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Kuppermann 2009

Acute imaging


Diagnostic radiology

The Concussion Care Process Model Team recommends following the Kuppermann (2009) clinical decision rule (CDR) when deciding to obtain a CT for a child with a sports related concussion. In general, children with a GCS = 15 who do not have evidence of a basilar skull fracture are not candidates for radiologic imaging. McCrory et al. (2013) state in the Zurich Consensus Statement that “acute clinical symptoms largely reflect a functional disturbance rather than a structural injury and as such, no abnormality is seen on standard structural neuroimaging studies.” Meehan (2011) reiterates that the adverse effects of radiologic testing may be worse than the index injury.

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These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly these guidelines should guide care with the understanding that departures from them may be required at times.