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Evidence based guidelines are required for the management of concussive injury in children
Consensus guidelines for managing sport related concussion in adults have been increasingly widely implemented.1 So far, there are no guidelines that enable clinicians to manage similar sporting concussive injuries in children. Furthermore, there are a number of important anatomical, physiological, and behavioural differences between adults and children that suggest that adult guidelines will need to be either modified or rewritten to manage injuries in this age group.
EPIDEMIOLOGY OF CONCUSSION IN CHILDREN
The annual incidence of traumatic brain injury (TBI) in adults is remarkably constant worldwide and has been estimated at between 180 and 300 cases per 100 000 population.2–5 This is believed to be an underestimate of the true incidence as an equivalent number of mild injuries are treated by general practitioners and do not result in hospital admission.6 Direct sport participation accounts for approximately 15–20% of all such TBI3,7 and in children a further smaller percentage of TBI is associated with play activities.8
In children aged 15 years and under, the estimated incidence rate of TBI is 180 per 100 000 children per year of which approximately 85% are categorised as mild injuries.7 In the US, it has been estimated that more than 1 million children sustain a TBI annually and that TBI accounts for more than 250 000 paediatric hospital admissions as well as more than 10% of all visits to emergency service settings.9
In child and adolescent populations, few well controlled studies exist to identify the age specific frequency and outcome of sport related concussive injuries.
INTRINSIC DIFFERENCES BETWEEN CHILD AND ADULT CONCUSSION
The most common cognitive sequelae of concussive injuries in children are the same as for adults, namely reduced speed of information processing, poor attention, and impaired executive function.10–14 Concussion may also have a significant …