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Recent Guideline Updates

Minor Revisions: December 2017-November 2019 

 

 

Domain	Recommendation	Update	Evidence**	%Consensus*
2- Initial Diagnosis and Management	2.1b: Note common modifiers that may delay recovery and use a clinical risk score to predict risk of prolonged symptoms.	Update the list of modifiers for a prolonged recovery to include: High symptom burden at initial presentation, clinical evidence of vestibular or oculomotor dysfunction, duration of recovery from a previous concussion.	Zemek et al 2016 Beauchamp et al 2018 Ellis et al 2018 Fehr et al 2019 Guerriero et al 2018 Howell et al 2018 Howell et al 2018 Ledoux et al 2019  Master et al 2018  Yeates et al 2019	100%
2- Initial Diagnosis and Management	2.2: Provide verbal information and written (electronic) handouts regarding the course of recovery and when the child/adolescent can return to school/activity/sport/work.	Include a sentence sharing that the information that females aged 13-18 years have an increased risk of a prolonged recovery.	Ledoux et al 2019	83%
7- Sleep	Introduction	Revision to the 4th sentence of the introduction to include: “Medication use, headaches and mental health conditions (e.g. anxiety, depression) may also affect sleep. Poor sleep may be related to cognitive complaints and worse post-concussion symptoms. A repeat…”	Murdough et al 2018	83%
4- Medical Clearance	4.1: Child/adolescent has successfully returned to all school activities including writing exams without symptoms above their previous pre-injury level or requiring accommodations related to their concussion/post-concussion symptoms.	Update level of evidence to	Dematteo et al 2019	100%
12- Return to School and Work	12.5: Return-to-school and return-to-sport strategies can be performed simultaneously. Recommend that the child/adolescent return-to-school full-time at a full academic load, including writing exams without accommodations related to their concussion/post-concussion symptoms, before returning to full-contact sport or high-risk activities.	Update level of evidence to	Dematteo et al 2019	80%

* Consensus for minor revisions: Minimum three domain experts vote on minor revisions. 75% consensus is required to proceed with a minor revision. Please see the Methodology Living Guideline pdf for more information.

** Definitions of the A, B, C level of evidence can be found here: Levels of Evidence