Does new research address persistent questions since the publication of the CDC's 2018 pediatric mTBI guideline.

IF 1.3 4区医学 Q4 CLINICAL NEUROLOGY

Child's Nervous System Pub Date : 2024-12-16 DOI:10.1007/s00381-024-06706-z

Rebecca Dann, Ankita Das, Alexandria Naftchi, Brinda Raval, Eris Spirollari, OluwaToba Akinleye, Sima Vazquez, Allison Zhong, Jose F Dominguez, Jared Pisapia, Carrie Muh, Rachana Tyagi

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引用次数: 0

Abstract

Background and objective: Due to the potential debilitating sequelae following pediatric mTBI, the CDC published the Guideline on the Diagnosis and Management of mTBI Among Children in 2018. However, the guideline identified several key gaps in our clinical knowledge to support several clinical recommendations. The objective of this review is to evaluate if subsequent research has addressed these gaps in clinical practice recommendations.

Methods: A literature review was conducted in PubMed using keywords from the CDC guidelines for the years of July 2015-January 2021. Articles were screened by title and abstract so only studies with children < 18 years of age and those focusing on mTBI were included.

Results: A total of 531 articles were identified after screening. Forty-three percent was prospective; 24% were case reports, literature reviews, comments, or protocols; 19% were retrospective, 7% were cross-sectional, 4% were RCTs, and 4% were systematic reviews/meta-analyses. Forty-nine percent focused on diagnosis, 17% on prognosis, and 34% on treatment. The four most published topics were neuropsychological tools (28%), risk factors for intracranial injury and computed tomography (11%), cognitive/physical rest (11%), and return to school (10%).

Conclusion: Since the release of the 2018 CDC guidelines, the majority of publications addressing pediatric mTBI have been prospective studies evaluating the clinical application of neuropsychological tools in concussion management. While these studies do address several of the clinical gaps noted by the CDC regarding the diagnosis and prognosis of pediatric mTBI, there remains a lack of high-quality studies focused on improving pediatric concussion treatment and outcomes.

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背景和目的：由于小儿 mTBI 后可能会导致衰弱性后遗症，美国疾病预防控制中心于 2018 年发布了《儿童 mTBI 诊断和管理指南》。然而，该指南指出了我们临床知识中的几个关键缺口，以支持几项临床建议。本综述旨在评估后续研究是否解决了临床实践建议中的这些差距：使用 2015 年 7 月至 2021 年 1 月疾病预防控制中心指南中的关键词在 PubMed 上进行了文献综述。根据标题和摘要对文章进行了筛选，以便只筛选有儿童参与的研究：经过筛选，共确定了 531 篇文章。43%为前瞻性研究；24%为病例报告、文献综述、评论或协议；19%为回顾性研究；7%为横断面研究；4%为研究性临床试验；4%为系统综述/计量分析。49%侧重于诊断，17%侧重于预后，34%侧重于治疗。发表最多的四个主题是神经心理学工具（28%）、颅内损伤的风险因素和计算机断层扫描（11%）、认知/身体休息（11%）和重返校园（10%）：自 2018 年美国疾病预防控制中心指南发布以来，大多数针对小儿 mTBI 的出版物都是前瞻性研究，评估神经心理学工具在脑震荡管理中的临床应用。虽然这些研究确实解决了疾病预防控制中心指出的有关小儿 mTBI 诊断和预后的一些临床差距，但仍然缺乏专注于改善小儿脑震荡治疗和预后的高质量研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Child's Nervous System 医学-临床神经学

CiteScore

3.00

自引率

7.10%

发文量

322

审稿时长

3 months

期刊介绍： The journal has been expanded to encompass all aspects of pediatric neurosciences concerning the developmental and acquired abnormalities of the nervous system and its coverings, functional disorders, epilepsy, spasticity, basic and clinical neuro-oncology, rehabilitation and trauma. Global pediatric neurosurgery is an additional field of interest that will be considered for publication in the journal.