TY - JOUR
T1 - Diagnosis and Management of Mild Traumatic Brain Injury in Children
T2 - A Systematic Review
AU - Lumba-Brown, Angela
AU - Yeates, Keith Owen
AU - Sarmiento, Kelly
AU - Breiding, Matthew J.
AU - Haegerich, Tamara M.
AU - Gioia, Gerard A.
AU - Turner, Michael
AU - Benzel, Edward C.
AU - Suskauer, Stacy J.
AU - Giza, Christopher C.
AU - Joseph, Madeline
AU - Broomand, Catherine
AU - Weissman, Barbara
AU - Gordon, Wayne
AU - Wright, David W.
AU - Moser, Rosemarie Scolaro
AU - McAvoy, Karen
AU - Ewing-Cobbs, Linda
AU - Duhaime, Ann Christine
AU - Putukian, Margot
AU - Holshouser, Barbara
AU - Paulk, David
AU - Wade, Shari L.
AU - Herring, Stanley A.
AU - Halstead, Mark
AU - Keenan, Heather T.
AU - Choe, Meeryo
AU - Christian, Cindy W.
AU - Guskiewicz, Kevin
AU - Raksin, P. B.
AU - Gregory, Andrew
AU - Mucha, Anne
AU - Taylor, H. Gerry
AU - Callahan, James M.
AU - Dewitt, John
AU - Collins, Michael W.
AU - Kirkwood, Michael W.
AU - Ragheb, John
AU - Ellenbogen, Richard G.
AU - Spinks, T. J.
AU - Ganiats, Theodore G.
AU - Sabelhaus, Linda J.
AU - Altenhofen, Katrina
AU - Hoffman, Rosanne
AU - Getchius, Tom
AU - Gronseth, Gary
AU - Donnell, Zoe
AU - O'Connor, Robert E.
AU - Timmons, Shelly D.
N1 - Funding Information:
receiving funding from the Orthopedic Research and Education Foundation. Dr Gioia reports receiving royalties for the Behavior Rating Inventory of Executive Function from Psychological Assessment Resources Inc. Dr Giza reports receiving fees as a consultant to the National Football League Neurological Care Program, National Hockey League Players’ Association, National Hockey League, Major League Soccer, National Basketball Association, US Soccer Federation, and the National Collegiate Athletic Association; medicolegal work on 1 or 2 cases annually; and research support from the National Football League and General Electric. Dr Halstead reports being a lead author on the American Academy of Pediatrics policy statement on concussion. Dr Herring reports past service on a medical advisory board for X2Biosystems and payment from Vicis, a helmet manufacturer. Dr Turner reports receiving financial support from Medtronic Corporation and NICO Corporation. Dr Wright reports receiving speaker and consultant fees from Astrocyte Pharmaceuticals Inc (Scientific Advisory Board), LPath Inc, and Biogen Inc and receiving commercial support from Astrocyte Pharmaceuticals Inc, LPath, and OneMind. Dr Choe reports serving as a consultant for the World Boxing Council, USA Swimming, and Neural Analytics. Dr Christian reports serving as a medical-legal expert in child abuse cases. Dr Collins reports Board Membership and role as codeveloper for ImPACT applications; he also serves as a consultant to the Pittsburgh Steelers and Pittsburgh Penguins, and he reports medical-legal work as an expert on mTBI cases. Dr Ellenbogen reports participating in General Electric scientific board review. Dr Mucha reports receiving speaker fees from American Physical Therapy Association, Medbridge Education, Impact Applications, and several healthcare organizations. Dr Paulk reports receiving fees for legal consulting for a Pennsylvania practice. Dr Putukian reports working as a consultant for the USA Football Medical Advisory Committee, National Football League Head Neck and Spine Committee, US Lacrosse Sports Science & Safety Committee, National Collegiate Athletics Association Concussion Task Force, and the US Soccer medical advisory committee and serving as a medical consultant for Major League Soccer; she also reports receiving a research grant support from the National Collegiate Athletics Association– Department of Defense Grand Alliance and the National Operating Committee on Standards for Athletic Equipment. Drs Gronesth, Getchius, Hoffman, and Donnell were compensated through a contract with the CDC (200-2007-20003 [019]) for their contributions to this study. No other disclosures were reported.
PY - 2018/11
Y1 - 2018/11
N2 - Importance: In recent years, there has been an exponential increase in the research guiding pediatric mild traumatic brain injury (mTBI) clinical management, in large part because of heightened concerns about the consequences of mTBI, also known as concussion, in children. The CDC National Center for Injury Prevention and Control's (NCIPC) Board of Scientific Counselors (BSC), a federal advisory committee, established the Pediatric Mild TBI Guideline workgroup to complete this systematic review summarizing the first 25 years of literature in this field of study. Objective: To conduct a systematic review of the pediatric mTBI literature to serve as the foundation for an evidence-based guideline with clinical recommendations associated with the diagnosis and management of pediatric mTBI. Evidence Review: Using a modified Delphi process, the authors selected 6 clinical questions on diagnosis, prognosis, and management or treatment of pediatric mTBI. Two consecutive searches were conducted on PubMed, Embase, ERIC, CINAHL, and SportDiscus. The first included the dates January 1, 1990, to November 30, 2012, and an updated search included December 1, 2012, to July 31, 2015. The initial search was completed from December 2012 to January 2013; the updated search, from July 2015 to August 2015. Two authors worked in pairs to abstract study characteristics independently for each article selected for inclusion. A third author adjudicated disagreements. The risk of bias in each study was determined using the American Academy of Neurology Classification of Evidence Scheme. Conclusion statements were developed regarding the evidence within each clinical question, and a level of confidence in the evidence was assigned to each conclusion using a modified GRADE methodology. Data analysis was completed from October 2014 to May 2015 for the initial search and from November 2015 to April 2016 for the updated search. Findings: Validated tools are available to assist clinicians in the diagnosis and management of pediatric mTBI. A significant body of research exists to identify features that are associated with more serious TBI-associated intracranial injury, delayed recovery from mTBI, and long-term sequelae. However, high-quality studies of treatments meant to improve mTBI outcomes are currently lacking. Conclusions and Relevance: This systematic review was used to develop an evidence-based clinical guideline for the diagnosis and management of pediatric mTBI. While an increasing amount of research provides clinically useful information, this systematic review identified key gaps in diagnosis, prognosis, and management..
AB - Importance: In recent years, there has been an exponential increase in the research guiding pediatric mild traumatic brain injury (mTBI) clinical management, in large part because of heightened concerns about the consequences of mTBI, also known as concussion, in children. The CDC National Center for Injury Prevention and Control's (NCIPC) Board of Scientific Counselors (BSC), a federal advisory committee, established the Pediatric Mild TBI Guideline workgroup to complete this systematic review summarizing the first 25 years of literature in this field of study. Objective: To conduct a systematic review of the pediatric mTBI literature to serve as the foundation for an evidence-based guideline with clinical recommendations associated with the diagnosis and management of pediatric mTBI. Evidence Review: Using a modified Delphi process, the authors selected 6 clinical questions on diagnosis, prognosis, and management or treatment of pediatric mTBI. Two consecutive searches were conducted on PubMed, Embase, ERIC, CINAHL, and SportDiscus. The first included the dates January 1, 1990, to November 30, 2012, and an updated search included December 1, 2012, to July 31, 2015. The initial search was completed from December 2012 to January 2013; the updated search, from July 2015 to August 2015. Two authors worked in pairs to abstract study characteristics independently for each article selected for inclusion. A third author adjudicated disagreements. The risk of bias in each study was determined using the American Academy of Neurology Classification of Evidence Scheme. Conclusion statements were developed regarding the evidence within each clinical question, and a level of confidence in the evidence was assigned to each conclusion using a modified GRADE methodology. Data analysis was completed from October 2014 to May 2015 for the initial search and from November 2015 to April 2016 for the updated search. Findings: Validated tools are available to assist clinicians in the diagnosis and management of pediatric mTBI. A significant body of research exists to identify features that are associated with more serious TBI-associated intracranial injury, delayed recovery from mTBI, and long-term sequelae. However, high-quality studies of treatments meant to improve mTBI outcomes are currently lacking. Conclusions and Relevance: This systematic review was used to develop an evidence-based clinical guideline for the diagnosis and management of pediatric mTBI. While an increasing amount of research provides clinically useful information, this systematic review identified key gaps in diagnosis, prognosis, and management..
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U2 - 10.1001/jamapediatrics.2018.2847
DO - 10.1001/jamapediatrics.2018.2847
M3 - Review article
C2 - 30193325
AN - SCOPUS:85053019958
SN - 2168-6203
VL - 172
JO - JAMA Pediatrics
JF - JAMA Pediatrics
IS - 11
ER -