Pediatric Concussion Severity Scale

The Pediatric Concussion Severity Scale is a clinical tool designed to assess the severity of a concussion in children and adolescents following a head injury. Concussions are a form of mild traumatic brain injury (mTBI) that can occur due to a blow to the head, a fall, or any activity that causes the brain to move rapidly within the skull. In pediatric patients, concussions are of particular concern because their brains are still developing, and symptoms can vary widely. The Pediatric Concussion Severity Scale helps healthcare providers evaluate the extent of a concussion, guide management, and determine when it is safe for a child to return to normal activities, including sports and school.

What is a Concussion?

A concussion is a type of traumatic brain injury that disrupts normal brain function. It occurs when the brain is jolted or shaken inside the skull due to a direct blow to the head, face, neck, or elsewhere on the body with an impulsive force transmitted to the head. Symptoms can range from mild to severe and can include headaches, dizziness, confusion, memory problems, nausea, fatigue, sleep disturbances, mood changes, and sensitivity to light or noise. Concussions are often classified as mild traumatic brain injuries, but their impact can be significant, especially in children.

How the Pediatric Concussion Severity Scale Works

The Pediatric Concussion Severity Scale is a comprehensive tool that takes into account various symptoms, signs, and risk factors to provide a structured assessment of concussion severity. The scale evaluates both the immediate signs and symptoms following the injury and the ongoing symptoms that may develop or persist over time. This information helps clinicians to categorize the concussion severity and tailor management plans accordingly.

The scale generally includes the following components:

• Initial Assessment of Symptoms and Signs: This includes the evaluation of acute symptoms immediately following the injury, such as loss of consciousness (LOC), amnesia, confusion, disorientation, and balance disturbances. Each symptom is scored based on its presence, duration, and intensity.
• Post-Concussion Symptoms: The scale assesses ongoing symptoms that may persist or develop in the hours, days, or weeks following the concussion. These symptoms can include headaches, dizziness, fatigue, irritability, difficulty concentrating, and sleep disturbances. Symptoms are graded based on their severity and impact on daily activities.
• Cognitive Function: The scale evaluates cognitive symptoms, such as memory loss, attention deficits, and slower reaction times, using specific cognitive tasks or standardized tools like the Standardized Assessment of Concussion (SAC) or the Child SCAT5 (Sport Concussion Assessment Tool).
• Physical Examination Findings: Physical examination focuses on neurological signs, balance testing (such as the Balance Error Scoring System – BESS), and other indicators of brain function. Abnormalities are noted and contribute to the overall severity score.
• Risk Factors for Prolonged Recovery: The scale takes into account risk factors that could indicate a prolonged recovery or more severe injury. These factors may include a history of previous concussions, age (younger children tend to have longer recovery periods), a history of migraines, learning disabilities, ADHD, and psychiatric disorders.

Based on the scoring of these components, the Pediatric Concussion Severity Scale assigns an overall score that helps classify the concussion into categories such as mild, moderate, or severe. This categorization guides clinical decisions regarding further imaging (e.g., CT scan), observation, treatment, and return-to-play or return-to-learn protocols.

How to Use the Pediatric Concussion Severity Scale

To use the Pediatric Concussion Severity Scale, healthcare providers follow a structured approach:

• Collect Detailed History: This includes understanding the mechanism of injury, initial symptoms, and whether there was a loss of consciousness, amnesia, or other acute symptoms.
• Conduct a Symptom Evaluation: The provider administers a detailed symptom checklist that covers common concussion-related symptoms such as headache, dizziness, nausea, balance issues, cognitive difficulties, and emotional symptoms.
• Perform Cognitive and Physical Assessments: Standardized cognitive assessments like the Child SCAT5 are used to evaluate memory, concentration, and cognitive function. Physical assessments focus on balance, coordination, and neurological signs.
• Assess Risk Factors: The presence of risk factors for prolonged recovery is documented, which may influence management decisions and recovery expectations.
• Calculate the Severity Score: Scores are assigned to each symptom and assessment finding, and a total score is calculated to categorize the severity of the concussion.
• Formulate a Management Plan: Depending on the severity score, the clinician decides on the appropriate level of care. Mild cases may be managed with rest and gradual return to activities, while moderate or severe cases may require further imaging, specialist referral, or more extended periods of rest and rehabilitation.