Does This Child Have a Concussion?

Which clinical history and physical examination findings are most accurate for identifying concussion in children and adolescents after a plausible mechanism of injury?In this systematic review and meta-analysis of 23 observational studies, symptoms that most increased the likelihood of concussion included mental fog, noise sensitivity, light sensitivity, and nausea, which each had high specificity and positive likelihood ratios. Oculomotor examination abnormalities—particularly abnormal near-point convergence, smooth pursuits, and saccades—also increased the likelihood of concussion but were present infrequently; absence of headache was the most useful finding for decreasing the likelihood of concussion.No single symptom or sign is sufficient to confirm or exclude concussion; however, specific symptoms and oculomotor abnormalities meaningfully shift diagnostic probability and support a clinical diagnosis when integrated into structured assessment tools for pediatric concussion.

Corresponding Author: Sonal N. Shah, MD, MPH, Division of Emergency Medicine, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115 (sonal.shah@childrens.harvard.edu).

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