Diagnosis and Management of Mild Traumatic Brain Injury in Children: A Systematic Review

Angela Lumba-Brown, Keith Owen Yeates, Kelly Sarmiento, Matthew J. Breiding, Tamara M. Haegerich, Gerard A. Gioia, Michael Turner, Edward C. Benzel, Stacy Jennifer M Suskauer, Christopher C. Giza, Madeline Joseph, Catherine Broomand, Barbara Weissman, Wayne Gordon, David W. Wright, Rosemarie Scolaro Moser, Karen McAvoy, Linda Ewing-Cobbs, Ann Christine Duhaime, Margot PutukianBarbara Holshouser, David Paulk, Shari L. Wade, Stanley A. Herring, Mark Halstead, Heather T. Keenan, Meeryo Choe, Cindy W. Christian, Kevin Guskiewicz, P. B. Raksin, Andrew Gregory, Anne Mucha, H. Gerry Taylor, James M. Callahan, John Dewitt, Michael W. Collins, Michael W. Kirkwood, John Ragheb, Richard G. Ellenbogen, T. J. Spinks, Theodore G. Ganiats, Linda J. Sabelhaus, Katrina Altenhofen, Rosanne Hoffman, Tom Getchius, Gary Gronseth, Zoe Donnell, Robert E. O'Connor, Shelly D. Timmons

Research output: Contribution to journalReview article

Abstract

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..

Original languageEnglish (US)
JournalJAMA Pediatrics
Volume172
Issue number11
DOIs
StatePublished - Nov 1 2018

Fingerprint

Brain Concussion
Pediatrics
Guidelines
Research
Wounds and Injuries
Advisory Committees
Centers for Disease Control and Prevention (U.S.)
PubMed

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Lumba-Brown, A., Yeates, K. O., Sarmiento, K., Breiding, M. J., Haegerich, T. M., Gioia, G. A., ... Timmons, S. D. (2018). Diagnosis and Management of Mild Traumatic Brain Injury in Children: A Systematic Review. JAMA Pediatrics, 172(11). https://doi.org/10.1001/jamapediatrics.2018.2847

Diagnosis and Management of Mild Traumatic Brain Injury in Children : A Systematic Review. / Lumba-Brown, Angela; Yeates, Keith Owen; Sarmiento, Kelly; Breiding, Matthew J.; Haegerich, Tamara M.; Gioia, Gerard A.; Turner, Michael; Benzel, Edward C.; Suskauer, Stacy Jennifer M; Giza, Christopher C.; Joseph, Madeline; Broomand, Catherine; Weissman, Barbara; Gordon, Wayne; Wright, David W.; Moser, Rosemarie Scolaro; McAvoy, Karen; Ewing-Cobbs, Linda; Duhaime, Ann Christine; Putukian, Margot; Holshouser, Barbara; Paulk, David; Wade, Shari L.; Herring, Stanley A.; Halstead, Mark; Keenan, Heather T.; Choe, Meeryo; Christian, Cindy W.; Guskiewicz, Kevin; Raksin, P. B.; Gregory, Andrew; Mucha, Anne; Taylor, H. Gerry; Callahan, James M.; Dewitt, John; Collins, Michael W.; Kirkwood, Michael W.; Ragheb, John; Ellenbogen, Richard G.; Spinks, T. J.; Ganiats, Theodore G.; Sabelhaus, Linda J.; Altenhofen, Katrina; Hoffman, Rosanne; Getchius, Tom; Gronseth, Gary; Donnell, Zoe; O'Connor, Robert E.; Timmons, Shelly D.

In: JAMA Pediatrics, Vol. 172, No. 11, 01.11.2018.

Research output: Contribution to journalReview article

Lumba-Brown, A, Yeates, KO, Sarmiento, K, Breiding, MJ, Haegerich, TM, Gioia, GA, Turner, M, Benzel, EC, Suskauer, SJM, Giza, CC, Joseph, M, Broomand, C, Weissman, B, Gordon, W, Wright, DW, Moser, RS, McAvoy, K, Ewing-Cobbs, L, Duhaime, AC, Putukian, M, Holshouser, B, Paulk, D, Wade, SL, Herring, SA, Halstead, M, Keenan, HT, Choe, M, Christian, CW, Guskiewicz, K, Raksin, PB, Gregory, A, Mucha, A, Taylor, HG, Callahan, JM, Dewitt, J, Collins, MW, Kirkwood, MW, Ragheb, J, Ellenbogen, RG, Spinks, TJ, Ganiats, TG, Sabelhaus, LJ, Altenhofen, K, Hoffman, R, Getchius, T, Gronseth, G, Donnell, Z, O'Connor, RE & Timmons, SD 2018, 'Diagnosis and Management of Mild Traumatic Brain Injury in Children: A Systematic Review', JAMA Pediatrics, vol. 172, no. 11. https://doi.org/10.1001/jamapediatrics.2018.2847
Lumba-Brown A, Yeates KO, Sarmiento K, Breiding MJ, Haegerich TM, Gioia GA et al. Diagnosis and Management of Mild Traumatic Brain Injury in Children: A Systematic Review. JAMA Pediatrics. 2018 Nov 1;172(11). https://doi.org/10.1001/jamapediatrics.2018.2847
Lumba-Brown, Angela ; Yeates, Keith Owen ; Sarmiento, Kelly ; Breiding, Matthew J. ; Haegerich, Tamara M. ; Gioia, Gerard A. ; Turner, Michael ; Benzel, Edward C. ; Suskauer, Stacy Jennifer M ; Giza, Christopher C. ; Joseph, Madeline ; Broomand, Catherine ; Weissman, Barbara ; Gordon, Wayne ; Wright, David W. ; Moser, Rosemarie Scolaro ; McAvoy, Karen ; Ewing-Cobbs, Linda ; Duhaime, Ann Christine ; Putukian, Margot ; Holshouser, Barbara ; Paulk, David ; Wade, Shari L. ; Herring, Stanley A. ; Halstead, Mark ; Keenan, Heather T. ; Choe, Meeryo ; Christian, Cindy W. ; Guskiewicz, Kevin ; Raksin, P. B. ; Gregory, Andrew ; Mucha, Anne ; Taylor, H. Gerry ; Callahan, James M. ; Dewitt, John ; Collins, Michael W. ; Kirkwood, Michael W. ; Ragheb, John ; Ellenbogen, Richard G. ; Spinks, T. J. ; Ganiats, Theodore G. ; Sabelhaus, Linda J. ; Altenhofen, Katrina ; Hoffman, Rosanne ; Getchius, Tom ; Gronseth, Gary ; Donnell, Zoe ; O'Connor, Robert E. ; Timmons, Shelly D. / Diagnosis and Management of Mild Traumatic Brain Injury in Children : A Systematic Review. In: JAMA Pediatrics. 2018 ; Vol. 172, No. 11.
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abstract = "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..",
author = "Angela Lumba-Brown and Yeates, {Keith Owen} and Kelly Sarmiento and Breiding, {Matthew J.} and Haegerich, {Tamara M.} and Gioia, {Gerard A.} and Michael Turner and Benzel, {Edward C.} and Suskauer, {Stacy Jennifer M} and Giza, {Christopher C.} and Madeline Joseph and Catherine Broomand and Barbara Weissman and Wayne Gordon and Wright, {David W.} and Moser, {Rosemarie Scolaro} and Karen McAvoy and Linda Ewing-Cobbs and Duhaime, {Ann Christine} and Margot Putukian and Barbara Holshouser and David Paulk and Wade, {Shari L.} and Herring, {Stanley A.} and Mark Halstead and Keenan, {Heather T.} and Meeryo Choe and Christian, {Cindy W.} and Kevin Guskiewicz and Raksin, {P. B.} and Andrew Gregory and Anne Mucha and Taylor, {H. Gerry} and Callahan, {James M.} and John Dewitt and Collins, {Michael W.} and Kirkwood, {Michael W.} and John Ragheb and Ellenbogen, {Richard G.} and Spinks, {T. J.} and Ganiats, {Theodore G.} and Sabelhaus, {Linda J.} and Katrina Altenhofen and Rosanne Hoffman and Tom Getchius and Gary Gronseth and Zoe Donnell and O'Connor, {Robert E.} and Timmons, {Shelly D.}",
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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 Jennifer M

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.

PY - 2018/11/1

Y1 - 2018/11/1

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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