CDC Guidelines for Managing Pediatric Mild Traumatic Brain Injury
The US Centers for Disease Control and Prevention conducted a systematic review and published guidelines for Mild traumatic brain injury (mTBI) care, including 25 yrs of literature up to 2015. Nineteen sets of recommendations regarding imaging, diagnosis, risk factors, and treatment were assigned levels of obligation (must, should, or may). No recommendations met the “Level A” standard (should almost always be followed). Level B recommendations (usually should be followed) include: 1) Do not routinely use head CT, MRI, single-photon CT (SPECT), and skull radiographs for mTBI. Providers should use validated clinical decision rules to determine when head CT is indicated; CT should be performed if headache acutely worsens. 2) Validated, age-appropriate rating scales should be used. 3) Patients and families should be counseled that symptoms do not typically last more than 1-3 months from injury, but there are risk factors for prolonged symptoms. 4) Health care providers should assess for risk factors and premorbid conditions that are associated with prolonged recovery after mTBI. 5) Children with risk factors for prolonged symptoms should be closely monitored, and if symptoms do not resolve then referred to specialty care. 5) Physical and cognitive activity should be gradually increased if symptoms are not exacerbated. 6) Guidance on proper sleep hygiene should be provided. 7) Attempt to determine the etiology of cognitive dysfunction, and provide appropriate treatment.