic brain injury.

Systematic Review: Clinical decision rules for children with minor head injury: a systematic review

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Pickering A, Harnan S, Fitzgerald P, Pandor A, Goodacre S

This study aimed to identify clinical decision rules for children with minor head injury and compare their diagnostic accuracy for detection of intracranial injury (ICI) and injury requiring neurosurgical intervention (NSI).

Systematic Review: Which symptom assessments and approaches are uniquely appropriate for paediatric concussion?

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Gioia GA, Schneider JC, Vaughan CG, Isquith PK

Objectives: To (a) identify post-concussion symptom scales appropriate for children and adolescents in sports; (b) review evidence for reliability and validity; and (c) recommend future directions for scale development.

Systematic Review: Predictors of clinical recovery from concussion: a systematic review

Visit

Iverson GL, Gardner AJ, Terry DP, Ponsford JL, Sills AK, Broshek DK, Solomon GS

This is a systematic review of factors that might be associated with, or influence, clinical recovery from sport-related concussion

Systematic Review: Rest and treatment/rehabilitation following sport-related concussion: a systematic review

Visit

Schneider KJ, Leddy JJ, Guskiewicz KM, Seifert T, McCrea M, Silverberg ND, Fe...

The objective of this systematic review was to evaluate the evidence regarding rest and active treatment/rehabilitation following sport-related concussion (SRC).

Systematic Review: Psychosocial consequences of mild traumatic brain injury in children: results of a systematic review by the International Collaboration on Mild Traumatic Brain Injury Prognosis

Visit

Keightley ML, Ct P, Rumney P, Hung R, Carroll LJ, Cancelliere C, Cassidy JD

Objective: To synthesize the best available evidence regarding psychosocial consequences of mild traumatic brain injury (MTBI) in children.

Systematic Review: Prognosticators of persistent symptoms following pediatric concussion: a systematic review

Visit

Zemek RL, Farion KJ, Sampson M, McGahern C

Objective: To identify predictors of persistent concussion symptoms (PCS) in children following concussion.

Systematic Review: Interventions provided in the acute phase for mild traumatic brain injury: a systematic review

Visit

Gravel J, D'Angelo A, Carrire B, Crevier L, Beauchamp MH, Chauny JM, Wassef M...

This systematic review investigated the effectiveness of interventions initiated in acute settings for patients who experience mild traumatic brain injury.

Systematic Review: Clinical decision rules for children with minor head injury: a systematic review

Visit

Pickering A, Harnan S, Fitzgerald P, Pandor A, Goodacre S

This study aimed to identify clinical decision rules for children with minor head injury and compare their diagnostic accuracy for detection of intracranial injury (ICI) and injury requiring neurosurgical intervention (NSI).

Systematic Review: Which symptom assessments and approaches are uniquely appropriate for paediatric concussion?

Visit

Gioia GA, Schneider JC, Vaughan CG, Isquith PK

Objectives: To (a) identify post-concussion symptom scales appropriate for children and adolescents in sports; (b) review evidence for reliability and validity; and (c) recommend future directions for scale development.

Key studies English (10) French All (10)

Key Study: Validation and refinement of a clinical decision rule for the use of computed tomography in children with minor head injury in the emergency department

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Osmond MH, Klassen TP, Wells GA, Davidson J, Correll R, Boutis K, Joubert G, ...

Methods: This multicentre cohort study in 9 Canadian pediatric emergency departments prospectively enrolled children with blunt head trauma presenting with a Glasgow Coma Scale score of 13-15 and loss of consciousness, amnesia, disorientation, persistent vomiting or irritability. Physicians completed standardized assessment forms before CT, including clinical predictors of the rule. The primary outcome was neurosurgical intervention and the secondary outcome was brain injury on CT. We calculated test characteristics of the rule and used recursive partitioning to further refine the rule.

Key Study: Clinical Risk Score for Persistent Postconcussion Symptoms Among Children With Acute Concussion in the ED

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Zemek R, Barrowman N, Freedman SB, Gravel J, Gagnon I, McGahern C, Aglipay M,...

Objective: To derive and validate a clinical risk score for persistent postconcussion symptoms among children presenting to the emergency department.

Key Study: Effect of cognitive activity level on duration of post-concussion symptoms

Visit

Brown NJ, Mannix RC, O'Brien MJ, Gostine D, Collins MW, Meehan WP III

Objective: To determine the effect of cognitive activity level on duration of post-concussion symptoms.

Key Study: Comparison of PECARN, CATCH, and CHALICE rules for children with minor head injury: a prospective cohort study

Visit

Easter JS, Bakes K, Dhaliwal J, Miller M, Caruso E, Haukoos JS

Objective: To evaluate the diagnostic accuracy of clinical decision rules and physician judgment for identifying clinically important traumatic brain injuries in children with minor head injuries presenting to the emergency department.

Key Study: Predicting postconcussion syndrome after mild traumatic brain injury in children and adolescents who present to the emergency department

Visit

Babcock L, Byczkowski T, Wade SL, Ho M, Mookerjee S, Bazarian JJ

Objective: To determine the acute predictors associated with the development of postconcussion syndrome (PCS) in children and adolescents after mild traumatic brain injury.

Key Study: Time interval between concussions and symptom duration

Visit

Eisenberg MA, Andrea J, Meehan W, Mannix R

Objective: To test the hypothesis that children with a previous history of concussion have a longer duration of symptoms after a repeat concussion than those without such a history.

Key Study: Mild traumatic brain injury: a description of how children and youths between 16 and 18 years of age perform leisure activities after 1 year

Visit

Jonsson C, Andersson EE

Objective: To describe how children and youths perform leisure activities, 1 year after a mild traumatic brain injury (MTBI).

Key Study: Identifying neurocognitive deficits in adolescents following concussion

Visit

Thomas DG, Collins MW, Saladino RA, Frank V, Raab J, Zuckerbraun NS

This study of concussed adolescents sought to determine if a computer-based neurocognitive assessment (Immediate Postconcussion Assessment and Cognitive Test [ImPACT]) performed on patients who present to the emergency department (ED) immediately following head injury would correlate with assessments performed 3 to 10 days postinjury and if ED neurocognitive testing would detect differences in concussion severity that clinical grading scales could not.

Key Study: Identifying the specific needs of adolescents after a mild traumatic brain injury: a service provider perspective

Visit

Swaine BR, Gagnon I, Champagne F, Lefebvre H, Friedman D, Atkinson J, Feldman D

Objectives: To identify the specific service needs of adolescents with mild traumatic brain injury (MTBI) and those of their parents through the perspective of expert service providers as well as to compare it to the perspective of adolescents and their parents obtained in a prior study.

Key Study: Visuomotor response time in children with a mild traumatic brain injury

Visit

Gagnon I, Swaine B, Friedman D, Forget R

Objective: To compare the visuomotor response times of children after a mild traumatic brain injury (mTBI) with those of noninjured children matched for age, sex, and premorbid level of physical activity.

Key Study: Validation and refinement of a clinical decision rule for the use of computed tomography in children with minor head injury in the emergency department

Visit

Osmond MH, Klassen TP, Wells GA, Davidson J, Correll R, Boutis K, Joubert G, ...

Methods: This multicentre cohort study in 9 Canadian pediatric emergency departments prospectively enrolled children with blunt head trauma presenting with a Glasgow Coma Scale score of 13-15 and loss of consciousness, amnesia, disorientation, persistent vomiting or irritability. Physicians completed standardized assessment forms before CT, including clinical predictors of the rule. The primary outcome was neurosurgical intervention and the secondary outcome was brain injury on CT. We calculated test characteristics of the rule and used recursive partitioning to further refine the rule.

Key Study: Clinical Risk Score for Persistent Postconcussion Symptoms Among Children With Acute Concussion in the ED

Visit

Zemek R, Barrowman N, Freedman SB, Gravel J, Gagnon I, McGahern C, Aglipay M,...

Objective: To derive and validate a clinical risk score for persistent postconcussion symptoms among children presenting to the emergency department.

Key Study: Effect of cognitive activity level on duration of post-concussion symptoms

Visit

Brown NJ, Mannix RC, O'Brien MJ, Gostine D, Collins MW, Meehan WP III

Objective: To determine the effect of cognitive activity level on duration of post-concussion symptoms.

Key Study: Comparison of PECARN, CATCH, and CHALICE rules for children with minor head injury: a prospective cohort study

Visit

Easter JS, Bakes K, Dhaliwal J, Miller M, Caruso E, Haukoos JS

Objective: To evaluate the diagnostic accuracy of clinical decision rules and physician judgment for identifying clinically important traumatic brain injuries in children with minor head injuries presenting to the emergency department.

Key Study: Predicting postconcussion syndrome after mild traumatic brain injury in children and adolescents who present to the emergency department

Visit

Babcock L, Byczkowski T, Wade SL, Ho M, Mookerjee S, Bazarian JJ

Objective: To determine the acute predictors associated with the development of postconcussion syndrome (PCS) in children and adolescents after mild traumatic brain injury.

Key Study: Time interval between concussions and symptom duration

Visit

Eisenberg MA, Andrea J, Meehan W, Mannix R

Objective: To test the hypothesis that children with a previous history of concussion have a longer duration of symptoms after a repeat concussion than those without such a history.

Key Study: Mild traumatic brain injury: a description of how children and youths between 16 and 18 years of age perform leisure activities after 1 year

Visit

Jonsson C, Andersson EE

Objective: To describe how children and youths perform leisure activities, 1 year after a mild traumatic brain injury (MTBI).

Key Study: Identifying neurocognitive deficits in adolescents following concussion

Visit

Thomas DG, Collins MW, Saladino RA, Frank V, Raab J, Zuckerbraun NS

This study of concussed adolescents sought to determine if a computer-based neurocognitive assessment (Immediate Postconcussion Assessment and Cognitive Test [ImPACT]) performed on patients who present to the emergency department (ED) immediately following head injury would correlate with assessments performed 3 to 10 days postinjury and if ED neurocognitive testing would detect differences in concussion severity that clinical grading scales could not.

Key Study: Identifying the specific needs of adolescents after a mild traumatic brain injury: a service provider perspective

Visit

Swaine BR, Gagnon I, Champagne F, Lefebvre H, Friedman D, Atkinson J, Feldman D

Objectives: To identify the specific service needs of adolescents with mild traumatic brain injury (MTBI) and those of their parents through the perspective of expert service providers as well as to compare it to the perspective of adolescents and their parents obtained in a prior study.

Key Study: Visuomotor response time in children with a mild traumatic brain injury

Visit

Gagnon I, Swaine B, Friedman D, Forget R

Objective: To compare the visuomotor response times of children after a mild traumatic brain injury (mTBI) with those of noninjured children matched for age, sex, and premorbid level of physical activity.