Rhode Island Medical Home Portal - Mild Traumatic Brain Injury (TBI) & Post-concussive Syndrome

Introduction

The terms “mild traumatic brain injury (TBI)” and “post-concussive syndrome” are confusing and may be used differently by different sources. Acutely, mild TBI, which is synonymous with concussion, describes a spectrum of brain injury that may include the following symptoms:

confusion
amnesia around the time of injury
Loss of consciousness for up to 30 minutes following the injury
Neurological or neuropsychological problems including problems with attention, concentration, memory, fatigue, dizziness, and others
A Glasgow Coma Scale of 13 or higher

For children with concussion or mild TBI in the emergency room, the primary focus is ruling out more serious injuries (e.g., subarachnoid hemorrhage). Although the majority of children with mild TBI recover quickly, some go on to have problems for weeks or months. The constellation of chronic symptoms is often referred to as post-concussive syndrome and also as part of the spectrum of mild TBI. There are no controlled studies detailing how often children who have sustained a concussion have these problems, but estimates in adults after concussions range from 40 to 80%. [Mittenberg: 2001] The symptoms of mild TBI vary from child to child, and symptoms may be mild or severe enough to interfere with daily living and quality of life.

Children with mild TBI may experience:

chronic headaches
sleep problems
problems with attention and concentration
memory problems
Behavior problems, including anger, immature behavior, acting out
Moodiness, anxiety, and symptoms of depression
Fatigue and dizziness

It is difficult to predict which children will go on to have post-concussive syndrome. Generally, symptoms will appear in the first few days after the injury, but in rare cases may not show up for weeks or months afterward. Family and personal prior medical history and behavior/functioning of the child before the mild TBI may influence outcome. For instance, a child with attention problems before the injury may have an increase in those problems. A child with a family history of migraines may be more prone to getting headaches after the accident. [Yeates: 2009] [Anderson: 2011] Sleep problems, if present, should be treated early and aggressively, as they may contribute to other symptoms associated with post-concussive syndrome.

Families should be given anticipatory guidance regarding symptoms that might develop and referred for follow-up with a physiatrist or neurologist if those symptoms are noted, depending on local expertise, if these symptoms occur. See [Kamerling: 2003] [Lovell: 2008] [Kirkwood: 2006] [Lee: 2007] for more information.

Prognosis

Most children will recover fully within weeks to months after mild TBI/post-concussive syndrome.

Management

The management of mild TBI is very individual, depending on the child's functioning, injury, and symptoms. [Anderson: 2011] [Yeates: 2009] A multi-disciplinary approach is often necessary to address problems with physical, emotional, and behavioral functioning of the child. Management approaches may include medications, physical therapy, biofeedback, school interventions, and counseling. Referral to an experienced pediatric physiatrist or neurologist is recommended unless the medical home has sufficient expertise/experience with children with mild TBI.

Resources

Information & Support

For Professionals

Sport-Related Concussion in Children and Adolescents (AAP)
Policy statement from the American Academy of Pediatrics on sport-related concussion.

Mild traumatic brain injury (CDC)
Information about diagnosis, prevention, and management from the CDC.

Patient education: Head injury in children and adolescents (Up To Date)

For Parents and Patients

Practice Guidelines

Kamerling SN, Lutz N, Posner JC, Vanore M.
Mild traumatic brain injury in children: practice guidelines for emergency department and hospitalized patients. The Trauma Program, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine.
Pediatr Emerg Care. 2003;19(6):431-40. PubMed abstract

Authors & Reviewers

Initial publication: January 2011; last update/revision: October 2020

Current Authors and Reviewers:

Author:	Lynne M. Kerr, MD, PhD
Reviewer:	Teresa Such-Neibar, DO

Authoring history

2011: update: Teresa Such-Neibar, DO^R

2011: first version: Lynne M. Kerr, MD, PhD^A

^AAuthor; ^CAContributing Author; ^SASenior Author; ^RReviewer

Page Bibliography

Anderson V, Brown S, Newitt H, Hoile H.
Long-term outcome from childhood traumatic brain injury: Intellectual ability, personality, and quality of life.
Neuropsychology. 2011. PubMed abstract

Kamerling SN, Lutz N, Posner JC, Vanore M.
Mild traumatic brain injury in children: practice guidelines for emergency department and hospitalized patients. The Trauma Program, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine.
Pediatr Emerg Care. 2003;19(6):431-40. PubMed abstract

Kirkwood MW, Yeates KO, Wilson PE.
Pediatric sport-related concussion: a review of the clinical management of an oft-neglected population.
Pediatrics. 2006;117(4):1359-71. PubMed abstract

Lee LK.
Controversies in the sequelae of pediatric mild traumatic brain injury.
Pediatr Emerg Care. 2007;23(8):580-3; quiz 584-6. PubMed abstract

Lovell MR, Fazio V.
Concussion management in the child and adolescent athlete.
Curr Sports Med Rep. 2008;7(1):12-5. PubMed abstract

Mittenberg W, Canyock EM, Condit D, Patton C.
Treatment of post-concussion syndrome following mild head injury.
J Clin Exp Neuropsychol. 2001;23(6):829-36. PubMed abstract

Yeates KO, Taylor HG, Rusin J, Bangert B, Dietrich A, Nuss K, Wright M, Nagin DS, Jones BL.
Longitudinal trajectories of postconcussive symptoms in children with mild traumatic brain injuries and their relationship to acute clinical status.
Pediatrics. 2009;123(3):735-43. PubMed abstract / Full Text