Appraisal of Clinical Practice Guideline: Centers for Disease Control and Prevention Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children

摘要

Date of latest update: September 2018. Date of next update: Not stated. Patient group: Paediatric athletes who have sustained a mild traumatic braininjury (sometimes known as concussion). Intended audience: Healthcareprofessionals involved in the management of paediatric mild traumatic braininjuries. Additional versions: This is the first published version. Expertworking group: The Pediatric Mild Traumatic Brain Injury Guideline Workgroup as established by the Centers for Disease Control and Prevention (CDC).This included a range of clinicians (eg, neurologists, neuropsychologists, athletic trainers, physiotherapists and emergency medicine physicians) representing various settings (eg, clinical, research, sports and education). Fundedby: The CDC provided complete financial support for the evidence review andto support the working group’s meetings. The CDC authors did not assist withthe development and preparation of the systematic review that underpinnedthis guideline. Consultation with: Ad hoc experts were invited to provideconsultation, where necessary, to the workgroup. Approved by: The CDC authors reviewed and approved the present guideline for publication. Location:The guideline and additional documents are available at: https://jamanetwork.com/journals/jamapediatrics/fullarticle/2698456. Description and key recommendations: This clinical practice guideline was presented as a Journal ofthe American Medical Association (JAMA) paediatrics special communication. Therecommendations are based upon a systematic review that aimed to answer sixclinical questions. The main objective of the review was to provide the first broadevidence-based guideline on the diagnosis and management of mild traumaticbrain injury in children aged 18 years. Findings from the review were synthesised into 46 recommendations (divided into 19 sets). Eleven recommendations pertained to diagnosis, 12 to prognosis and 23 to treatment/management. Each recommendation was assigned a level of confidence in the research (‘high’to ‘very low’), and an indication of how often the recommendation should befollowed (‘almost always’ to ‘may sometimes’). A short summary of the evidencefollows each set of recommendations. The guideline recommends the use of theterm ‘mild traumatic brain injury’, as opposed to ‘concussion’ or ‘minor headinjury’, in order to remove different interpretations between families, researchers and healthcare professionals. Of interest to physiotherapists, theguideline does not recommend the use of any imaging modality to diagnose mildtraumatic brain injury but does recommend using clinical decision rules and,potentially, imaging to exclude intracranial injury (eg, subdural haemorrhage).The strongest recommendations pertain to the education that patients andfamilies should receive following an instance of mild traumatic brain injury inchildren. The working group recommend providing education about the warningsigns of more serious injuries, prevention of further injury, expected course ofrecovery, instructions on monitoring symptoms, and management of mildtraumatic brain injury. The additional 22 treatment/management recommendations pertain to cognitive/physical rest, aerobic exercise, psychosocial support,post-traumatic headache treatment, vestibulo-oculomotor dysfunction, sleep,cognitive impairment and return to school.