In addition, the guideline provides recommendations on return to cognitive and physical activity. The guideline provides specific recommendations for emergency department counseling, including the use of discharge instructions for return to activity. The guide will allow patients and families to better implement a plan for recovery. This includes more restrictive physical and cognitive activity during the first two to three days, followed by a gradual return to activity/play that does not significantly exacerbate symptoms, and monitoring of symptom number and severity. Follow-up instructions related to longer-term activity integration cannot be determined from an emergency department setting, and joint medical (primary care physicians, neurologists, etc.) and school-based teams should address these specific issues, including “clearance” for full activity. Emergency department clinicians may also recommend sleep hygiene to facilitate recovery.

Key Recommendations

1. Do not routinely image patients to diagnose mTBI.
2. Use validated, age-appropriate symptom scales to diagnose mTBI.
3. Assess evidence-based risk factors for prolonged recovery.
4. Provide patients with instructions on return to activity customized to their symptoms.
5. Counsel patients to return gradually to non-sports activities after no more than two to three days of rest.

To learn more about the guideline and the methodology for developing the guideline, visit HEADSUP.

Disclaimer: The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the CDC.

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Dr. Joseph is professor of emergency medicine and pediatrics and assistant chair of pediatric emergency medicine quality improvement in the department of emergency medicine at the University of Florida College of Medicine–Jacksonville.

Dr. Lumba-Brown is clinical assistant professor in the departments of emergency medicine and pediatrics and co-director of the Stanford Concussion and Brain Performance Center at Stanford University School of Medicine in Palo Alto, California.

Dr. Yeates is Ronald and Irene Ward Chair in pediatric brain injury and professor and head of the department of psychology at the University of Calgary in Alberta.

Dr. Wright is professor and interim chair of emergency medicine in the department of emergency medicine at Emory University School of Medicine in Atlanta.

References

1. Bryan MA, Rowhani-Rahbar A, Comstock RD, et al. Sports and recreation-related concussions in US youth. Pediatrics. 2016;138(1):e20154635.
2. Taylor CA, Bell JM, Breiding MJ, et al. Traumatic brain injury-related emergency department visits, hospitalizations, and deaths—United States, 2007 and 2013. MMWR Surveill Summ. 2017;66(9):1-16.
3. Lumba-Brown A, Yeates KO, Sarmiento K, et al. Centers for Disease Control and Prevention guideline on the diagnosis and management of mild traumatic brain injury among children. JAMA Pediatr. 2018;172(11):e182853.
4. Lumba-Brown A, Wright DW, Sarmiento K, et al. Emergency department implementation of the Centers for Disease Control and Prevention pediatric mild traumatic brain injury guideline recommendations. Ann Emerg Med. 2018;72(5):581-585.
5. Kuppermann N, Holmes JF, Dayan PS, et al. Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet. 2009;374(9696):1160-1170.