Evaluating for Pediatric Concussion

This episode of JAMA Clinical Reviews explores the diagnosis and management of pediatric concussion, featuring Dr. Sonal Shah, an assistant professor of pediatrics and emergency physician at Boston Children's Hospital. The discussion begins with a detailed explanation of the biomechanical and metabolic changes in the brain following head impact, including ionic fluxes, cerebral blood flow alterations, and neuronal dysfunction that underlie concussion symptoms. Dr. Shah emphasizes the importance of immediate sideline evaluation using tools like the SCAT-6, highlighting red flags such as loss of consciousness, seizures, severe headache, and abnormal neurological signs that necessitate urgent medical assessment. She then details key diagnostic indicators in the clinical setting, noting that symptoms like headache, dizziness, nausea, and light sensitivity are most predictive of concussion when reported within the first 24–72 hours. Ocular motor abnormalities—particularly near-point convergence, smooth pursuits, and saccades—emerge as highly reliable bedside signs. The episode also covers the role of multimodal assessment tools like SCAT-6 and child SCAT-6, which should be administered by trained clinicians within 72 hours of injury. For return-to-play decisions, persistent symptoms such as delayed reaction time, visual motion sensitivity, and abnormal balance testing beyond one week post-injury are strong indicators that a child should remain out of sport. The episode concludes with a call to integrate these high-yield clinical tools into routine practice to improve early diagnosis, accelerate recovery, and support safe return to activity.