What is the recommended management for a child admitted to the hospital with a concussion?

From the Guidelines

The recommended duration for monitoring a child in the hospital after a concussion is typically 24-48 hours, as this allows for observation of postconcussive symptoms and prevention of further injury, with a strong emphasis on clear clinician follow-up instructions 1.

Key Considerations for Management

• The management of a child with a concussion should focus on physical and cognitive rest, symptom monitoring, and gradual return to activities.
• Pain management typically involves acetaminophen rather than NSAIDs or aspirin, which may increase bleeding risk.
• Sleep disturbances should be addressed through good sleep hygiene rather than medications.
• Neurological checks should be performed regularly to monitor for deterioration, including pupillary responses, level of consciousness, and vital signs.
• Screen time and cognitive demands should be limited initially and gradually reintroduced as symptoms improve.

Return to Activities

• The child should follow a stepwise return-to-learn protocol before returning to physical activities, with each step taking at least 24 hours and regression if symptoms worsen.
• Family education about expected recovery timeline (typically 2-4 weeks) and warning signs requiring immediate medical attention (worsening headache, repeated vomiting, seizures, increasing confusion, or unusual behavior) is essential for proper management, as emphasized by the Centers for Disease Control and Prevention 1.

Evidence-Based Recommendations

• The most recent and highest quality study recommends a period of relative rest for 24 to 48 hours immediately following acute mild traumatic brain injury (mTBI) 1.
• The study also highlights the importance of informing the family on warning signs of more serious injury, description of injury and expected course of symptoms and recovery, instructions on how to monitor postconcussive symptoms, prevention of further injury, management of cognitive and physical activity/rest, instructions regarding return to play/recreation and school, and clear clinician follow-up instructions 1.

From the Research

Recommended Management for a Child Admitted to the Hospital with a Concussion

The management of a child admitted to the hospital with a concussion involves several key considerations, including:

• The necessity of hospital admission for pediatric patients with concussive symptoms and a negative computed tomography (CT) of the head 2
• The use of standardized clinical tools for assessment of acute concussion 3
• Symptomatic treatment and return to learn/play recommendations 4

Monitoring and Discharge

According to a study published in The Journal of surgical research, patients with concussion and a negative head CT who tolerate a diet can be safely discharged home 2. The study found that:

• 94.4% of patients were discharged within 24 hours of admission
• The average length of stay for patients who stayed longer than 24 hours was 2.75 days
• There was no difference in Glasgow coma scale in comparison to patients who were discharged within 24 hours

Evaluation and Management

Other studies emphasize the importance of proper evaluation and management of concussion, including:

• Rapid removal from play and symptomatic treatment 4
• Use of a physical examination toolbox that includes evaluation of cranial nerves, manual muscle testing, and deep tendon reflexes 5
• Assessment of cognitive issues, psychiatric symptoms, and sleep disturbance 6