The Age Variable in Childhood Concussion Management: A Systematic Review.

ABSTRACT

BACKGROUND: Sports-related concussion in young children has become a significant international public health issue. This paper reviews the research literature in an effort to shed light on the question, "At what age should young children be managed differently than adults or older adolescents?" METHOD: A systematic review, registered with PROSPERO and using PRISMA guidelines, was conducted rendering 37 sports concussion original research studies that examined age as a variable (5-18 years), and which met specific inclusion/exclusion criteria. FINDINGS: There are no defined, evidence-based age groups for childhood concussion to substantiate differential management across the childhood and adolescent age span. There is evidence to support (1) concussion may present differently across developmental stages; (2) with increasing age, adolescents may exhibit more symptoms from concussion; (3) the age range of 12-13 is the most frequently used cutoff point between younger and older children; (4) sports concussion research has classified the age variable in children in a number of manners educational, developmental, sport level, or as a continuous variable, or matter of sample convenience; and (5) four general groupings of young versus pre-puberty child and early versus late adolescent are often utilized. CONCLUSIONS: Due to limited measures and challenges of assessing younger children, current research presents a limited understanding of childhood concussion. Studies in children often lack explained rationales or theories behind age groupings or cutoffs. There is a need for studies dedicated to the question of how concussion varies developmentally from preschool through late adolescence to guide diagnosis and management.