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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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Key studies English (45) French All (45)

Key study: Association between ondansetron use and symptom persistence in children with concussions: A 5P substudy

Visit

Gravel J, Boutis K, Tang K, et al.

Ondansetron is increasingly administered to children suffering from concussion-associated nausea/vomiting. We examined the association between ondansetron administration and post-concussion symptoms in children at 1 week and 1 month following the concussion.

Key study: Association of time since injury to the first clinic visit with recovery following concussion

Visit

Kontos AP, Jorgensen-Wagers K, Trbovich AM, et al.

To investigate the association of time since injury with initiation of clinical care on recovery time following concussion.

Key study: Characteristics of concussion in elementary school-aged children: implications for clinical management

Visit

Master CL, Curry AE, Pfeiffer MR, et al.

To comprehensively characterize the clinical presentation and course of care for concussion among 5- to 11-year-old children, identifying preinjury and injury factors potentially influencing clinical outcomes.

Key study: Characteristics of diagnosed concussions in children aged 0 to 4 years presenting to a large pediatric healthcare network

Visit

Podolak OE, Chaudhary S, Haarbauer-Krupa J, et al.

The aim of the study was to comprehensively describe the natural history of concussion in early childhood between 0 and 4 years.

Key study: Concussion Guidelines Step 2: evidence for subtype classification

Visit

Lumba-Brown A, Teramoto M, Bloom OJ, et al.

Objective: To use evidence-based methodology to characterize the 5 concussion subtypes and 2 associated conditions and report their prevalence in acute concussion patients as compared to baseline or controls within 3 d of injury.

Key study: Concussion-symptom rating correlation between pediatric patients and their parents

Visit

Patsimas T, Howell DR, Potter MN, Potter MN, Provance AJ, Kirkwood MW, Wilson JC

To examine patient-parent correlations and agreement on concussion-symptom ratings, to identify differences in patient-parent symptom reporting between children (8-12 years of age) and adolescents (13-18 years of age), and to evaluate the correlation between patient and parent initial symptom-severity ratings with symptom duration and return-to-play time.

Key study: Continuing play, symptom severity, and symptom duration after concussion in youth athletes

Visit

Howell DR, O'Brien MJ, Fraser J, Meehan WP.

Objective: To determine whether continuing to play after a concussion is associated with higher symptom burden or prolonged symptom duration.

Key study: Delayed symptom onset following pediatric sport-related concussion

Visit

Olson A, Ellis MJ, Selci E, Russell K.

Objective: (1) To examine the prevalence of delayed symptom onset (DSO) among pediatric sport-related concussion (SRC) patients as well as the effect of symptom onset on initial symptom severity, length of recovery, and development of delayed recovery; (2) to evaluate the impact of symptom onset on sideline management.

Key study: Early versus delayed emergency department presentation following mild traumatic nrain injury and the presence of symptom at 1, 4 and 12 weeks in children

Visit

Gravel J, Ledoux AA, Tang K, et al.

We evaluated the association between timing of presentation and postconcussive symptoms (PCS) at 1, 4 and 12 weeks after injury.

Key study: Effect of cognitive and physical rest on persistent postconcussive symptoms following a pediatric head injury

Visit

Root JM, Sady MD, Gai J, Vaughan CG, Madati PJ

To evaluate the effect of cognitive and physical rest on persistent postconcussive symptoms in a pediatric population.

Key study: Participation in physical activity at time of presentation to a specialty concussion clinic is associated with shorter time to recovery

Visit

Coslick AM, Chin KE, Kalb LG, Slomine BS, Suskauer SJ.

To determine if level of physical activity at presentation to a rehabilitation-based concussion specialty clinic predicted days from injury to recovery.

Key study: Pediatric minor head injury imaging practices: results from an ESPR survey

Visit

Argyropoulou MI, Alexiou GA, Xydis VG, et al.

Objective: Computed tomography (CT) for minor head injury exposes a large number of children to ionizing radiation, with an associated increased lifetime risk of malignancy. To study imaging practices for children with minor head injury and the level of awareness of radiologists of the current clinical decision rules for minor traumatic brain injury (TBI).

Key study: Reliability of the visio-vestibular examination for concussion among providers in a pediatric emergency department

Visit

Corwin DJ, Arbogast KB, Swann C, et al.

Our objective was to determine the inter-rater (IRR) and test-retest reliability (TRR) of the VVE in a pediatric ED.

Key study: Trajectories and predictors of clinician-determined recovery after child concussion

Visit

Anderson V, Davis GA, Takagi M, et al.

We mapped concussion recovery to 3 months post-injury and explored non-modifiable (e.g., age, sex, pre-injury factors, injury mechanism, acute PCS) and modifiable (post-acute child symptoms) predictors of persisting symptoms in order to identify opportunities for early intervention.

Key study: Use of the sport concussion assessment tools in the emergency department to predict persistent post-concussive symptoms in children

Visit

Bressan S, Clarke CJ, Anderson V, et al.

We aim to assess the predictive value of the main SCAT3/ChildSCAT3 components for PPCS when applied in the ED.

Key study: A longitudinal investigation of sleep and daytime wakefulness in children and youth with concussion

Visit

Wiseman-Hakes C, Gosselin N, Sharma B, Langer L, Gagnon I.

In this study, we investigated the trajectory of sleep and daytime sleepiness in a prospective cohort of 40 children and youth (6-18 years old) with concussion, 40 age-and sex-matched healthy children and youth, and 40 with upper-extremity orthopedic injury.

Key study: Admission of pediatric concussion injury patients: is it necessary?

Visit

Lindholm EB, DCruz R, Fajardo R, et al.

The purpose of this study was to determine if pediatric patients evaluated in the emergency department (ED) for concussion with a negative head CT scan require routine hospital admission.

Key study: Concussion symptom profiles among child, adolescent, and young adult athletes

Visit

Howell DR, Kriz P, Mannix RC, Kirchberg T, Master C L, Meehan WP

(1) To examine how age influences initial symptom presentation following concussion; and (2) to determine whether specific symptom profiles are associated with duration of postconcussion symptoms, and whether they vary by age group.

Key study: Delayed presentations to emergency departments of children with head injury: A PREDICT Study

Visit

Borland ML, Dalziel SR, Phillips N, et al.

Objective: Existing clinical decision rules guide management for head-injured children presenting 24 hours or sooner after injury, even though some may present greater than 24 hours afterward. We seek to determine the prevalence of traumatic brain injuries for patients presenting to emergency departments greater than 24 hours after injury and identify symptoms and signs to guide management.

Key study: Derivation and initial validation of clinical phenotypes of children presenting with concussion acutely in the emergency department: latent class analysis of a multi-center, prospective cohort, observational study

Visit

Yeates KO, Tang K, Barrowman N, et al.

This study used latent class analysis (LCA) to identify discernible phenotypes among children with acute concussion and examine the association between phenotypes and persistent post-concussive symptoms (PPCS) at 4 and 12 weeks post-injury. We conducted LCA of variables representing pre-injury history, clinical presentation, and parent symptom ratings, derived from a prospective cohort, observational study that recruited participants from August 2013 until June 2015 at nine pediatric emergency departments within the Pediatric Emergency Research Canada network.

Key study: Early subthreshold aerobic exercise for sport-related concussion: a randomized clinical trial

Visit

Leddy JJ, Haider MN, Ellis MJ, et al.

To assess the effectiveness of subsymptom threshold aerobic exercise vs a placebo-like stretching program prescribed to adolescents in the acute phase of recovery from SRC.

Key study: Insomnia in adolescents with slow recovery from concussion

Visit

Brooks BL, Sayers PQ, Virani S, Rajaram AA, Tomfohr-Madsen L.

This study examined: 1) some of the psychometric properties of the Insomnia Severity Index (ISI), 2) the prevalence and severity of insomnia symptoms, and 3) associations between insomnia symptoms and clinical measures of post-concussion symptoms, mental health symptoms, and cognitive tests in adolescents with slow recovery from concussion.

Key study: Low-value diagnostic imaging use in the pediatric emergency department in the United States and Canada

Visit

Cohen E, Rodean J, Diong C, et al.

Objective To compare overall and low-value use of diagnostic imaging across pediatric ED visits in Ontario, Canada, and the United States.

Key study: Natural progression of symptom change and recovery from concussion in a pediatric population

Visit

Ledoux AA, Tang K, Yeates KO, et al.

Objectives: To describe the natural progression of symptom change by age group (5-7, 8-12, and 13-18 years) and sex, as well as to develop centile curves to inform families about children after injury recovery.

Key study: Persistent vestibular-ocular impairment following concussion in adolescents

Visit

Sinnott AM, Elbin RJ, Collins MW, Reeves VL, Holland CL, Kontos AP.

Objectives: The current study investigated the role of persistent vestibular-ocular symptoms and impairment following sport-related concussion on recovery time and clinical outcomes among adolescents.

Key study: Physical activity after mild traumatic brain injury: what are the relationships with fatigue and sleep quality?

Visit

van Markus-Doornbosch F, Peeters E, van der Pas S, Vlieland TV, Meesters J.

To determine self-reported physical activity (PA) levels and relationships with fatigue and sleep quality in adolescents and young adults after mild traumatic brain injury (mTBI).

Key study: Practice patterns in pharmacological and non-pharmacological therapies for children with mild traumatic brain injury: a survey of 15 canadian and United States centers

Visit

Mannix R, Zemek R, Yeates KO, et al.

Given the lack of evidence regarding effective pharmacological and non-pharmacological interventions for pediatric mild traumatic brain injury (mTBI) and the resultant lack of treatment recommendations reflected in consensus guidelines, variation in the management of pediatric mTBI is to be expected. We therefore surveyed practitioners across 15 centers in the United States and Canada who care for children with pediatric mTBI to evaluate common-practice variation in the management of pediatric mTBI.

Key study: Quality of life and symptom burden 1 month after concussion in children and adolescents

Visit

Howell DR, Wilson JC, Kirkwood MW, Grubenhoff JA.

We conducted a prospective study of children and adolescents (n = 176; mean age = 13.0 2.7 years; 38% female) assessed acutely post-concussion and again 30 days later. We investigated the association between symptom burden and quality of life (QOL) outcomes, as well as the effect of age on QOL.

Key study: Reduction of computed tomography use for pediatric closed head injury evaluation at a nonpediatric community emergency department

Visit

Puffenbarger MS, Ahmad FA, Argent M, Gu H, Samson C, Quayle KS, Saito JM.

The purpose of this study was to determine if implementation of a Pediatric Emergency Care Applied Research Network (PECARN)-based Closed Head Injury Assessment Tool could safely decrease computed tomography (CT) use for pediatric head injury evaluation at a nonpediatric community emergency department (ED).

Key study: Risk factors for prolonged symptoms of mild traumatic brain injury: a pediatric sports concussion clinic cohort

Visit

Fehr SD, Nelson LD, Scharer KR, et al.

To examine predictors of prolonged symptom duration from mild traumatic brain injury (mTBI) in a pediatric sports medicine specialty clinic cohort as these predictors may be distinct in this population.

Key study: Trouble falling asleep after concussion is associated with higher symptom burden among children and adolescents

Visit

Howell DR, Oldham JR, Brilliant AN, Meehan WP.

Our objective was to identify factors associated with trouble falling asleep postconcussion.

Key study: Use of the vestibular and oculomotor examination for concussion in a pediatric emergency department

Visit

Corwin DJ, Propert KJ, Zorc JJ, Zonfrillo MR, Wiebe DJ.

We aimed to measure rates of exam performance after implementation of training and support tools in a pediatric emergency department.

Key study: What comes first: return to school or return to activity for youth after concussion? Maybe we dont have to choose.

Visit

DeMatteo CA, Randall S, Lin CA, Claridge EA.

This study investigates recovery trajectories of children/youth while following RTA and RTS protocols simultaneously, with the following objectives: (1) to compare rates and patterns of progression through the stages of both protocols; (2) to evaluate symptom trajectories of youth post-concussion while progressing through stages of RTS and RTA; and (3) to propose a new model for concussion management in youth that involves the integration of Return to Activity and Return to School protocols.

Key study: Characterizing hospitalizations for pediatric concussion and trends in care

Visit

Rhine T, Byczkowski T, Altaye M, Wade SL, Babcock L.

Objective: Delineate a cohort of children admitted for concussion, describe care practices received, examine factors associated with prolonged length of stay (LOS) or emergency department (ED) readmission, and investigate changes in care over time.

Key study: Identifying persistent postconcussion symptom risk in a pediatric sports medicine clinic

Visit

Howell DR, Zemek R, Brilliant AN, Mannix RC, Master CL, Meehan WP.

To determine if the Predicting Persistent Post-concussive Problems in Pediatrics (5P) clinical risk score, an emergency department (ED)derived and validated tool, is associated with developing PPCS when obtained in a primary care sports concussion setting.

Key study: MRI in mild pediatric traumatic brain injury: diagnostic overkill or useful tool?

Visit

Cohrs, G., Huhndorf, M., Niemczyk, N. et al.

Magnetic resonance imaging (MRI) is a sensitive imaging tool which lacks the burden of ionizing radiation. It is not established as primary diagnostic tool in traumatic brain injury (TBI). The purpose of this study was to evaluate the usefulness of MRI as initial imaging modality in the emergency management of mild pediatric TBI.

Key study: No association between metoclopramide treatment in ED and reduced risk of post-concussion headache

Visit

Bresee N, Aglipay M, Dubrovsky AS, et al.

There is a lack of definitive pediatric literature on effective pharmacotherapy for persistent post-concussion headache symptoms. This study assessed whether acute metoclopramide treatment in the Emergency Department (ED) was associated with a reduction in persistent headache in children at 1- and 4-weeks post-concussion.

Key study: Resumption of physical activity within 7 days of a concussion was associated with lower rates of persistent postconcussive symptoms (PPCS)

Visit

Kanani AN, Hartshorn S.

A planned secondary analysis of nine pediatric emergency departments of return to physical activity within 7 days postinjury (ranging from light exercise to a full return to competitive sports).

Key study: The diagnosis of concussion in pediatric emergency departments: a prospective multicenter study

Visit

Boutis K, Gravel J, Freedman SB, et al.

Objectives: We compared the frequency of persistent concussion symptoms in children who were provided the diagnosis of concussion by an emergency physician versus those who met Berlin/Zurich international criteria for this diagnosis. We also determined the clinical variables independently associated with a physician-diagnosed concussion.

Key study: Vision and vestibular system dysfunction predicts prolonged concussion recovery in children

Visit

Master CL, Master SR, Wiebe DJ, et al.

Objective: Up to one-third of children with concussion have prolonged symptoms lasting beyond 4 weeks. Vision and vestibular dysfunction is common after concussion. It is unknown whether such dysfunction predicts prolonged recovery. We sought to determine which vision or vestibular problems predict prolonged recovery in children.

Key study: Symptom-guided emergency department discharge instructions for children with concussion

Visit

Brooks TM, Smith MM, Silvis RM, et al.

Objectives: The objective was to evaluate the use and utility of a novel set of emergency department discharge instructions (DIs) for concussion based on a child's ongoing symptoms: symptom-guided DIs (symptom DIs). Differences in clinical outcomes were also assessed.

Key study: The Child Sport Concussion Assessment Tool 5th Edition (Child SCAT5): Background and rationale

Visit

Davis GA, Purcell L, Schneider KJ, et al.

This article presents the Child Sport Concussion Assessment Tool 5th Edition (Child SCAT5). The Sport Concussion Assessment Tool was introduced in 2004, following the 2nd International Conference on Concussion in Sport in Prague, Czech Republic.

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: Association between early participation in physical activity following acute concussion and persistent postconcussive symptoms in children and adolescents

Visit

Grool AM, Aglipay M, Momoli F, et al.

To investigate the association between participation in physical activity within 7 days postinjury and incidence of persistent postconcussive symptoms (PPCS).

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: Association between ondansetron use and symptom persistence in children with concussions: A 5P substudy

Visit

Gravel J, Boutis K, Tang K, et al.

Ondansetron is increasingly administered to children suffering from concussion-associated nausea/vomiting. We examined the association between ondansetron administration and post-concussion symptoms in children at 1 week and 1 month following the concussion.

Key study: Association of time since injury to the first clinic visit with recovery following concussion

Visit

Kontos AP, Jorgensen-Wagers K, Trbovich AM, et al.

To investigate the association of time since injury with initiation of clinical care on recovery time following concussion.

Key study: Characteristics of concussion in elementary school-aged children: implications for clinical management

Visit

Master CL, Curry AE, Pfeiffer MR, et al.

To comprehensively characterize the clinical presentation and course of care for concussion among 5- to 11-year-old children, identifying preinjury and injury factors potentially influencing clinical outcomes.

Key study: Characteristics of diagnosed concussions in children aged 0 to 4 years presenting to a large pediatric healthcare network

Visit

Podolak OE, Chaudhary S, Haarbauer-Krupa J, et al.

The aim of the study was to comprehensively describe the natural history of concussion in early childhood between 0 and 4 years.

Key study: Concussion Guidelines Step 2: evidence for subtype classification

Visit

Lumba-Brown A, Teramoto M, Bloom OJ, et al.

Objective: To use evidence-based methodology to characterize the 5 concussion subtypes and 2 associated conditions and report their prevalence in acute concussion patients as compared to baseline or controls within 3 d of injury.

Key study: Concussion-symptom rating correlation between pediatric patients and their parents

Visit

Patsimas T, Howell DR, Potter MN, Potter MN, Provance AJ, Kirkwood MW, Wilson JC

To examine patient-parent correlations and agreement on concussion-symptom ratings, to identify differences in patient-parent symptom reporting between children (8-12 years of age) and adolescents (13-18 years of age), and to evaluate the correlation between patient and parent initial symptom-severity ratings with symptom duration and return-to-play time.

Key study: Continuing play, symptom severity, and symptom duration after concussion in youth athletes

Visit

Howell DR, O'Brien MJ, Fraser J, Meehan WP.

Objective: To determine whether continuing to play after a concussion is associated with higher symptom burden or prolonged symptom duration.

Key study: Delayed symptom onset following pediatric sport-related concussion

Visit

Olson A, Ellis MJ, Selci E, Russell K.

Objective: (1) To examine the prevalence of delayed symptom onset (DSO) among pediatric sport-related concussion (SRC) patients as well as the effect of symptom onset on initial symptom severity, length of recovery, and development of delayed recovery; (2) to evaluate the impact of symptom onset on sideline management.

Key study: Early versus delayed emergency department presentation following mild traumatic nrain injury and the presence of symptom at 1, 4 and 12 weeks in children

Visit

Gravel J, Ledoux AA, Tang K, et al.

We evaluated the association between timing of presentation and postconcussive symptoms (PCS) at 1, 4 and 12 weeks after injury.

Key study: Effect of cognitive and physical rest on persistent postconcussive symptoms following a pediatric head injury

Visit

Root JM, Sady MD, Gai J, Vaughan CG, Madati PJ

To evaluate the effect of cognitive and physical rest on persistent postconcussive symptoms in a pediatric population.

Key study: Participation in physical activity at time of presentation to a specialty concussion clinic is associated with shorter time to recovery

Visit

Coslick AM, Chin KE, Kalb LG, Slomine BS, Suskauer SJ.

To determine if level of physical activity at presentation to a rehabilitation-based concussion specialty clinic predicted days from injury to recovery.

Key study: Pediatric minor head injury imaging practices: results from an ESPR survey

Visit

Argyropoulou MI, Alexiou GA, Xydis VG, et al.

Objective: Computed tomography (CT) for minor head injury exposes a large number of children to ionizing radiation, with an associated increased lifetime risk of malignancy. To study imaging practices for children with minor head injury and the level of awareness of radiologists of the current clinical decision rules for minor traumatic brain injury (TBI).

Key study: Reliability of the visio-vestibular examination for concussion among providers in a pediatric emergency department

Visit

Corwin DJ, Arbogast KB, Swann C, et al.

Our objective was to determine the inter-rater (IRR) and test-retest reliability (TRR) of the VVE in a pediatric ED.

Key study: Trajectories and predictors of clinician-determined recovery after child concussion

Visit

Anderson V, Davis GA, Takagi M, et al.

We mapped concussion recovery to 3 months post-injury and explored non-modifiable (e.g., age, sex, pre-injury factors, injury mechanism, acute PCS) and modifiable (post-acute child symptoms) predictors of persisting symptoms in order to identify opportunities for early intervention.

Key study: Use of the sport concussion assessment tools in the emergency department to predict persistent post-concussive symptoms in children

Visit

Bressan S, Clarke CJ, Anderson V, et al.

We aim to assess the predictive value of the main SCAT3/ChildSCAT3 components for PPCS when applied in the ED.

Key study: A longitudinal investigation of sleep and daytime wakefulness in children and youth with concussion

Visit

Wiseman-Hakes C, Gosselin N, Sharma B, Langer L, Gagnon I.

In this study, we investigated the trajectory of sleep and daytime sleepiness in a prospective cohort of 40 children and youth (6-18 years old) with concussion, 40 age-and sex-matched healthy children and youth, and 40 with upper-extremity orthopedic injury.

Key study: Admission of pediatric concussion injury patients: is it necessary?

Visit

Lindholm EB, DCruz R, Fajardo R, et al.

The purpose of this study was to determine if pediatric patients evaluated in the emergency department (ED) for concussion with a negative head CT scan require routine hospital admission.

Key study: Concussion symptom profiles among child, adolescent, and young adult athletes

Visit

Howell DR, Kriz P, Mannix RC, Kirchberg T, Master C L, Meehan WP

(1) To examine how age influences initial symptom presentation following concussion; and (2) to determine whether specific symptom profiles are associated with duration of postconcussion symptoms, and whether they vary by age group.

Key study: Delayed presentations to emergency departments of children with head injury: A PREDICT Study

Visit

Borland ML, Dalziel SR, Phillips N, et al.

Objective: Existing clinical decision rules guide management for head-injured children presenting 24 hours or sooner after injury, even though some may present greater than 24 hours afterward. We seek to determine the prevalence of traumatic brain injuries for patients presenting to emergency departments greater than 24 hours after injury and identify symptoms and signs to guide management.

Key study: Derivation and initial validation of clinical phenotypes of children presenting with concussion acutely in the emergency department: latent class analysis of a multi-center, prospective cohort, observational study

Visit

Yeates KO, Tang K, Barrowman N, et al.

This study used latent class analysis (LCA) to identify discernible phenotypes among children with acute concussion and examine the association between phenotypes and persistent post-concussive symptoms (PPCS) at 4 and 12 weeks post-injury. We conducted LCA of variables representing pre-injury history, clinical presentation, and parent symptom ratings, derived from a prospective cohort, observational study that recruited participants from August 2013 until June 2015 at nine pediatric emergency departments within the Pediatric Emergency Research Canada network.

Key study: Early subthreshold aerobic exercise for sport-related concussion: a randomized clinical trial

Visit

Leddy JJ, Haider MN, Ellis MJ, et al.

To assess the effectiveness of subsymptom threshold aerobic exercise vs a placebo-like stretching program prescribed to adolescents in the acute phase of recovery from SRC.

Key study: Insomnia in adolescents with slow recovery from concussion

Visit

Brooks BL, Sayers PQ, Virani S, Rajaram AA, Tomfohr-Madsen L.

This study examined: 1) some of the psychometric properties of the Insomnia Severity Index (ISI), 2) the prevalence and severity of insomnia symptoms, and 3) associations between insomnia symptoms and clinical measures of post-concussion symptoms, mental health symptoms, and cognitive tests in adolescents with slow recovery from concussion.

Key study: Low-value diagnostic imaging use in the pediatric emergency department in the United States and Canada

Visit

Cohen E, Rodean J, Diong C, et al.

Objective To compare overall and low-value use of diagnostic imaging across pediatric ED visits in Ontario, Canada, and the United States.

Key study: Natural progression of symptom change and recovery from concussion in a pediatric population

Visit

Ledoux AA, Tang K, Yeates KO, et al.

Objectives: To describe the natural progression of symptom change by age group (5-7, 8-12, and 13-18 years) and sex, as well as to develop centile curves to inform families about children after injury recovery.

Key study: Persistent vestibular-ocular impairment following concussion in adolescents

Visit

Sinnott AM, Elbin RJ, Collins MW, Reeves VL, Holland CL, Kontos AP.

Objectives: The current study investigated the role of persistent vestibular-ocular symptoms and impairment following sport-related concussion on recovery time and clinical outcomes among adolescents.

Key study: Physical activity after mild traumatic brain injury: what are the relationships with fatigue and sleep quality?

Visit

van Markus-Doornbosch F, Peeters E, van der Pas S, Vlieland TV, Meesters J.

To determine self-reported physical activity (PA) levels and relationships with fatigue and sleep quality in adolescents and young adults after mild traumatic brain injury (mTBI).

Key study: Practice patterns in pharmacological and non-pharmacological therapies for children with mild traumatic brain injury: a survey of 15 canadian and United States centers

Visit

Mannix R, Zemek R, Yeates KO, et al.

Given the lack of evidence regarding effective pharmacological and non-pharmacological interventions for pediatric mild traumatic brain injury (mTBI) and the resultant lack of treatment recommendations reflected in consensus guidelines, variation in the management of pediatric mTBI is to be expected. We therefore surveyed practitioners across 15 centers in the United States and Canada who care for children with pediatric mTBI to evaluate common-practice variation in the management of pediatric mTBI.

Key study: Quality of life and symptom burden 1 month after concussion in children and adolescents

Visit

Howell DR, Wilson JC, Kirkwood MW, Grubenhoff JA.

We conducted a prospective study of children and adolescents (n = 176; mean age = 13.0 2.7 years; 38% female) assessed acutely post-concussion and again 30 days later. We investigated the association between symptom burden and quality of life (QOL) outcomes, as well as the effect of age on QOL.

Key study: Reduction of computed tomography use for pediatric closed head injury evaluation at a nonpediatric community emergency department

Visit

Puffenbarger MS, Ahmad FA, Argent M, Gu H, Samson C, Quayle KS, Saito JM.

The purpose of this study was to determine if implementation of a Pediatric Emergency Care Applied Research Network (PECARN)-based Closed Head Injury Assessment Tool could safely decrease computed tomography (CT) use for pediatric head injury evaluation at a nonpediatric community emergency department (ED).

Key study: Risk factors for prolonged symptoms of mild traumatic brain injury: a pediatric sports concussion clinic cohort

Visit

Fehr SD, Nelson LD, Scharer KR, et al.

To examine predictors of prolonged symptom duration from mild traumatic brain injury (mTBI) in a pediatric sports medicine specialty clinic cohort as these predictors may be distinct in this population.

Key study: Trouble falling asleep after concussion is associated with higher symptom burden among children and adolescents

Visit

Howell DR, Oldham JR, Brilliant AN, Meehan WP.

Our objective was to identify factors associated with trouble falling asleep postconcussion.

Key study: Use of the vestibular and oculomotor examination for concussion in a pediatric emergency department

Visit

Corwin DJ, Propert KJ, Zorc JJ, Zonfrillo MR, Wiebe DJ.

We aimed to measure rates of exam performance after implementation of training and support tools in a pediatric emergency department.

Key study: What comes first: return to school or return to activity for youth after concussion? Maybe we dont have to choose.

Visit

DeMatteo CA, Randall S, Lin CA, Claridge EA.

This study investigates recovery trajectories of children/youth while following RTA and RTS protocols simultaneously, with the following objectives: (1) to compare rates and patterns of progression through the stages of both protocols; (2) to evaluate symptom trajectories of youth post-concussion while progressing through stages of RTS and RTA; and (3) to propose a new model for concussion management in youth that involves the integration of Return to Activity and Return to School protocols.

Key study: Characterizing hospitalizations for pediatric concussion and trends in care

Visit

Rhine T, Byczkowski T, Altaye M, Wade SL, Babcock L.

Objective: Delineate a cohort of children admitted for concussion, describe care practices received, examine factors associated with prolonged length of stay (LOS) or emergency department (ED) readmission, and investigate changes in care over time.

Key study: Identifying persistent postconcussion symptom risk in a pediatric sports medicine clinic

Visit

Howell DR, Zemek R, Brilliant AN, Mannix RC, Master CL, Meehan WP.

To determine if the Predicting Persistent Post-concussive Problems in Pediatrics (5P) clinical risk score, an emergency department (ED)derived and validated tool, is associated with developing PPCS when obtained in a primary care sports concussion setting.

Key study: MRI in mild pediatric traumatic brain injury: diagnostic overkill or useful tool?

Visit

Cohrs, G., Huhndorf, M., Niemczyk, N. et al.

Magnetic resonance imaging (MRI) is a sensitive imaging tool which lacks the burden of ionizing radiation. It is not established as primary diagnostic tool in traumatic brain injury (TBI). The purpose of this study was to evaluate the usefulness of MRI as initial imaging modality in the emergency management of mild pediatric TBI.

Key study: No association between metoclopramide treatment in ED and reduced risk of post-concussion headache

Visit

Bresee N, Aglipay M, Dubrovsky AS, et al.

There is a lack of definitive pediatric literature on effective pharmacotherapy for persistent post-concussion headache symptoms. This study assessed whether acute metoclopramide treatment in the Emergency Department (ED) was associated with a reduction in persistent headache in children at 1- and 4-weeks post-concussion.

Key study: Resumption of physical activity within 7 days of a concussion was associated with lower rates of persistent postconcussive symptoms (PPCS)

Visit

Kanani AN, Hartshorn S.

A planned secondary analysis of nine pediatric emergency departments of return to physical activity within 7 days postinjury (ranging from light exercise to a full return to competitive sports).

Key study: The diagnosis of concussion in pediatric emergency departments: a prospective multicenter study

Visit

Boutis K, Gravel J, Freedman SB, et al.

Objectives: We compared the frequency of persistent concussion symptoms in children who were provided the diagnosis of concussion by an emergency physician versus those who met Berlin/Zurich international criteria for this diagnosis. We also determined the clinical variables independently associated with a physician-diagnosed concussion.

Key study: Vision and vestibular system dysfunction predicts prolonged concussion recovery in children

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Master CL, Master SR, Wiebe DJ, et al.

Objective: Up to one-third of children with concussion have prolonged symptoms lasting beyond 4 weeks. Vision and vestibular dysfunction is common after concussion. It is unknown whether such dysfunction predicts prolonged recovery. We sought to determine which vision or vestibular problems predict prolonged recovery in children.

Key study: Symptom-guided emergency department discharge instructions for children with concussion

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Brooks TM, Smith MM, Silvis RM, et al.

Objectives: The objective was to evaluate the use and utility of a novel set of emergency department discharge instructions (DIs) for concussion based on a child's ongoing symptoms: symptom-guided DIs (symptom DIs). Differences in clinical outcomes were also assessed.

Key study: The Child Sport Concussion Assessment Tool 5th Edition (Child SCAT5): Background and rationale

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Davis GA, Purcell L, Schneider KJ, et al.

This article presents the Child Sport Concussion Assessment Tool 5th Edition (Child SCAT5). The Sport Concussion Assessment Tool was introduced in 2004, following the 2nd International Conference on Concussion in Sport in Prague, Czech Republic.

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: Association between early participation in physical activity following acute concussion and persistent postconcussive symptoms in children and adolescents

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Grool AM, Aglipay M, Momoli F, et al.

To investigate the association between participation in physical activity within 7 days postinjury and incidence of persistent postconcussive symptoms (PPCS).

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

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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.

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