Living Guideline Updates

Last update: Jan 24, 2022

Please see the Living Guideline Methodology section for information about how the updates are performed and how the website is kept up to date.

Summary of New Evidence:

The information below highlights several recommendations related to the diagnosis and management of pediatric concussion that have changed since the 2014 Guideline on the Diagnosis and Management of Pediatric Concussion.

Considerations for telemedicine and virtual concussion care

In January 2021 the Living Guideline team released a new set of recommendations that include a clinical algorithm for determining when a child or adolescent would benefit from a virtual consultation (versus in-person). In January 2022 a new resource has been added to this domain, an interactive training manual that includes videos designed to assist front-line healthcare professionals who are caring for patients that cannot be seen in person or have already had an in-person assessment and require follow-up.

Diagnosing Concussion:

Children and adolescents with a suspected concussion should be referred to a physician or nurse practitioner to perform a comprehensive medical assessment to exclude more severe injuries, consider a full differential diagnosis, and confirm the diagnosis of concussion.    Routine neuroimaging (CT scan or MRI) is not required for diagnosing a concussion. A CT scan of the brain or cervical spine is only recommended for cases of a suspected structural intracranial or cervical spine injury.

 Resuming Activity After a Concussion:

Prolonged rest beyond the first 24-48 hours after a concussion is no longer recommended and may cause more harm than good. After an initial rest period (24-48 hours), children/adolescents should gradually resume low-risk activity, even in the presence of post-concussion symptoms. Return to physical and cognitive activity should be gradual and individualized based on activity tolerance and symptom presentation (e.g., the child/adolescent is able to engage in an activity without worsening of post-concussion symptoms). Activities that pose a risk for a repeated concussion must be avoided when still experiencing symptoms. See Recommendation 2.3 for more information. 

Highly active children/adolescents, those in competitive sport, those who are not tolerating a graduated return to physical activity, or those who are slow to recover may benefit from early referral to a medically supervised interdisciplinary team with the ability to individually assess sub-symptom threshold aerobic exercise tolerance and to prescribe aerobic exercise treatment.

Risk Factors for a Delayed Recovery (Risk-Modifiers That May Delay Recovery):

Consider referring children or adolescents who have a higher risk for a delayed recovery to an interdisciplinary concussion team earlier than 4-weeks post-concussion.

Return-to-School and Sports

Children and adolescents should return to a full school load, without accommodation, before they return to full-contact sport and game play.

Baseline testing is not recommended or required for concussion diagnosis or management in children or adolescents.

According to Parachute Canada’s Statement on Baseline Testing, baseline testing is “the practice of having an athlete complete certain concussion assessment tools/tests prior to sports participation to provide baseline measurements that can be compared to post-injury values in the event of a suspected concussion”. Current evidence does not support a significant added benefit of using baseline testing in children and adolescents.  See Recommendation 5.2 for more information.

Mental Health

Early identification of common mental health disorders and risk factors for mental health disorders may prevent/mitigate additional problems such as learning and behavior problems, school avoidance, and exacerbation of pre-existing problems in children/adolescents who are recovering from a concussion.      



Risk modifiers that may delay recovery
👉♀️sex/older age
👉migraine/mental health/learning difficulty/SES
👉symptom burden/VOM/tandem stance/preinjury
👉past concussion recovery
High risk? Refer early➡️interdisciplinary concussion team

#pediatric #concussion myths!

Fact or Myth #2: “Younger children take longer to recover from concussions, compared with older teens.“

Thanks to @PedsConcussion co-lead Dr. Roger Zemek
@CHEO and @SIRCtweets for preparing these videos!


Let's highlight #pediatric #concussion myths!

Day 1: See video from @PedsConcussion co-lead Dr. Roger Zemek @CHEO

Fact or Myth #1: “Following concussion youth may safely resume physical activity ONLY once they are symptom-free.“
video credit: @SIRCtweets

🚩James Lind Alliance Priority Setting Partnership Survey to identify the top 10 #Concussion research areas. Share with youth, families, friends, teachers, coaches, and healthcare professionals managing concussion

👉Have your say in the future directions of concussion research!

Concussion Priority Setting Partnership@concussionpsp1

Are you living with a #concussion? Tell us which questions about #concussion are most important to you. Take this quick survey:

🚩New Resource Alert: #LivingGuideline🚩

Virtual Concussion Exam: A training manual to assist front-line healthcare professionals who are caring for patients that cannot be seen in person or have already had an in-person assessment & require followup


Deciding which #concussion patients would benefit from virtual care or telemedicine?
👀#PedsConcussion #LivingGuideline domain15 & clinical algorithm. Recommendations were developed in collaboration with 45 experts from 🇨🇦& 🇺🇸 and are updated every 6m 1/


FACT: See @PedsConcussion Rec# 2.3b: 24-48 hours after a concussion, activities that pose no/low risk of sustaining a concussion and do not worsen symptoms should be resumed even if mild or residual symptoms are present..."

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