title: Development of a conservative protocol to return children and youth to activity following concussive injury.
abstract: BACKGROUND
  Consensus-based guidelines exist for adult athletes returning to play after concussion, but there are no protocols developed specifically for children. The goal of this knowledge translation research was to develop evidence-based materials to inform physicians about pediatric concussion.
  
  
  METHODS
  A pediatric concussion protocol was developed based on the National Institute for Health and Care Excellence procedures.
  
  
  RESULTS
  This return to activity protocol was developed to guide management when children/youth sustain a concussion. The protocol incorporated 3 main themes: (a) a protocol must include return to all activity, including sport and school; (b) existing consensus-based adult protocols are not appropriate for children; and (c) a more conservative protocol is needed. After pilot testing, the developed protocol is being used across Ontario.
  
  
  CONCLUSIONS
  Implementation of these new pediatric recommendations is an important addition to prevention of subsequent concussions during vulnerable recovery periods, with potential to facilitate recovery by preventing prolonged symptomatology, and secondary sequelae.
authors.affiliation: McMaster University, Hamilton, Ontario, Canada dematteo@mcmaster.ca.
authors.forename: Carol
authors.initials: C
authors.lastname: DeMatteo
authors.affiliation: McMaster University, Hamilton, Ontario, Canada.
authors.forename: Kathy
authors.initials: K
authors.lastname: Stazyk
authors.affiliation: McMaster University, Hamilton, Ontario, Canada McMaster Children's Hospital, Hamilton, Ontario, Canada.
authors.forename: Sheila K
authors.initials: SK
authors.lastname: Singh
authors.affiliation: McMaster University, Hamilton, Ontario, Canada McMaster Children's Hospital, Hamilton, Ontario, Canada.
authors.forename: Lucy
authors.initials: L
authors.lastname: Giglia
authors.affiliation: McMaster University, Hamilton, Ontario, Canada McMaster Children's Hospital, Hamilton, Ontario, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Hollenberg
authors.affiliation: McMaster University, Hamilton, Ontario, Canada McMaster Children's Hospital, Hamilton, Ontario, Canada.
authors.forename: Charles H
authors.initials: CH
authors.lastname: Malcolmson
authors.affiliation: McMaster University, Hamilton, Ontario, Canada McMaster Children's Hospital, Hamilton, Ontario, Canada.
authors.forename: William
authors.initials: W
authors.lastname: Mahoney
authors.affiliation: McMaster University, Hamilton, Ontario, Canada.
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Harper
authors.affiliation: McMaster University, Hamilton, Ontario, Canada.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Missiuna
authors.affiliation: McMaster University, Hamilton, Ontario, Canada.
authors.forename: Mary
authors.initials: M
authors.lastname: Law
authors.affiliation: McMaster Children's Hospital, Hamilton, Ontario, Canada.
authors.forename: Dayle
authors.initials: D
authors.lastname: McCauley
mesh_terms: D000293:Adolescent; D001265:Athletic Injuries / Q000628:therapy*; D001924:Brain Concussion / Q000628:therapy*; D002648:Child; D002985:Clinical Protocols; D006801:Humans; D009864:Ontario; D010372:Pediatrics / Q000379:methods*; D020127:Recovery of Function; D012574:Schools
keywords: child; mild traumatic brain injury/concussion; postconcussion syndrome/recovery; return to activity; return to play