Research papers that support the present guideline recommendations:

Aggarwal SS, Ott SD, Padhye NS, et al. Sex, race, ADHD, and prior concussions as predictors of concussion recovery in adolescents. Brain Inj. 2020 May 11;34(6):809–17.

Aggarwal, S. S., Ott, S. D., Padhye, N. S., Meininger, J. C., & Armstrong, T. S. (2019). Clinical and demographic predictors of concussion resolution in adolescents: A retrospective study. Applied Neuropsychology: Child, 8(1), 50–60.

Anderson V, Davis GA, Takagi M, et al. Trajectories and Predictors of Clinician-Determined Recovery after Child Concussion. J Neurotrauma. 2020 Jun 15;37(12):1392–400.

Argyropoulou MI, Alexiou GA, Xydis VG, et al. Pediatric minor head injury imaging practices: results from an ESPR survey. Neuroradiology. 2020 Feb 1;62(2):251–5.

Beauchamp, M. H., Aglipay, M., Yeates, K. O., Désiré, N., Keightley, M., Anderson, P., … Moore, J. (2018). Predictors of neuropsychological outcome after pediatric concussion. Neuropsychology, 32(4), 495–508.

Billeck J, Peeler J. The influence of fatiguing exercise on Sport Concussion Assessment Tool (SCAT) scoring in a female pediatric population. Phys Sportsmed [Internet]. 2020 Oct 1;48(4):458–62. Available from:

Borland ML, Dalziel SR, Phillips N, et al. Delayed Presentations to Emergency Departments of Children With Head Injury: A PREDICT Study. Ann Emerg Med [Internet]. 2019 Jul 1;74(1):1–10. Available from:

Boutis, K., Gravel, J., Freedman, S. B., Craig, W., Tang, K., DeMatteo, C. A., … Zemek, R. (2018). The Diagnosis of Concussion in Pediatric Emergency Departments: A Prospective Multicenter Study. Journal of Emergency Medicine, 54(6), 757–765.

Boutis, K., Weerdenburg, K., Koo, E., Schneeweiss, S., & Zemek, R. (2015). The diagnosis of concussion in a pediatric emergency department. Journal of Pediatrics, 166(5), 1214–1220.e1.

Bozan Ö, Aksel G, Kahraman HA, et al. Comparison of PECARN and CATCH clinical decision rules in children with minor blunt head trauma. Eur J Trauma Emerg Surg [Internet]. 2019 Oct 25;45(5):849–55. Available from:

Bramley, H., McFarland, C., Lewis, M. M., Shaffer, M. L., Cilley, R., Engbrecht, B., … Dias, M. S. (2014). Short-term outcomes of sport- and recreation-related concussion in patients admitted to a pediatric trauma service. Clinical Pediatrics, 53(8), 784–790.

Bressan S, Clarke CJ, Anderson V, et al. Use of the sport concussion assessment tools in the emergency department to predict persistent post-concussive symptoms in children. J Paediatr Child Health [Internet]. 2020 Aug 21;56(8):1249–56. Available from:

Brooks, T. M., Smith, M. M., Silvis, R. M., Lerer, T., Mulvey, C. H., Maitland, R., … Smith, S. R. (2017). Symptom-Guided Emergency Department Discharge Instructions for Children with Concussion. Pediatric Emergency Care, 33(8), 553–563.

Bunt SC, Didehbani N, Tarkenton T, et al. Sex Differences and Reporting of SCAT-5 Concussion Symptoms in Adolescent Athletes. Clin J Sport Med. 2020;Publish Ah(00).

Chan, C., Iverson, G. L., Purtzki, J., Wong, K., Kwan, V., Gagnon, I., & Silverberg, N. D. (2018). Safety of Active Rehabilitation for Persistent Symptoms After Pediatric Sport-Related Concussion: A Randomized Controlled Trial. Archives of Physical Medicine and Rehabilitation, 99(2), 242–249.

Chrisman SPD, Whitlock KB, Mendoza JA, et al. Corrigendum: Pilot Randomized Controlled Trial of an Exercise Program Requiring Minimal In-person Visits for Youth With Persistent Sport-Related Concussion. Front Neurol [Internet]. 2020 Feb 21;11. Available from:

Cohen, E., Rodean, J., Diong, C., Hall, M., Freedman, S. B., Aronson, P. L., … Neuman, M. I. (2019). Low-Value Diagnostic Imaging Use in the Pediatric Emergency Department in the United States and Canada. JAMA Pediatrics, 173(8).

Cohrs, G., Huhndorf, M., Niemczyk, N., Volz, L. J., Bernsmeier, A., Singhal, A., … Knerlich-Lukoschus, F. (2018). MRI in mild pediatric traumatic brain injury: Diagnostic overkill or useful tool? Child’s Nervous System, 34(7), 1345–1352.

Corwin DJ, Arbogast KB, Swann C, et al. Reliability of the visio-vestibular examination for concussion among providers in a pediatric emergency department. Am J Emerg Med [Internet]. 2020 Sep;38(9):1847–53. Available from:

Coslick AM, Chin KE, Kalb LG, et al. Participation in Physical Activity at Time of Presentation to a Specialty Concussion Clinic Is Associated With Shorter Time to Recovery. PM R [Internet]. 2020 Dec 3;12(12):1195–204. Available from:

Davis, G. A., Purcell, L., Schneider, K. J., Yeates, K. O., Gioia, G. A., Anderson, V., … Kutcher, J. S. (2017). The Child Sport Concussion Assessment Tool 5th Edition (Child SCAT5): Background and rationale. British Journal of Sports Medicine, 51(11), 859–861.

DeMatteo C, Bednar ED, Randall S, et al. Effectiveness of return to activity and return to school protocols for children postconcussion: a systematic review. BMJ Open Sport Exerc Med [Internet]. 2020 Feb 24;6(1):e000667. Available from:

Dobney, D. M., Grilli, L., Kocilowicz, H., Beaulieu, C., Straub, M., Friedman, D., & Gagnon, I. J. (2018). Is There an Optimal Time to Initiate an Active Rehabilitation Protocol for Concussion Management in Children? A Case Series. Journal of Head Trauma Rehabilitation, 33(3), E11–E17.

Durish, C. L., Yeates, K. O., & Brooks, B. L. (2018). Psychological Resilience as a Predictor of Persistent Post-Concussive Symptoms in Children with Single and Multiple Concussion. Journal of the International Neuropsychological Society, 24(8), 759–768.

Elbin, R. J., Sufrinko, A., Schatz, P., French, J., Henry, L., Burkhart, S., … Kontos, A. P. (2016). Removal From Play After Concussion and Recovery Time. Pediatrics, 138(3), e20160910–e20160910.

Ellis, M. J., McDonald, P. J., Olson, A., Koenig, J., & Russell, K. (2019). Cervical Spine Dysfunction Following Pediatric Sports-Related Head Trauma. Journal of Head Trauma Rehabilitation, 34(2), 103–110.

Ellis, M., Krisko, C., Selci, E., & Russell, K. (2018). Effect of concussion history on symptom burden and recovery following pediatric sports-related concussion. Journal of Neurosurgery: Pediatrics, 21(4), 401–408.

Fehr, S. D., Nelson, L. D., Scharer, K. R., Traudt, E. A., Veenstra, J. M., Tarima, S. S., … Walter, K. D. (2019). Risk Factors for Prolonged Symptoms of Mild Traumatic Brain Injury: A Pediatric Sports Concussion Clinic Cohort. Clinical Journal of Sport Medicine, 29(1), 11–17.

Gagnon I, Teel E, Gioia G, et al. Parent-Child Agreement on Postconcussion Symptoms in the Acute Postinjury Period. Pediatrics [Internet]. 2020 Jul;146(1):e20192317. Available from:

Gauvin-Lepage, J., Friedman, D., Grilli, L., Sufrategui, M., De Matteo, C., Iverson, G. L., & Gagnon, I. (2018). Effectiveness of an Exercise-Based Active Rehabilitation Intervention for Youth Who Are Slow to Recover After Concussion. Clinical Journal of Sport Medicine, 00(00), 1.

Gladstone E, Narad ME, Hussain F, et al. Neurocognitive and Quality of Life Improvements Associated With Aerobic Training for Individuals With Persistent Symptoms After Mild Traumatic Brain Injury: Secondary Outcome Analysis of a Pilot Randomized Clinical Trial. Front Neurol [Internet]. 2019 Sep 18;10(September):1–9. Available from:

Glaviano, N. R., Benson, S., Goodkin, H. P., Broshek, D. K., & Saliba, S. (2015). Baseline SCAT2 Assessment of Healthy Youth Student-Athletes: Preliminary Evidence for the Use of the Child-SCAT3 in Children Younger Than 13 Years. Clinical Journal of Sport Medicine, 25(4), 373–379.

Gravel J, Ledoux AA, Tang K, et al. Early versus delayed emergency department presentation following mild Traumatic Brain Injury and the presence of symptom at 1, 4 and 12 weeks in children. Emerg Med J [Internet]. 2020 Jun;37(6):338–43. Available from:

Grool, A. M., Aglipay, M., Momoli, F., Meehan, W. P., Freedman, S. B., Yeates, K. O., … Zemek, R. (2016). Association Between Early Participation in Physical Activity Following Acute Concussion and Persistent Postconcussive Symptoms in Children and Adolescents. Jama, 316(23), 2504.

Guerriero, R. M., Kuemmerle, K., Pepin, M. J., Taylor, A. M., Wolff, R., & Meehan, W. P. (2018). The Association Between Premorbid Conditions in School-Aged Children With Prolonged Concussion Recovery. Journal of Child Neurology, 33(2), 168–173.

Haider MN, Johnson SL, Mannix R, et al. The Buffalo Concussion Bike Test for Concussion Assessment in Adolescents. Sport Heal A Multidiscip Approach [Internet]. 2019 Nov 5;11(6):492–7. Available from:

Haider MN, Worts PR, Viera KB, et al. Postexercise Slowing on the King-Devick Test and Longer Recovery From Sport-Related Concussion in Adolescents: A Validation Study. J Athl Train [Internet]. 2020 May 1;55(5):482–7. Available from:

Haider, M. N., Leddy, J. J., Wilber, C. G., Viera, K. B., Bezherano, I., Wilkins, K. J., … Willer, B. S. (2019). The predictive capacity of the buffalo concussion treadmill test after sport-related concussion in adolescents. Frontiers in Neurology, 10(APR), 1–7.

Howell, D. R., Kriz, P., Mannix, R. C., Kirchberg, T., Master, C. L., & Meehan, W. P. (2019). Concussion Symptom Profiles Among Child, Adolescent, and Young Adult Athletes. Clinical Journal of Sport Medicine : Official Journal of the Canadian Academy of Sport Medicine, 29(5), 391–397.

Howell, D. R., Zemek, R., Brilliant, A. N., Mannix, R. C., Master, C. L., & Meehan, W. P. (2018). Identifying Persistent Postconcussion Symptom Risk in a Pediatric Sports Medicine Clinic. American Journal of Sports Medicine, 46(13), 3254–3261.

Hunt, A. W., Laupacis, D., Kawaguchi, E., Greenspoon, D., & Reed, N. (2018). Key ingredients to an active rehabilitation programme post-concussion: perspectives of youth and parents. Brain Injury, 32(12), 1534–1540.

Kontos AP, Jorgensen-Wagers K, Trbovich AM, et al. Association of Time Since Injury to the First Clinic Visit With Recovery Following Concussion. JAMA Neurol [Internet]. 2020 Apr 1;77(4):435. Available from:

Lawrence, D. W., Richards, D., Comper, P., & Hutchison, M. G. (2018). Earlier time to aerobic exercise is associated with faster recovery following acute sport concussion. PLoS ONE, 13(4), 1–12.

Leddy, J. J., Haider, M. N., Ellis, M. J., Mannix, R., Darling, S. R., Freitas, M. S., … Willer, B. (2019). Early Subthreshold Aerobic Exercise for Sport-Related Concussion: A Randomized Clinical Trial. JAMA Pediatrics, 173(4), 319–325.

Leddy, J. J., Haider, M. N., Hinds, A. L., Darling, S., & Willer, B. S. (2019). A Preliminary Study of the Effect of Early Aerobic Exercise Treatment for Sport-Related Concussion in Males. Clinical Journal of Sport Medicine : Official Journal of the Canadian Academy of Sport Medicine, 29(5), 353–360.

Leddy, J. J., Hinds, A. L., Miecznikowski, J., Darling, S., Matuszak, J., Baker, J. G., … Willer, B. (2018). Safety and prognostic utility of provocative exercise testing in acutely concussed adolescents: A randomized trial. Clinical Journal of Sport Medicine, 28(1), 13–20.

Ledoux, A. A., Tang, K., Yeates, K. O., Pusic, M. V., Boutis, K., Craig, W. R., … Zemek, R. L. (2019). Natural Progression of Symptom Change and Recovery from Concussion in a Pediatric Population. JAMA Pediatrics, 173(1), 1–11.

Lindholm EB, D’Cruz R, Fajardo R, et al. Admission of Pediatric Concussion Injury Patients: Is it Necessary? J Surg Res. 2019 Dec 1;244:107–10.

Lumba-Brown, A., Yeates, K. O., Sarmiento, K., Breiding, M. J., Haegerich, T. M., Gioia, G. A., … Timmons, S. D. (2018). Diagnosis and Management of Mild Traumatic Brain Injury in Children: A Systematic Review. JAMA Pediatrics, 172(11).

Mannix, R., Zemek, R., Yeates, K. O., Arbogast, K., Atabaki, S., Badawy, M., … Wisniewski, S. (2019). Practice patterns in pharmacological and non-pharmacological therapies for children with mild traumatic brain injury: A survey of 15 canadian and United States centers. Journal of Neurotrauma, 36(20), 2886–2894.

Master CL, Curry AE, Pfeiffer MR, et al. Characteristics of Concussion in Elementary School-Aged Children: Implications for Clinical Management. J Pediatr [Internet]. 2020;223:128–35. Available from:

Master, C. L., Master, S. R., Wiebe, D. J., Storey, E. P., Lockyer, J. E., Podolak, O. E., & Grady, M. F. (2018). Vision and Vestibular System Dysfunction Predicts Prolonged Concussion Recovery in Children. Clinical Journal of Sport Medicine, 28(2), 139–145.

McCrory, P., Meeuwisse, W., Dvořák, J., Aubry, M., Bailes, J., … Vos, P.E. (2017) Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. British Journal of Sports Medicine. 51(11),838-847.

Mckinlay, A., Ligteringen, V., & Than, M. (2014). A comparison of concussive symptoms reported by parents for preschool versus school-aged children. Journal of Head Trauma Rehabilitation, 29(3), 233–238.

Miller, J. H., Gill, C., Kuhn, E. N., Rocque, B. G., Menendez, J. Y., O’Neill, J. A., … Johnston, J. M. (2016). Predictors of delayed recovery following pediatric sports-related concussion: a case-control study. Journal of Neurosurgery: Pediatrics, 17(4), 491–496.

Olson A, Ellis MJ, Selci E, et al. Delayed Symptom Onset Following Pediatric Sport-Related Concussion. Front Neurol. 2020 Apr 3;11.

Orr, R., Bogg, T., Fyffe, A., Lam, L. T., & Browne, G. J. (2018). Graded Exercise Testing Predicts Recovery Trajectory of Concussion in Children and Adolescents. Clinical Journal of Sport Medicine, 00(00), 1.

Patsimas T, Howell DR, Potter MN, et al. Concussion-symptom rating correlation between pediatric patients and their parents. J Athl Train. 2020 Feb 7;55(10):1020–6.

Plourde, V., Yeates, K. O., & Brooks, B. L. (2018). Predictors of long-term psychosocial functioning and health-related quality of life in children and adolescents with prior concussions. Journal of the International Neuropsychological Society, 24(6), 540–548.

Podolak OE, Chaudhary S, Haarbauer-Krupa J, et al. Characteristics of Diagnosed Concussions in Children Aged 0 to 4 Years Presenting to a Large Pediatric Healthcare Network. Pediatr Emerg Care [Internet]. 2020 Jun 16;Publish Ah. Available from:

Puffenbarger, M. S., Ahmad, F. A., Argent, M., Gu, H., Samson, C., Quayle, K. S., & Saito, J. M. (2019). Reduction of Computed Tomography Use for Pediatric Closed Head Injury Evaluation at a Nonpediatric Community Emergency Department. Academic Emergency Medicine, 26(7), 784–795.

Root JM, McNamara B, Ledda M, et al. Pediatric Patient Compliance With Recommendations for Acute Concussion Management. Clin Pediatr (Phila). 2019 Jun 1;58(7):731–7.

Root JM, Sady MD, Gai J, et al. Effect of Cognitive and Physical Rest on Persistent Postconcussive Symptoms  following a Pediatric Head Injury. J Pediatr. 2020 Dec;227:184-190.e4.

Russell, K., Selci, E., Black, B., & Ellis, M. J. (2019). Health-related quality of life following adolescent sports-related concussion or fracture: A prospective cohort study. Journal of Neurosurgery: Pediatrics, 23(4), 455–464.

Schilling S, Mansour A, Sullivan L, et al. Symptom burden and profiles in concussed children with and without prolonged recovery. Int J Environ Res Public Health. 2020 Jan 1;17(1).

Stumph, J., Young, J., Singichetti, B., Yi, H., Valasek, A., Bowman, E., … Fischer, A. (2019). Effect of Exercise Recommendation on Adolescents With Concussion. Journal of Child Neurology.

Sutton M, Chan V, Escobar M, et al. Neck injury comorbidity in concussion-related emergency department visits: A population-based study of sex differences across the life span. J Women’s Heal. 2019 Apr 1;28(4):473–82.

Taubman, B., Rosen, F., McHugh, J., Grady, M. F., & Elci, O. U. (2016). The Timing of Cognitive and Physical Rest and Recovery in Concussion. Journal of Child Neurology, 31(14), 1555–1560.

Terry DP, Reddi PJ, Cook NE, et al. Acute Effects of Concussion in Youth With Pre-existing Migraines. Clin J Sport Med [Internet]. 2019 Nov 26;November. Available from:

Terwilliger, V. K., Pratson, L., Vaughan, C. G., & Gioia, G. A. (2016). Additional Post-Concussion Impact Exposure May Affect Recovery in Adolescent Athletes. Journal of Neurotrauma, 33(8), 761–765.

Willer, B. S., Haider, M. N., Bezherano, I., Wilber, C. G., Mannix, R., Kozlowski, K., & Leddy, J. J. (2019). Comparison of Rest to Aerobic Exercise and Placebo-like Treatment of Acute Sport-Related Concussion in Male and Female Adolescents. Archives of Physical Medicine and Rehabilitation, 1–9.

Yeates, K. O., Tang, K., Barrowman, N., Freedman, S. B., Gravel, J., Gagnon, I., … Zemek, R. (2019). Derivation and Initial Validation of Clinical Phenotypes of Children Presenting with Concussion Acutely in the Emergency Department: Latent Class Analysis of a Multi-Center, Prospective Cohort, Observational Study. Journal of Neurotrauma, 36(11), 1758–1767.

Zemek, R., Barrowman, N., Freedman, S. B., Gravel, J., Gagnon, I., McGahern, C., … Moore, J. (2016). Clinical risk score for persistent postconcussion symptoms among children with acute concussion in the ED. JAMA – Journal of the American Medical Association, 315(10), 1014–1025.

Zou L, Li H, Jiang Z, et al. Modified decision-making rule supported by scheduled telephone follow-up reduces head computed tomography utilization in children with mild traumatic brain injury: A cohort study. Medicine (Baltimore). 2020 May 1;99(18):e20088.

Research papers not associated with a current recommendation

Bresee, N., Aglipay, M., Dubrovsky, A. S., Ledoux, A. A., Momoli, F., Gravel, J., … Zemek, R. (2018). No association between metoclopramide treatment in ED and reduced risk of post-concussion headache. American Journal of Emergency Medicine, 36(12), 2225–2231.

Corwin, D. J., Propert, K. J., Zorc, J. J., Zonfrillo, M. R., & Wiebe, D. J. (2019). Use of the vestibular and oculomotor examination for concussion in a pediatric emergency department. American Journal of Emergency Medicine, 37(7), 1219–1223.

Gravel, J., Boutis, K., Tang, K., Beauchamp, M. H., Freedman, S. B., Dubrovsky, A. S., … Zemek, R. (2019). Association between ondansetron use and symptom persistence in children with concussions: A 5P substudy. Canadian Journal of Emergency Medicine, 21(2), 204–210.

Greenberg, J. K., Yan, Y., Carpenter, C. R., Lumba-Brown, A., Keller, M. S., Pineda, J. A., … Limbrick, D. D. (2018). Development of the CIDSS2 Score for Children with Mild Head Trauma without Intracranial Injury. Journal of Neurotrauma, 35(22), 2699–2707.

Howell, D. R., Potter, M. N., Kirkwood, M. W., Wilson, P. E., Provance, A. J., & Wilson, J. C. (2019). Clinical predictors of symptom resolution for children and adolescents with sport-related concussion. Journal of Neurosurgery: Pediatrics, 24(1), 54–61.

Kanani, A. N., & Hartshorn, S. (2018). Resumption of physical activity within 7 days of a concussion was associated with lower rates of persistent postconcussive symptoms (PPCS). Archives of Disease in Childhood: Education and Practice Edition, 103(2), 110.

Lumba-Brown, A., Teramoto, M., Bloom, O. J., Brody, D., Chesnutt, J., Clugston, J. R., … Ghajar, J. (2019). Concussion Guidelines Step 2: Evidence for Subtype Classification. Neurosurgery, 0(0), 1–12.

Lyons, T. W., Miller, K. A., Miller, A. F., & Mannix, R. (2019). Racial and ethnic differences in emergency department utilization and diagnosis for sports-related head injuries. Frontiers in Neurology, 10(JUL), 1–8.

Murdaugh, D. L., Ono, K. E., Morris, S. O., & Burns, T. G. (2018). Effects of Developmental Age on Symptom Reporting and Neurocognitive Performance in Youth After Sports-Related Concussion Compared to Control Athletes. Journal of Child Neurology, 33(7), 474–481.

Oyegbile, T. O., Delasobera, B. E., & Zecavati, N. (2018). Postconcussive Symptoms After Single and Repeated Concussions in 10- to 20-Year-Olds: A Cross-Sectional Study. Journal of Child Neurology, 33(6), 383–388.

Takagi, M., Hearps, S. J. C., Babl, F. E., Anderson, N., Bressan, S., Clarke, C., … Anderson, V. (2019). Does a computerized neuropsychological test predict prolonged recovery in concussed children presenting to the ED? Child Neuropsychology, 00(00), 1–15.

Date of last update: January 4, 2021