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Ontario Neurotrauma Foundation issues first pediatric concussion living guideline

September 11, 2019

The Ontario Neurotrauma Foundation (ONF) has issued the first Living Guideline for Diagnosing and Managing Pediatric Concussion. The guideline, targeted at healthcare providers, offers a series of recommendations to help children and adolescents get back to their everyday life.

This is the first ONF clinical practice guideline to be available in a fully digital version, ensuring it will be quickly available to those who can use it. Clinicians are provided with 22 tools and a broad range of recommendations in the 14 domains covered in the guideline. The new guideline replaces one originally published by ONF in 2014.

An expert panel facilitated and funded by ONF and led by Dr. Nick Reed (Associate Professor, Department of Occupational Science and Occupational Therapy, University of Toronto and Adjunct Scientist, Holland Bloorview Kids Rehabilitation Hospital,) and Dr. Roger Zemek (Senior Scientist, CHEO Research Institute and Professor, University of Ottawa) included more than 50 experts in childhood and adolescent concussion from Canada and the United States. Expert panel members represented various clinical disciplines such as physicians, nurses, diagnosticians, rehabilitation specialists, etc.

Facts about children and concussion   

  • There are more than 35, 000 pediatric (children and adolescents under the age of 18) visits for concussion in Ontario every year.
  • For the majority of children and adolescents,  concussion symptoms will resolve in the first 1-4 weeks.
  • After a brief period of rest (24-48 hours), most children and adolescents are encouraged to resume a graduated return to school and low-risk physical activities, as can be tolerated and in consultation with a health professional.
  • Injury during sports and recreational activities are the most frequent cause of concussion in children and adolescents.
  • Injuries to children and adolescents lead to a loss of work-time for parents and caregivers.


ONF has been happy to facilitate the development of this evidence-based Guideline as the funder. There was a real need for a pediatric-focused guideline that is based on research. We look forward to supporting the implementation of the guideline recommendations across the province and further, working with our national and international partners. The first edition has been widely referenced throughout the world; we are pleased to be a leader in the development of clinical-practice guidelines and hope this “living format” has an even broader reach to improve the quality of pediatric concussion care.

Judy Gargaro – Program Director, Acquired Brain Injury

Why a living guideline?

A living guideline is developed and maintained in an interactive digital format through a continual process of review, evaluation and revision by a group of clinical experts. The ONF Living Guideline for Diagnosing and Managing Pediatric Concussion will be updated as research supporting change in clinical practice becomes available. Practically, this means the guideline or parts of it could be updated as often as every few months.

From our partners

Every month we learn more about how to better treat children and youth with concussion due to ground-breaking clinical research, much of which is being led out of Canada.  Prior recommendations used to demand that children simply rest, which was often misinterpreted as home jail.  We now know that to improve recovery, it is important that children remain physically active and engaged in school as they recover from concussion, while ensuring their activities remain as safe as possible.

Dr. Roger Zemek – Senior Scientist, CHEO Research Institute | Emergency physician, CHEO | Professor, University of Ottawa

Children, adolescents and their families are seeking care for concussion at higher rates than ever before.  In order to meet their needs, health-care professionals require a trustworthy, evidence-based and easy to use way to know how to best support their patients.  This guideline is a ‘one stop shop’ for health care professionals to provide the right care, in the right way and at the right time when diagnosing and managing concussion in children and adolescents.

Dr. Nick Reed – Associate Professor, Department of Occupational Science and Occupational Therapy, University of Toronto, Adjunct Scientist Holland Bloorview Kids Rehabilitation Hospital

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