– [Presenter 1] CDC, a young
boy rubs the top of his head. A red spiral rotates above his head. A woman runs toward him. Then a boy sitting in front of
a fallen bike rubs his head. Another boy rubs his head
while standing between puddles of water on the floor. – [Presenter 2] Traumatic brain injuries, including mild traumatic
brain injuries, MTBI, are a major problem for children. – [Presenter 1] A head with a
visible brain whips backwards, the front and back part
of the brain lights up and a lightning bolt flashes
in the middle of the brain. – [Presenter 2] This injury leads to pathophysiologic injuries
and associated symptoms that can result in poor
physical, cognitive or psychological function. – [Presenter 1] A woman
wearing a white coat named Dr. Maggie talks on the phone as she sits behind a desk.
– [Presenter 2] In this video, we'll explore the current
diagnostic criteria and unique considerations
for MTBI in children. – [Presenter 1] A flow chart
for the six criteria appears – [Presenter 2] In 2023,
the American Congress of Rehabilitation Medicine
or ACRM published an updated diagnostic algorithm for MTBI
that includes six criteria. Criterion one, there must be a
plausible mechanism of injury reported through direct
observation or witness report. – [Presenter 1] The number
eight football player tackles the number 23 football player. – [Presenter 2] This may include an external force to
the head or to the body that causes the brain
to move back and forth or a transfer of energy to the brain from a blast or explosion.
If a plausible mechanism
of injury is established, healthcare providers should
review the other criteria in the algorithm. Criterion two, one or more clinical signs that present immediately after the injury. – [Presenter 1] A young
girl slumps over her desk. A baseball player stares blankly
and shrugs his shoulders. A text bubble above a lacrosse
player reads, "I don't know." – [Presenter 2] These may
include loss of consciousness, alteration of mental status,
such as acting confused, disoriented or dazed,
complete or partial amnesia, acute neurological signs such as motor in coordination or seizure.
Criterion three, two or more
new or worsening acute symptoms that present immediately after or up to 72 hours post-injury. – [Presenter 1] A question
mark pops up in a text bubble over a boy's head standing
in front of lockers. A girl presses her forehead
with the palm of her hand. A text bubble above a boy
reads, "What day is it?" A boy frowns and his face turns red. – [Presenter 2] These
may include alteration and mental status, physical
symptoms such as headache, nausea, dizziness or balance problems.
Cognitive symptoms such
as feeling slowed down, difficulty concentrating
or memory problems. Emotional symptoms such as emotional liability or irritability. – [Presenter 1] Text, criterion four, clinical examination and
laboratory findings, one or more. – [Presenter 2] Criterion
four, abnormal clinical examination or laboratory findings. – [Presenter 1] A woman
writes on a clipboard as she leans down to a young girl. A girl looks down as she walks slowly. A text bubble above a
girl reading a book reads, "Things look kind of fuzzy." – [Presenter 2] This may
include cognitive impairment on acute clinical examination,
balance impairment on acute clinical examination,
oculomotor impairment or symptom provocation in response to vestibular ocular-motor challenge on acute clinical examination.
Elevated blood biomarker levels indicative of intracranial injury. Criterion five, abnormal
neuroimaging findings. – [Presenter 1] A person
in scrubs looks at images of a brain on two screens. – [Presenter 2] If
completed, this would include intracranial abnormalities on CT or MRI. – [Presenter 1] Text, criterion six, not better accounted for
by confounding factors. – [Presenter 2] Criterion
six, findings in criterion two through five are not better
accounted for by preexisting or co-occurring conditions. The ACRM diagnostic
algorithm also indicates that patients who have a
plausible mechanism of injury and two or more acute symptoms or two or more clinical
or laboratory findings, but do not meet other criteria sufficient for diagnosing an MTBI
should be diagnosed as having a suspected MTBI. – [Presenter 1] Text, MTBI versus TBI. The mild qualifier is not used
if any of the injury severity indicators listed below are present, loss of consciousness duration
greater than 30 minutes. After 30 minutes, a Glasgow Coma Scale, GCS score of less than 13.
Post-traumatic amnesia,
greater than 24 hours. – [Presenter 2] And a patient
should receive a diagnosis of traumatic brain injury
instead of an MTBI or mild TBI. If they experienced a
loss of consciousness greater than 30 minutes post-injury. Have a Glasgow Coma Scale,
GCS of less than 13, 30 minutes post-injury. Experience post-traumatic amnesia for greater than 24 hours post-injury. Future definitions of
TBI will likely include a new classification system that moves away from the
traditional mild, moderate, and severe classification scheme. – [Presenter 1] How MTBIs happen. – [Presenter 2] Now, let's
explore the series of events leading to a pediatric MTBI. – [Presenter 1] A head with a
visible brain whips backwards. The front and back part
of the brain lights up and a lightning bolt flashes
in the middle of the brain. – [Presenter 2] An MTBI
is associated with a force or an impact to the head or
body that causes the brain to accelerate or decelerate
with translational and angular forces. – [Presenter 1] The camera
zooms inside the brain revealing lines extending in
all directions from circles.
The circles flash red and
a lightning bolt appears. – [Presenter 2] These
translational and angular motions stretch the neurons, triggering
a complex cascade of ionic, metabolic and physiologic
events often resulting in microscopic axonal disfunction. So why are MTBIs and pediatric populations
especially common? – [Presenter 1] A young
boy sitting on the floor picks up a block. – [Presenter 2] Reason
one, a developing brain. Children's brains are still developing, with less white matter,
myelination and synaptic pruning. These factors make children's
brains more susceptible to stretching as well as chemical and metabolic changes
associated with MTBI. – [Presenter 1] A figure
splits into muscles, nerves, organs, a skeleton and then a black form. – [Presenter 2] Reason
two, a developing body. Children have less developed musculature, including cervical and shoulder muscles, making them less able to
absorb mechanical energy. – [Presenter 1] A boy walks past trees.
– [Presenter 2] Reason three, curiosity. Children are naturally curious and engage in more risk taking behavior. – [Presenter 1] The boy balances on a log fallen across a stream. He loses his balance and
falls into the water. – [Presenter 2] While this
trait supports learning and development, it
also increases the risk of injury including MTBI. – [Presenter 1] A boy with an
exposed brain walks forward. – [Presenter 2] Most children
who experience an MTBI will have a good recovery,
but for some, an injury to the developing brain can
disrupt a child's development and negatively impact
behavior and cognitive skills, potentially altering
developmental trajectories across multiple domains. – [Presenter 1] The scene
returns to Dr. Maggie talking on the phone. – [Presenter 2] As a healthcare provider, your role is crucial in
providing the best possible medical care to children affected by MTBI. To ensure positive outcomes
for their long-term recovery. – [Presenter 1] Text, click
the next button to continue. An arrow points to the
bottom right hand corner..