Isch Emily L, Schillinger Kristen, Monzy Judith N, Galantini Gianfranco, Self Dwight Mitchell, Habarth-Morales Theodore E, Caterson Edward J
Department of General Surgery, Thomas Jefferson University Hospital, Philadelphia, PA.
Department of Surgery, Division of Plastic Surgery, Nemours Children's Hospital Wilmington, DE.
J Craniofac Surg. 2024 Nov 1. doi: 10.1097/SCS.0000000000010837.
Pediatric concussions, particularly in youth sports, are a significant public health concern, with up to 18% of children experiencing one by age 17. Return-to-play (RTP) guidelines aim to protect athletes from the adverse effects of repeated injuries, but these protocols vary widely based on factors such as age, sport, and geography. This review synthesizes current literature on RTP guidelines for pediatric concussions to provide evidence-based recommendations.
A systematic search of PubMed was conducted using Medical Subject Headings (MeSH) terms "return to play," "pediatric concussion," and "mild traumatic brain injury." Studies published between January 2000 and December 2023 were included if they focused on RTP protocols for children aged 5 to 17. After screening 60 articles, 45 were selected for review. Study quality was assessed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias Tool.
RTP protocols showed significant variability influenced by age, gender, and sport type. Common themes included initial rest followed by a gradual return to activity. Female athletes generally required longer recovery periods. Multidisciplinary care and early therapeutic interventions, such as vestibular therapy, were associated with better outcomes and faster recovery.
There is a need for standardized, evidence-based RTP guidelines to address inconsistencies in concussion management. Future research should focus on creating universally applicable protocols, with attention to gender, sport-specific factors, and early intervention to improve recovery outcomes for young athletes.
小儿脑震荡，尤其是在青少年体育运动中，是一个重大的公共卫生问题，多达18%的儿童在17岁前经历过一次脑震荡。重返比赛（RTP）指南旨在保护运动员免受反复受伤的不利影响，但这些方案因年龄、运动项目和地理位置等因素而有很大差异。本综述综合了当前关于小儿脑震荡RTP指南的文献，以提供基于证据的建议。
使用医学主题词（MeSH）“重返比赛”、“小儿脑震荡”和“轻度创伤性脑损伤”对PubMed进行系统检索。纳入2000年1月至2023年12月发表的研究，如果它们关注5至17岁儿童的RTP方案。在筛选60篇文章后，选择45篇进行综述。使用纽卡斯尔-渥太华量表和Cochrane偏倚风险工具评估研究质量。
RTP方案显示出受年龄、性别和运动类型影响的显著差异。常见主题包括最初休息，随后逐渐恢复活动。女运动员通常需要更长的恢复期。多学科护理和早期治疗干预，如前庭治疗，与更好的结果和更快的恢复相关。
需要标准化的、基于证据的RTP指南来解决脑震荡管理中的不一致问题。未来的研究应专注于制定普遍适用的方案，关注性别、特定运动因素和早期干预，以改善年轻运动员的恢复结果。
