Concussion: Why Nurses Need to Understand This Hidden Injury

Ann Worley


Pediatr Nurs. 2019;45(5):235-243. 

In This Article

Abstract and Introduction


On the spectrum of brain injury classification, a concussion is labeled as a "mild traumatic brain injury" (mTBI), yet if not managed properly, it can lead to prolonged symptoms, and less commonly, to serious chronic impairments. Concussions are not revealed on standard neuro-imaging, and symptoms can be numerous, variable, and often subtle; thus, it is referred to as 'the hidden injury.' Children experiencing a concussion often exhibit unique vulnerabilities and challenges in the context of a developing brain. In the face of an increasing incidence of concussions in children and adolescents, and concerns about sports participation by parents and caregivers, it is crucial that pediatric nurses be knowledgeable about current recommendations and best practice to recognize, manage, and educate patients, families, and significant others to promote best outcomes.


Traumatic brain injuries (TBIs) are a leading cause of morbidity and mortality in the United States. Although a wide variation of brain injury statistics exists in the literature, Taylor, Bell, Breiding, and Xu (2017) reported that approximately 2.8 million TBI-related emergency department (ED) visits, hospitalizations, and deaths occurred in the United States in 2013. The incidence of sports-related concussions in children/adolescents age 19 years and under more than doubled from 2001 to 2012 (Centers for Disease Control and Prevention [CDC], 2017b). Leading causes of all TBI-related ED visits, hospitalizations, and deaths in 2013 per the CDC were falls (47%), being struck by or against an object (15%), motor vehicle collisions (14%), and intentional self-harm (33%); however, these statistics vary by age (CDC, 2017b). Approximately 75% to 90% of TBIs are concussions, classified as 'mild' or mTBIs (Gioia, Collins, & Isquith, 2008; Watts, Gibbons, & Kurzweil, 2011). For this article, both 'concussion' and 'mTBI' will be used interchangeably. The term 'mild' tends to diminish its seriousness, yet a concussion can cause potentially serious lasting effects. Unlike the devastatingly severe forms of TBI, a concussion is insidious in nature because symptoms are often subtle, varied, and nonspecific. As a result, many concussion injuries go undiagnosed and untreated.

Pediatric nurses need to understand the unique vulnerabilities of the child's and the adolescent's developing brain, as well as the risk of prolonged and even potentially life-long sequelae resulting from failure to appropriately identify and manage this injury. Early recognition and intervention are key in promoting optimal recovery. Although much of the content of this article focuses on sports-related concussions and management, the purpose is to close the knowledge gaps that exist among pediatric nurses about concussions from all causes, and to provide a review of pertinent facts to help them recognize and manage concussions and educate patients/families.