TABLE 1

Clinical Management Overview of Pediatric Sport-Related Concussion

Preparticipation medical contact
    Gather relevant data
        Brain injury history, including symptom-based concussion assessment
        Baseline level of “postconcussive” symptomatology
    Provide education
        Injury prevention
        Injury recognition (eg, loss of consciousness is not the only indication of a concussion)
Immediate postconcussion evaluation
    Rule out medical emergencies
        Thorough physical examination
        Neuroimaging as indicated
    Assess mental status in standardized fashion
    If concussion is suspected, no return to play until medically cleared
Recovery tracking
    Conduct serial physical examination
    Systematically evaluate PCS
Return to play
    At earliest, return athlete to play when:
        No signs or symptoms of any kind are apparent at rest or during exertion
        Neurologic examination is normal
        Neuroimaging is unremarkable when performed
    Return in gradual, stepwise fashion
Nonsport considerations
    Provide general concussion education to patient, parents, and school personnel
    Ensure appropriate support in place for transition back to school
    Treat each medical problem symptomatically
    Expect positive outcome for most children
        When recovery is not proceeding as expected, promptly refer to specialists (eg, in neuropsychology, neurology, rehabilitation, sports medicine, pain management, education, behavioral health)