CLINICAL QUESTION

What are current clinical practice guidelines for imaging in children with acute mild traumatic brain injury (mTBI)?

BOTTOM LINE

In children with acute mTBI, commonly called concussion, the best evidence suggests that computed tomography (CT) of the head should be considered only for children with severe headache, worsening symptoms, or when a head or neck injury is suspected. Radiography of the skull does not have a role in the management of mTBI, and routine imaging is not supported by high-quality evidence. (Level of Evidence = 5)

SYNOPSIS

The investigators searched four databases, including Cochrane Central, and identified 11 clinical practice guidelines that provide guidance for the management of mTBI in children. Pairs of reviewers selected guidelines for inclusion and extracted their recommendation. They determined the quality of evidence supporting each of the guidelines and evaluated the applicability of the guidelines to emergency management. Six of the guidelines were rated as high quality. The investigators identified 34 recommendations based on moderate- to high-quality evidence. Routine imaging is not recommended. CT of the head or neck should be considered in children when an injury is suspected. CT of the head should be considered in children with severe headache, and clinical decision-making rules should be followed. In children with acutely worsening symptoms, immediate imaging should be performed. Radiography of the skull should not be used for screening or diagnosis of mTBI in children.

Study design: Systematic review

Funding source: Government

Setting: Various (meta-analysis)

Reference: Moore L, Ben Abdeljelil A, Tardif PA, et al. Clinical practice guideline recommendations in pediatric mild traumatic brain injury: a systematic review. Ann Emerg Med. 2024;83(4):327-339.

Editor's Note: Dr. Shaughnessy is an assistant medical editor for AFP.