Last reviewed: March 2019
Last updated: November  2018
20 Nov 2018

CDC recommends use of validated clinical decision rules to help decide need for imaging in children with concussion

Large numbers of children present with mild traumatic brain injury (TBI, concussion) each year, prompting the US Centers for Disease Control and Prevention (CDC) to produce a new guideline based on a systematic review of the evidence on diagnosis, prognosis, and management. [91]

Recommendations on diagnosis include:

  • In the acute setting, do not routinely use imaging to diagnose mild TBI in children, but use validated clinical decision rules that predict risk for more serious injury to decide if imaging is required. One example is the Pediatric Emergency Care Applied Research Network [PECARN] decision rule. [92]

  • Use validated age-appropriate symptom scales as a component in the assessment of children with mild TBI to document neurocognitive insults, and to guide activity restrictions and appropriate follow-up. Examples include the Post-Concussion Symptom Scale, Health and Behaviour Inventory, Post-Concussion Symptom Inventory, and Acute Concussion Evaluation.

Further information and resources to help implement the recommendations are available via the CDC website. CDC: pediatric mTBI guideline

See Diagnosis: approach

Original source of update




  • Skull fracture (excl. base of skull)
  • Base of skull fracture
  • Cerebral contusion
  • Intracerebral haemorrhage
  • Subdural haematoma
  • Epidural haematoma
  • Intraventricular haemorrhage
  • Traumatic subarachnoid haemorrhage
  • Penetrating injuries
  • Diffuse axonal injury
  • Mild traumatic brain injury


Authors VIEW ALL

Albert J. Lauro Professor of Medicine/Emergency Medicine

Clinical Professor Medicine/Emergency Medicine

Section of Emergency Medicine

Louisiana State University Health Science Center

New Orleans



MJH is an author of a reference cited in this topic.

Dr Micelle J. Haydel would like to gratefully acknowledge Dr Victoria E. Johnson, Dr Marek Ma, Dr Nathan Ranalli, and Dr Douglas H. Smith, previous contributors to this topic. VEJ, MM, NR, and DHS declare that they have no competing interests.

Peer reviewers VIEW ALL

Director of Research

Department of Emergency Medicine

Emory University




DWW declares that he has no competing interests.

Senior Lecturer In Neurology

Imperial College




DS declares that he has no competing interests.

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