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Current evidence for pharmacological management of pediatric concussion: a systematic review

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Abstract

Purpose

Mild traumatic brain injury (mTBI) is a global public health problem and its current management is limited to rest and symptom management. Despite frequent use of drugs for symptom control, there is a lack of consensus on the optimal pharmacological management of post-concussive symptoms. We reviewed the relevant literature to compile the evidence about the pharmaceutical management of pediatric mTBI.

Methods

We performed a systematic review of the literature available in PubMed, Cochrane CENTRAL, and ClinicalTrials.Gov as well as through citation tracing. A modified PICO framework was used for the construction of search strategy and eligibility criteria. Risk of bias was assessed using RoB-2 tool for randomized and ROBINS-I for non-randomized studies.

Results

A total of 6260 articles were screened for eligibility. After exclusions, a total of 88 articles received full text review. A total of 15 reports representing 13 studies (5 randomized clinical trials, 1 prospective randomized cohort study, 1 prospective cohort study, and 6 retrospective cohort studies) met the eligibility criteria and were included in the review. We identified 16 pharmacological interventions in a total of 931 pediatric patients with mTBI. Amytriptiline (n = 4), ondansetron (n = 3), melatonin (n = 3), metoclopramide (n = 2), magnesium (n = 2), and topiramate (n = 2) were investigated in multiple studies. All RCTs were relatively of small size (n ≤ 33/group).

Conclusion

The available evidence supporting pharmacological intervention in pediatric mild traumatic brain injury is scarce. We propose a framework to facilitate future collaborative research efforts to test and validate various pharmacological interventions for acute and persistent post-concussive symptoms in children.

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Data, materials, and code availability

The datasets generated and/or used during this systematic review are available from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. Division of Neurosurgery, Barrow Neurological Institute at Phoenix Children’s Hospital, Phoenix, AZ, USA

    Damla Hanalioglu & Jorge I. Arango

  2. Division of Pediatric Emergency Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey

    Damla Hanalioglu

  3. Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA

    Sahin Hanalioglu

  4. Department of Neurosurgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey

    Sahin Hanalioglu

  5. Department of Neurosurgery, Rockefeller Neuroscience Institute at WVU Medicine, Morgantown, WV, USA

    P. David Adelson

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  4. P. David Adelson
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Contributions

All authors contributed to the study conception and design. Literature search and data analysis were performed by Damla Hanalioglu and Sahin Hanalioglu. The first draft of the manuscript was written by Damla Hanalioglu and Sahin Hanalioglu and all authors commented on previous versions of the manuscript. Jorge Arango and David Adelson critically revised the work. All authors read and approved the final manuscript.

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Correspondence to P. David Adelson.

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This is a systematic review of the current literature. Authors declare that PRISMA guidelines were followed when preparing the manuscript.

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The authors declare no competing interests.

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Hanalioglu, D., Hanalioglu, S., Arango, J.I. et al. Current evidence for pharmacological management of pediatric concussion: a systematic review. Childs Nerv Syst 39, 1831–1849 (2023). https://doi.org/10.1007/s00381-023-05960-x

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