Posted by: Salvatore J. Zambri, founding member and partner
Developed by a panel of 30 medical experts from Canada and the United States,
Guidelines for Diagnosing and Managing Pediatric Concussions (first edition) was published in June, 2014. In a review of the guidelines,
Physicians Weekly summarizes: “The guidelines provide healthcare providers with evidence-based
recommendations to standardize the diagnosis and management of concussion
in children aged 5 to 18 years old, from the initial assessment through
to the period of recovery, which can last months.” The recommendations
provide a useful step-by-step approach to understanding the concussion
“timeline” from pre-participation screening to management
of acute symptoms, discharge, interim assessment, and re-assessment after
Listed below are Key Recommendations from the Guideline:
♦ “For children participating in high-risk sports (contact
and collision sports), consider baseline neurocognitive testing.
♦ On initial presentation, assess and treat physical, cognitive,
and other neurologic deficits:
– Manage acute symptoms, including identifying any so-called red
flags and assessing need for emergent neuroimaging.
– Perform an acute concussion evaluation based on a standardized tool.
– Prescribe physical and cognitive rest.
♦ On discharge, provide education and a postconcussion care plan
with explicit direction for teachers and school-based activities:
– Educate about the risks for persistent symptoms including managing
sleep, headaches, and fatigue.
– Counsel patients on avoiding alcohol, recreational drugs, and
driving during recovery.
– Instruct patients to have close primary care follow-up and referral
to a specialist in concussion management if symptoms persist beyond 1 month.
♦ On interim assessment, have return-to-learn and return-to-play
stepwise plans and refer children with multiple concussions to specialized
care by a concussion expert.
♦ At 1 month, if symptoms persist, patients should undergo a more
comprehensive health evaluation to:
– Look for underlying physical or mental health modifiers.
– Consider a program of sleep hygiene.
– Prescribe short-term medications as needed for sleep and headaches.
– Refer patients with neurocognitive or mental health needs to relevant
I have been coaching youth soccer for more than 12 years. As a coach, I
am always mindful of my players’ safety and health. Whether on the
field or off, any head injury should always be taken seriously.
About the author:
Mr. Zambri is a board-certified civil trial attorney by the National Board of Trial
Advocates and a Past-President of the Trial Lawyers Association of Metropolitan
Washington, D.C. The association recently named him "Trial Lawyer
of the Year".
Super Lawyers recently named him among the "Top Ten" lawyers in the Metro
Area (out of more than 80,000 attorneys). He has been rated by
Washingtonian magazine as a "Big Gun" and among the "top 100″ lawyers
in the entire metropolitan area. The magazine also describes him as "one
of Washington's best-most honest and effective lawyers" who specializes
in personal injury matters, including automobile accident claims, premises
liability, product liability, medical malpractice, and work-accident claims.
He has successfully litigated multiple cases against truck and bus companies,
the Washington Metropolitan Area transit Authority, and other automobile
owners. His law firm, in fact, has obtained the largest settlement ever
in a personal injury case involving WMATA. Mr. Zambri has also been acknowledged
as one of "The Best Lawyers in America" by
Best Lawyers (2014 edition) and has been repeatedly named a "Super Lawyer" by
Super Lawyer magazine (2014) - national publications that honor the top lawyers in America.