The most recent international consensus statement on sport-related concussions ("Zurich consensus statement") [1] identifies several important differences in the way concussions are diagnosed and treated in children and adolescents:
Child - SCAT3 Symptom Evaluation
CHILD REPORT | Never | Rarely | Sometimes | Often |
---|---|---|---|---|
1. I have trouble paying attention | ||||
2. I get distracted easily | ||||
3. I have a hard time concentrating | ||||
4. I have problems remembering what people tell me | ||||
5, I have problems following directions | ||||
6. I daydream too much | ||||
7. I get confused | ||||
8. I forget things | ||||
9. I have problems finishing things | ||||
10. I have trouble figuring things out | ||||
11. It's hard for me to learn new things | ||||
12. I have headaches | ||||
13, I feel dizzy | ||||
14. I feel like the room is spinning | ||||
15. I feel like I'm going to faint | ||||
16. Things are blurry when I look at them | ||||
17. I see double | ||||
18. I feel sick to my stomach | ||||
19. I get tired a lot | ||||
20. I get tired easily | ||||
21. Difficulty remembering [8] | ||||
22. Visual problems |
Parent report | Never | rarely | sometimes | often |
---|---|---|---|---|
The child: | ||||
1. has trouble sustaining attention | ||||
2. is easily distracted | ||||
3. has difficulty concentrating | ||||
4. has problems remembering what he/she is told | ||||
5. has difficulty following directions | ||||
6. tends to daydream | ||||
7. gets confused | ||||
8. is forgetful | ||||
9. has difficulty completing tasks | ||||
10. has poor problem solving skills | ||||
11. has problems learning | ||||
12. has headaches | ||||
13. feels dizzy | ||||
14. has a feeling the room is spinning | ||||
15. feels faint | ||||
16. has blurred vision | ||||
17. has double vision | ||||
18. experiences nausea | ||||
19. gets tired a lot | ||||
20. gets tired easily |
As with other symptoms scales [7] in use, however, these new child- and parent-symptom scales have not yet been the subject of large scale, controlled studies to establish their effectiveness in identifying young athletes with concussion.
The presence of multiple symptoms does not, in and of itself, determine whether a concussion has occurred; rather, it is information that can help a health care professional in making an overall diagnosis, gauging injury severity, assessing recovery, and, because of the unreliability of athletes' reports [9] of being symptom-free, [4] in making the all-important return-to-play determination.
While concerns are routinely expressed about athletes underreporting concussion [10] or their symptoms, symptom assessment remains a critical component of concussion assessment, ideally in combination with other functional [(e.g. neurocognitive [8], balance [11])] tests.[5]
To determine a younger athlete's orientation to time and place, the Child-SCAT3 calls for a child to be asked four so-called "Maddocks questions" [12][6] than called for under the SCAT3[3] (which asks five slightly different questions):
Unlike the SCAT3 for older athletes, the Child-SCAT3 specifically addresses a child's need for cognitive rest [2] after concussion, including:
"Because of the different physiological response and longer recovery after concussion and specific risks (eg. second impact syndrome [14]), related to head impact during childhood and adolescence," the Zurich consensus statement recommends a more conservative return to play approach, extending the amount of time of asymptomatic rest and/or the length of the graded exertion [5] for children and teens.[1].
The timing of post-concussion neurocognitive testing [8] for younger athletes may also be different. Typically performed when an athlete is reporting no symptoms, a neurocognitive assessment for children may be useful during the early stages following injury to assist in making return-to-school decisions, an assessment which is "best determined" in consultation with a trained pediatric neuropsychologist, says the Zurich consensus statement, "particularly [for] children with learning disorders and/or ADHD [15] who may need more sophisticated assessment strategies."
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Looking for more information about concussions? For the most up-to-date and comprehensive concussion information for sports parents on the web, check out the MomsTeam Concussion Center [16].
1. McCrory P, et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Br J Sports Med 2013;47:250-258.
2. Child SCAT3. Br J Sports Med 2013;47:263.
3. SCAT3 [17]. Br J Sports Med 2013;47:259.
4. Sandel N, Lovell M, Kegel N, Collins M, Kontos A. The Relationship Of Symptoms and Neurocognitive Performance to Perceived Recovery From Sports-Related Concussion Among Adolescent Athletes. Applied Neuropsychology: Child. 2012; DOI:10.1080/21622965.201 2.670680 (published online ahead of print 22 May 2012)(accessed June 5, 2012)
5. Mcrea M, Iverson G, Echemendia, et al. Day of injury assessment of sport-related concussion. Br J Sports Med 2013;47:272-284.
6. Maddocks DL, Dicker GD, Saling MM. The assessment of orientation following concussion in athletes. Clin J Sport Med 1995;5(1):32-35.
7. Zuckerman SL, Lee YM, Odom MJ, Solomon GS, Forbes JA, Stills AK. Recovery from sport-related concussion: Days to return to neurological baseline in adolescents versus young adults. Surg Neurol Int. 2012;3:130. Epub 2012 Oct 27.
8. Brown NJ, Mannix RC, O'Brien MJ, Gostine D, Collins MW, Meehan WP. Effect of Cognitive Activity Level on Duration of Post-Concussion Symptoms. Pediatrics 2014;133(2):1-6.
Posted April 22, 2013; most recently revised January 14, 2014; most recently reviewed December 4, 2015
Links:
[1] https://momsteam.com/node/146
[2] https://momsteam.com/node/4176
[3] https://momsteam.com/node/7003
[4] https://momsteam.com/node/3319
[5] https://momsteam.com/node/128
[6] https://momsteam.com/node/1335
[7] https://momsteam.com/node/149
[8] https://momsteam.com/node/801
[9] https://momsteam.com/node/4924
[10] https://momsteam.com/node/4804
[11] https://momsteam.com/node/221
[12] https://momsteam.com/node/6150
[13] https://momsteam.com/node/6780
[14] https://momsteam.com/node/208
[15] https://momsteam.com/node/6289
[16] https://momsteam.com/node/305
[17] http://bjsm.bmj.com/content/47/5/259.full.pdf
[18] https://momsteam.com/health-safety/sport-concussion-assessment-tool-evaluation-and-management
[19] https://momsteam.com/health-safety/standardized-assessment-of-concussion-a-valuable-tool-for-sideline-evaluation
[20] https://momsteam.com/cerebral-blood-flow/new-study-supports-more-conservative-management-concussions-in-children-teens
[21] https://momsteam.com/post-concussion/more-post-concussion-help-students-in-classroom-needed
[22] https://momsteam.com/academic/post-concussion-strategies-for-the-classroom
[23] https://momsteam.com/health-safety/neuropsychologist-should-help-plan-academic-accommodations-after-concussion
[24] https://momsteam.com/academic-accommodations/ensure-successful-return-to-classroom-after-concussion--says-pediatrics-group
[25] https://momsteam.com/cognitive-rest/full-cognitive-activity-after-concussion-delays-recovery-study-finds