Childrens’ developing brains are more 

vulnerable to mTBI because:

CDC PEDIATRIC mTBI GUIDELINE

Diagnostic Recommendations

This handout for healthcare providers describes diagnosis-related 

recommendations contained in the CDC Pediatric mTBI Guideline.

GOAL OF THE CDC mTBI GUIDELINE

The goal of the CDC Pediatric Mild Traumatic Brain Injury (mTBI) 

Guideline is to help healthcare providers take action to improve 

the health of their pediatric patients with mTBI. To do this, the 

Guideline consists of 19 clinical recommendations that cover 

diagnosis, prognosis, and management and treatment. These 

recommendations are applicable to healthcare providers working 

in: inpatient, emergency, primary, and outpatient care settings. 

The Guideline was developed through a rigorous process guided 

by the American Academy of Neurology methodology and 2010 

National Academy of Sciences methodology for the development 

of evidence-based guidelines. An extensive review of scientific 

literature, spanning 25 years of research, formed the basis of 

the Guideline. 

Their axons are not 

as well-myelinated.

They are more 

susceptible to chemical 

and metabolic changes.

Six sets of diagnostic recommendations are included in the Guideline. These recommendations focus on: 

Neuroimaging Neuropsychological tools Serum Biomarkers

RECOMMENDATIONS FOR THE DIAGNOSIS OF mTBI

mTBI in children
www.cdc.gov/HEADSUP

NEUROIMAGING

Clinical evaluation of a child with possible mTBI includes balancing 

the likelihood of potentially devastating complications of a more 

severe injury against the risks associated with a head CT. 

Computed Tomography (CT)

• Healthcare providers should not routinely obtain a head CT 

for diagnostic purposes in children with mTBI.

• Healthcare providers should use validated clinical decision 

rules to identify children with mTBI at low risk for intracranial 

injury (ICI), in whom a head CT is not indicated, as well as 

children who may be at higher risk for clinically important ICI, 

and therefore may warrant a head CT. Existing decision rules 

combine a variety of factors that, when assessed together, 

may increase the risk for more serious injury. Such risk factors 

include the following:

There is currently insufficient evidence to recommend the use of brain MRI in the diagnosis of mTBI in children.

Insufficient evidence currently exists to recommend the use of SPECT in the diagnosis of mTBI in children.

CT is better at detecting intracranial injuries, and in the instances where CT is not available, validated clinical 

decision rules are better than skull X-rays when screening patients with increased risk for ICI.

Magnetic Resonance Imaging (MRI)

Single Photon Emission Computed Tomography (SPECT)

Skull X-rays

• Healthcare providers should not routinely use MRI in the acute evaluation of cases of suspected or diagnosed mTBI. 

• Healthcare providers should not use SPECT in the acute evaluation of cases of suspected or diagnosed mTBI. 

• Skull X-rays should not be used in the diagnosis of pediatric mTBI.

• Skull X-rays should not be used in the screening for ICI.

• For children diagnosed with mTBI, healthcare providers 

should discuss the risk of a pediatric head CT in the context 

of risk factors for ICI with the patient and his/her family. 

- Age < 2 years old

- Loss of consciousness

- Severe mechanism of injury

- Vomiting

- Amnesia

- Clinical suspicion for 

skull fracture

- Severe or worsening 

headache

- Nonfrontal scalp hematoma

- Glasgow Coma Score < 15

CDC PEDIATRIC mTBI GUIDELINE

Diagnostic Recommendations

CDC PEDIATRIC mTBI GUIDELINE: Diagnostic Recommendations

It is critical to rule out ICI while avoiding 

unnecessary risks related to exposure from a head 

CT. Strong clinical evidence indicates that use of 

clinical decision rules are effective in identifying 

children at low risk for ICI. 

USE VALIDATED CLINICAL DECISION 

RULES TO IDENTIFY ICI
NEUROPSYCHOLOGICAL TOOLS

There are several validated tools that can be applied quickly 

and inexpensively.

There is insufficient evidence to determine whether baseline 

testing in children better identifies mTBI as compared to postinjury scores alone.

There is insufficient evidence to support the use of the SAC 

in the diagnosis of children with mTBI.

Symptom Scales

Computerized Cognitive Testing

Standardized Assessment of Concussion (SAC)

• Healthcare providers should use an age-appropriate, 

validated symptom rating scale as a component of the 

diagnostic evaluation in children presenting with acute mTBI. 

• Healthcare providers may use validated, ageappropriate computerized cognitive testing in 

the acute period of injury as a component of the 

diagnosis of mTBI. 

There is insufficient evidence to currently recommend any of the studied biomarkers for the diagnosis of mTBI in children.

Serum Biomarkers

• Healthcare providers should not perform these tests outside of a research setting at this time for the 

diagnosis of children with mTBI. 

SERUM BIOMARKERS

To view all 19 sets of recommendations, including those 

that cover prognosis and management/treatment, and 

to learn more about the CDC Pediatric mTBI Guideline, 

visit www.cdc.gov/HEADSUP.

Take action to improve the 

health of your young patients 

with mTBI.

CDC PEDIATRIC mTBI GUIDELINE: Diagnostic Recommendations www.cdc.gov/HEADSUP

CDC PEDIATRIC mTBI GUIDELINE

Diagnostic Recommendations

EXAMPLES OF VALIDATED 

SCALES INCLUDE, BUT 

AREN’T LIMITED TO:

• Post-Concussion Symptom Scale

• Health and Behavior Inventory

• Post-Concussion Symptom Inventory

• Acute Concussion Evaluation 
CDC PEDIATRIC mTBI GUIDELINE: Diagnostic Recommendations www.cdc.gov/HEADSUP