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 one month.
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 specialists.”
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.