Chester County Medicine Summer 2018 - 11

age 2 years and over who warrant neuroimaging.
These include loss of consciousness, seizure, persistent
confusion, severe or worsening headache, vomiting
more than once, high risk mechanism, or clinical
conditions placing the child at higher risk for
complications, such as coagulopathy. Physical exam
findings which may indicate a need for imaging
include scalp hematomas, indicators of basilar skull
fracture, abnormal mental status (or caregiver report
of abnormal behavior in an infant), bulging anterior
fontanelle in infants, or focal neurologic deficits.
Clinical risk calculators, such as Pediatric Emergency
Care Applied Research Network (PECARN) low-risk
clinical decision rules, are helpful in guiding a decision
whether or not to image. For infants up to age 2, a
lower threshold is prudent; children who do not need
imaging should meet stringent criteria. In children
younger than 2 without a high-risk mechanism of
injury no neuroimaging is recommended for those
who have: a normal neurologic exam including mental
status, a normal fontanelle, no seizures or vomiting,
no concern for abuse, no non-frontal scalp hematoma,
no signs of skull fracture, no loss of consciousness >5
seconds, and normal behavior.
For adults with traumatic brain injury, several
approaches to determining who needs imaging have
been prospectively validated, including the Canadian
CT head rule (CCHR), the New Orleans criteria
(NOC), and the National Emergency X-Radiography
Utilization Study II (NEXUS II) criteria. Overall,
criteria for low-risk adults who do not need a head
CT scan are similar to criteria for older children and
adolescents as described above.

CONCUSSION
in SPORTS
STATISTICS

In 2009,

NEARLY 250,000

KIDS AND TEENS
were treated in emergency
departments for sports and
recreation-related TBI,
including concussion.

WHEN IN DOUBT,

SIT THEM OUT!
WHEN APPROPRIATE MAKE SURE AN
ATHLETE USES THE CORRECT HELMET
FOR THEIR ACTIVITY.

LEARN CONCUSSION SIGNS

SYMPTOMS
SEE FULL LIST OF SYMPTOMS @

Difficulty
Thinking Clearly
Sensitivity to
Noise & Light

www.cdc.gov/Concussion

if
help protect athletes
from serious brain or
head injuries.

1
2

THERE IS NO "CONCUSSION-PROOF" HELMET.

YOU THINK
AN ATHLETE HAS A CONCUSSION

USE THE HEADS UP ACTION PLAN

Wearing a helmet can

Initial Management
In patients with mild TBI and low risk of
complications, observation for the first 24 hours
should include instructions to seek immediate
medical care for severe or worsening headache,
seizures, vomiting, excessive sleepiness, incontinence,
numbness or weakness, or vision changes. It is no
longer thought to be necessary or beneficial to
awaken the injured person from sleep to assess mental
status. General physical rest for the initial 24-48
hours should be aimed at not triggering or worsening
symptoms, rather than a complete cessation of all
activity. Cognitive rest should similarly be customized
to prevent recurrence or exacerbation of symptoms.
Strong evidence for an exact approach is lacking,
as some studies show that rest is needed and others
indicate that prolonged or restrictive approaches
may lead to prolonged symptoms. The best practice
appears to be allowing the amount of activity (both

Headache
Dizziness
Blurred Vision

3

Remove the athlete from play.

Keep the athlete out of play the day of
the injury.

An athlete should only return to play with
permission from an appropriate health care
professional.

HELP KEEP ATHLETES SAFE from CONCUSSIONS
AND OTHER SERIOUS BRAIN INJURIES

Remind your athletes to tell Make sure that athletes
coaching staff right away if follow the rules for safety
and the rules of the sport.
they think they have a
concussion or that a
teammate has a concussion.

Encourage athletes to
practice good sportsmanship
at all times.

Keep the Heads Up
Action Plan at all
games and practices.

LEARN more AT:

www.cdc.gov/Concussion

SUMM
RM
2 0E 1R82 0| 1 8
C H|E SCTHEERSCT O
U NC TOYU NMTeYd i M
c i ende i c1i n1 e 1 1
S UE M
ER
http://www.cdc.gov/Concussion http://www.cdc.gov/Concussion
Chester County Medicine Summer 2018

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