![]() Patients who may have structural intracranial injuries or an injury to their cervical spine should be referred to an emergency department for diagnostic imaging ( 3, 7–9).Īlgorithm for the management of actute and chronic symptoms for pediatric concussion with risk modifiers that may delay recovery. Neuroimaging is not required to diagnose a concussion. ![]() No single physical, functional, advanced neuroimaging, or blood test exists to rule out or diagnose concussion or monitor recovery ( 5, 6). Figure 1 shares an acute and prolonged concussion clinical algorithm that includes a link to a comprehensive physical examination tool. This in-office assessment should include an extensive medical history and physical examination in order to consider a thorough differential diagnosis and rule out severe traumatic brain injuries, cervical spine injuries, and other medical, mental health, or neurological conditions. A medical examination by a physician or nurse practitioner is required for all patients who have suspected concussion ( 3). The onset of symptoms may be immediate or may be delayed. Concussion signs and symptoms can be nonspecific and include physical, cognitive, sleep-related, and emotional symptoms. Youth who sustain any direct or indirect impact to their head or neck and experience concussion-like signs and symptoms may have a concussion ( 4). MEDICAL ASSESSMENT AND DIAGNOSIS OF CONCUSSION Key clinical recommendations relevant for general paediatricians and family doctors are shared in this review article and include the following: 1) guidance and a clinical algorithm for medical assessment and diagnosis 2) guidance on rest and resuming activities, school, work, devices with screens, and driving after concussion 3) guidance on managing symptoms and recovery following concussion 4) guidance on what to include in the written medical assessment and medical clearance letters and 5) information about when and where to refer children/adolescents for specialized care. The clinical guideline website and recommendations are updated on a quarterly basis with experts considering all new research as it is published. The guideline shares recommendations and validated clinical algorithms for the full spectrum of paediatric clinical care, including concussion recognition, diagnosis, acute management, persistent symptom management, clinical utility of advanced radiologic and serologic biomarkers, and telemedicine. To fill this need, a North American team of 43 paediatric concussion experts created a living clinical guideline resource based on current research and expert consensus ( 2, 3). Although the reason for this increase remains unknown (e.g., more risky behaviour versus increased awareness of concussion and what to do if you think you have a concussion), there is an urgent need for increased implementation of standardized diagnosis and management protocols for the primary care setting ( 1). The number of children and adolescents seeking initial care and follow-up for concussion is increasing across Canada ( 1). Those at high-risk of prolonged recovery should be referred to an interdisciplinary concussion team for targeted care, including potential prescribed aerobic exercise.
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