Experience symptoms 

one month post-injury

Experience symptoms

three months post-injury

Experience symptoms 

one year post-injury

Symptoms of mTBI generally fall into four categories:

Symptom resolution:

• Somatic • Cognitive • Mood/Affective • Sleep

mTBI in children

30% 10% 5%

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. 

CDC PEDIATRIC mTBI GUIDELINE

Prognostic Recommendations

Counseling patients 

on prognosis

Use of tools for 

predicting prognosis

Interventions for 

poor prognosis

Assessing for 

risk factors

Evaluating for 

premorbid conditions

This handout for healthcare providers describes prognosis-related 

recommendations contained in the CDC Pediatric mTBI Guideline.

RECOMMENDATIONS FOR THE PROGNOSIS OF mTBI

Five sets of prognostic recommendations are included in the Guideline. These recommendations focus on: 
GENERAL HEALTHCARE PROVIDER 

COUNSELING OF PROGNOSIS

PROGNOSIS RELATED TO PREMORBID CONDITIONS

Evidence suggests education and clear communication from 

healthcare providers can optimize outcomes.

There is an increased risk of delayed recovery or prolonged symptoms associated with certain premorbid 

conditions in children with mTBI.

• Healthcare providers should counsel patients and families 

that the large majority (70-80%) of children with mTBI do 

not show significant difficulties that last more than 1-3 

months post-injury. 

• Healthcare providers should counsel patients and families that 

although some factors predict an increased or decreased risk 

for prolonged symptoms, each child’s recovery from mTBI 

is unique and will follow its own trajectory.

• Healthcare providers should assess the premorbid history of children either prior to an injury, as a part of 

pre-participation athletic examinations, or as soon as possible post-injury in children with mTBI, to assist 

in determining prognosis.

• Healthcare providers should counsel children and families completing pre-participation athletic examinations, 

and children with mTBI and their families, that recovery from mTBI might be delayed in those with:

www.cdc.gov/HEADSUP

- Premorbid histories of mTBI

- Lower cognitive ability (for children 

with an intracranial lesion)

- Neurological or psychiatric disorder

- Learning difficulties

- Increased pre-injury symptoms 

(such as headache disorders)

- Family and social stressors

FACTORS ASSOCIATED WITH 

POOR PROGNOSIS:

- Older children or adolescents

- Children of Hispanic ethnicity

- Children from a lower socioeconomic status

- Children with more severe presentations of 

mTBI (including those associated with an 

intracranial injury)

- Children who report a higher level of acute 

postconcussion symptoms

- Children with a neurological or psychiatric disorder

- Children with learning difficulties

- Children with family and social stressors

ASSESSMENT OF CUMULATIVE 

RISK FACTORS AND PROGNOSIS

Evidence indicates that a variety of demographic and injury-related 

factors predict outcomes in pediatric mTBI.

• Healthcare providers should screen for a variety of known 

risk factors for persistent symptoms in children with mTBI. 

• Healthcare providers may use validated prediction rules, which 

combine information about multiple risk factors for persistent 

symptoms, to provide prognostic counseling to children with 

mTBI evaluated in emergency department settings. 

CDC PEDIATRIC mTBI GUIDELINE: Prognostic Recommendations

CDC PEDIATRIC mTBI GUIDELINE

Prognostic Recommendations
INTERVENTIONS FOR mTBI 

WITH POOR PROGNOSIS

ASSESSMENT TOOLS AND PROGNOSIS

While most symptoms of mTBI resolve within 1-3 months, some children are at 

risk for persistent symptoms or delayed recovery. Children who are at higher 

risk for delayed recovery are more likely to need further intervention.

Healthcare providers can more effectively counsel patients with mTBI when they have assessed risk factors for 

outcomes and recovery. However, there is no single assessment tool to predict outcomes.

• Healthcare providers should monitor children with mTBI who are 

determined to be at high risk for persistent symptoms based on 

premorbid history, demographics, or injury characteristics. 

• For children with mTBI whose symptoms do not resolve as expected 

with standard care (i.e., after 4-6 weeks), healthcare providers should

provide or refer for appropriate assessments or interventions. 

• Healthcare providers should use a combination of tools to assess recovery in children with mTBI. 

• Healthcare providers should use validated symptom scales to assess recovery in children with mTBI. 

• Healthcare providers may use validated cognitive testing (including measures of reaction time) to

assess recovery in children with mTBI.

• Healthcare providers may use balance testing to assess recovery in adolescent athletes with mTBI.

To view all 19 sets of recommendations, including those that cover diagnosis and management and 

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: Prognostic Recommendations www.cdc.gov/HEADSUP

CDC PEDIATRIC mTBI GUIDELINE

Prognostic Recommendations

EXAMPLES OF VALIDATED SCALES 

INCLUDE, BUT AREN’T LIMITED TO:

• Post-Concussion Symptom Scale

• Health and Behavior Inventory

• Post-Concussion Symptom Inventory

• Accute concussion Evaluation
CDC PEDIATRIC mTBI GUIDELINE: Prognostic Recommendations www.cdc.gov/HEADSUP