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found to be helpful. While many sports professionals administer
preparticipation assessments utilizing these tools, it is not standard, and
those results may not be accessible to the clinician during the initial
posttraumatic evaluation.
Diagnostic Imaging. Neuroimaging, whether CT or MRI, is not routinely
performed, except as a concern for ciTBI arises. As previously discussed,
features that warrant emergent neuroimaging include altered mental status,
evidence of depressed or basilar skull fracture, posttraumatic seizure,
prolonged loss of consciousness, worsening headache, and focal neurologic
examination findings. CT is widely available and quickly detects significant
ciTBI. MRI may be preferred to CT to avoid radiation exposure but is not
as widely available and time may be of the essence with neurologic
deterioration. MRI may be performed as an outpatient if the patient has
worsening or prolonged duration of symptoms after the initial evaluation.
Preliminary evidence reveals that functional MRI as well as proton
magnetic resonance spectroscopy and diffusion tensor imaging may identify
abnormalities associated with cognitive deficits. These imaging modalities
are quite specific and not currently accessible at most centers.
Management. If the injury occurs during a sporting event, an on-field or
sideline evaluation is done to determine disposition. If there is no licensed
healthcare provider immediately available to make that determination, the
patient should be removed from participation. This necessitates a complete
evaluation by a physician, which may involve an ED visit. As with any
trauma evaluation, the initial assessment should focus on Airway,
Breathing, Circulation, Disability, and Exposure per trauma guidelines.
Please review Chapter 7 A General Approach to the Ill or Injured Child for
additional details.
After excluding ciTBI or other traumatic injuries, strategic concussion
management includes symptomatic relief and restriction of activity with
physical and cognitive rest. Most authors recommend a graduated return to
activities. Judicious use of pain medication and antiemetics should be

recommended as not to mask symptoms. Their use may be necessary, but
should be taken into account when recommending return to activities. Most
consensus statements recommend returning to physical activities once the