Development of a conservative protocol to return children and youth to activity following concussive injury

Clin Pediatr (Phila). 2015 Feb;54(2):152-63. doi: 10.1177/0009922814558256. Epub 2014 Nov 23.


Background: Consensus-based guidelines exist for adult athletes returning to play after concussion, but there are no protocols developed specifically for children. The goal of this knowledge translation research was to develop evidence-based materials to inform physicians about pediatric concussion.

Methods: A pediatric concussion protocol was developed based on the National Institute for Health and Care Excellence procedures.

Results: This return to activity protocol was developed to guide management when children/youth sustain a concussion. The protocol incorporated 3 main themes: (a) a protocol must include return to all activity, including sport and school; (b) existing consensus-based adult protocols are not appropriate for children; and (c) a more conservative protocol is needed. After pilot testing, the developed protocol is being used across Ontario.

Conclusion: Implementation of these new pediatric recommendations is an important addition to prevention of subsequent concussions during vulnerable recovery periods, with potential to facilitate recovery by preventing prolonged symptomatology, and secondary sequelae.

Keywords: child; mild traumatic brain injury/concussion; postconcussion syndrome/recovery; return to activity; return to play.

Publication types

  • Practice Guideline
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Athletic Injuries / therapy*
  • Brain Concussion / therapy*
  • Child
  • Clinical Protocols*
  • Humans
  • Ontario
  • Pediatrics / methods*
  • Recovery of Function*
  • Schools