Concussion in childhood
An excellent article on pediatric concussion outlines our knowledge (or lack thereof!) on all aspects of concussion. "Concussion is defined as a complex pathophysiological process affecting the brain induced by traumatic biomechanical forces." It includes five major features:
1. Caused by a direct blow to the head, face or neck
(or elsewhere on the body with force being transmitted to the head).
2. It results in the rapid onset of short-lived impaired neurologic function which usually (but not always) resolves quickly and spontaneously.
3. Acute symptoms reflect a functional disturbance and include physical, cognitive, emotional and sleep perturbations.
4. Loss of consciousness (LOC) may or may not be a feature of the episode. LOC, headache and amnesia may indicate a more serious injury.
5. Neuroimaging is normal.
There is a lack of consensus, perhaps due to a lack of evidence-based data, regarding management. Avoidance of activity to allow for full recovery of physical and cognitive function remains the mainstay of treatment. There is no evidence demonstrating the value of medications in shortening the course of the process. If medication is used these should not be required prior to return to play.
A questionnaire was distributed to 1,305 appropriate section members of the AAP indicates that a majority routinely manage symptoms with medications in spite of the lack of evidence indicating benefit.