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Pediatric Concussion: Practice Pearls

Pediatric Concussion: Practice Pearls

The patient is a 14-year-old volleyball player who, 2 nights ago, collided with an opponent and struck her head. She did not lose consciousness and she has no amnesia surrounding the event, but she has “felt fuzzy” since the incident. It is hard for her to concentrate and she has had a constant headache. She does not like taking medicine and has not tried anything for her pain. She appears quite comfortable, is appropriate, and is smiling.

The examination is completely normal: there is no hemotympanum, her fundi appear normal, and her vision is baseline. Neurologically, she is normal. She has no facial asymmetry, no pronator drift, no Romberg sign. Speech, gait, and mentation are normal. Cranial nerves 2 through 12 are intact; her Glascow Coma Score is 15.

Her next volleyball game is later today and she vehemently wants to play. Her mother is nervous and thinks her daughter needs a CT scan because without it “she will be worried all the time.” She has been waking her daughter every 2 hours for the past 2 evenings “just to make sure she was ok.”

What’s the next step?

1. Refer the patient to the ED. (They see everything in the ED.)
2. Send her for CT imaging. (If you don’t, her mom will find somebody who will.)
3. Send the patient to a neurologist. (Neurologists specialize in headaches.)
4. Tell the mom that the decision about when her daughter can return to play is up to her trainer or coach.
5. Suggest that the mom ask for your partner next time.

(Click here for answer and discussion)

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