children

Importance: Concussion is a mild traumatic brain injury with associated abnormalities in brain function, rather than structural injury. An estimated 1.1 million to 1.9 million pediatric concussions occur annually in the US.

Objective: To determine the accuracy of clinical history and physical examination findings for identifying concussion in children and adolescents who have had a plausible mechanism of injury.

Data sources and study selection: PubMed, Embase, ClinicalTrials.gov, Cochrane Library, CINAHL, Web of Science, and Google Scholar were searched from January 2002 through December 2025 without language restrictions. Observational studies including patients aged 2 to 18 years evaluated for concussion in outpatient, emergency, or inpatient settings were included.

Data extraction and synthesis: Four reviewers independently extracted study characteristics and diagnostic accuracy data and assessed study quality with the Rational Clinical Examination levels of evidence.

Main outcomes and measures: Sensitivity, specificity, and likelihood ratios (LRs) for symptoms and physical signs associated with concussion were calculated using random-effects meta-analysis when summary measures were appropriate.

Results: Of 7110 screened abstracts, 23 studies (level 4 evidence; case-control design) met inclusion criteria. The presence of mental fog (LR, 11.8-12.0; specificity, 0.96), noise sensitivity (LR, 6.9; 95% CI, 3.6-13.1; specificity, 0.94), nausea (LR, 6.7; 95% CI, 3.1-14.6; specificity, 0.93), and light sensitivity (LR, 6.4; 95% CI, 2.1-19.7; specificity, 0.93) were most useful for increasing the likelihood of a concussion diagnosis. The absence of headache was the most useful symptom for decreasing the likelihood of concussion (LR, 0.20; 95% CI, 0.10-0.39; sensitivity, 0.74). Signs that increased the likelihood of concussion were abnormal near-point convergence, which is the inability to maintain ocular convergence on a near target (LR, 7.0; 95% CI, 2.0-24.9; specificity, 0.97); abnormal smooth pursuits, which are jerky, irregular eye movements when tracking a target (LR, 6.5; 95% CI, 2.4-17.5; specificity, 0.96); and saccades, which are inaccurate or slow eye movements with overshooting or undershooting when looking between 2 or more targets (LR, 4.8; 95% CI, 1.8-13.1; specificity, 0.92); however, none of these findings had a sensitivity of more than 0.40. A consensus statement by the International Conference on Concussion in Sport recommends the Sport Concussion Assessment Tool to systematize the comprehensive evaluation of patients with symptoms concerning for concussion.

Conclusions and relevance: While no single finding was sufficient to confirm or exclude concussion, the presence of mental fog, noise and light sensitivity, nausea, or ocular abnormalities were most useful to identify patients more likely to have had a concussion, while absence of a headache made a concussion less likely. These symptoms and signs are integrated into structured clinical assessments to support the clinical diagnosis and management of pediatric concussion.

Many of these injuries are preventable by taking simple steps to make your home safer and knowing what to do when a fire occurs. Most accidental home fires start from cooking, heating equipment, electrical items, or smoking materials. Never leave food unattended on the stove while cooking. Use the back burners, when possible, to keep the hot stove surface and the hot pots and pans out of young children’s reach. Keep a fire extinguisher readily available in the kitchen, and make sure all caregivers know how to use it. Place space heaters away from anything that can catch fire, and always turn them off before going to bed or leaving the room. Ensure fireplaces and wood stoves are screened so that young children are not accidentally burned. This ensures embers stay inside, too. To prevent electrical fires, cover all unused electrical outlets, avoid overloading outlets, and replace any old cords. If you smoke, avoid doing so in the home, especially in bed. Carefully dispose of smoking waste, such as cigarette butts, used matches, and ashes.

If there is a fire, a smoke alarm can warn you to leave the home early and safely. Ensure that a smoke alarm is present on each floor and near every bedroom, avoiding areas like the kitchen to prevent false alarms. Check your smoke alarms monthly and change the batteries once a year unless your alarm has long-life batteries. If you need help, the local fire department can check your fire alarms and can often provide free new ones or replacements. Families with caregivers or children with hearing impairments should use alarms that include flashing lights.

Carbon monoxide is a poisonous gas created from fuel-burning heaters, cars, generators, and appliances. Many smoke alarms are combined with carbon monoxide detectors. If your smoke alarms are not, install a separate carbon monoxide detector on each floor of your home.

A fire escape plan prepares families to understand how to safely exit each room in the home during a fire. To create a fire escape plan, draw a simple map of your home showing 2 escape routes from each room. If you live in an apartment, talk to your children about the importance of using the stairs and avoiding elevators during fires. Establish a common meeting place outside the house. Review the plan with your whole family and with caregivers, such as babysitters, so everyone knows what to do. Practice your escape plan every 6 months so everyone becomes familiar. Children younger than 5 years will need a caregiver to help them during a fire.

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Pediatric healthcare update from OUHSC Family Medicine Grand Rounds.