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Module 7: Head Injuries

Segment 3: Concussion

References labeled PEDS contain a pediatric element or primary focus.

Topic: Concussion/mTBI

  • ACS Trauma Quality Improvement Program. Best practice guidelines in imaging. 2018. https://www.facs.org/media/oxdjw5zj/imaging_guidelines.pdf.
  • Baldwin GT, Breiding MJ, Dawn Comstock R. Epidemiology of sports concussion in the United States. Handb Clin Neurol. 2018;158:63-74. doi: 10.1016/b978-0-444-63954-7.00007-0 https://pubmed.ncbi.nlm.nih.gov/30482376/.
  • Banbury C, Harris G, Clancy M, et al. Window into the mind: Advanced handheld spectroscopic eye-safe technology for point-of-care neurodiagnostic. Sci Adv. 2023;9(46):eadg5431. doi: 10.1126/sciadv.adg5431 https://pubmed.ncbi.nlm.nih.gov/37967190/.
  • Benhamed A, Crombé A, Matichard R, et al. Risk factors associated with significant posttraumatic brain hemorrhage as per the QueBIC categories: A retrospective multicenter study. J Trauma Acute Care Surg. 2026;doi: 10.1097/ta.0000000000005090 https://pubmed.ncbi.nlm.nih.gov/42283508/.
  • Bilgin Y, Sari FM, Gunay M, et al. Diagnostic accuracy of GFAP and UCH-L1 for intracranial hemorrhage in blunt head trauma: a prospective study. BMC Emerg Med. 2025;25(1):240. doi: 10.1186/s12873-025-01398-3 https://pubmed.ncbi.nlm.nih.gov/41257604/.
  • Broughton-Miller K, Goshorn K, Fox J, et al. Prevalence of concussion in the admitted trauma patients using systematic screening. J Trauma Nurs. 2026;doi: 10.1097/jtn.0000000000000927 https://pubmed.ncbi.nlm.nih.gov/42335389/.
  • Campbell KR, Antonellis P, Peterka RJ, et al. In people with subacute mild traumatic brain injury, earlier physical therapy improved symptoms at a faster rate than later physical therapy: Randomized controlled trial. Phys Ther. 2024;doi: 10.1093/ptj/pzae180 https://pubmed.ncbi.nlm.nih.gov/39693261/.
  • Elkhodair S, Lalor J, Altaher M, et al. Use of plasma-based brain biomarkers in the emergency department to rule out the need for unnecessary head CT imaging in acute mild traumatic brain injury patients. Am J Emerg Med. 2026;103:152-156. doi: 10.1016/j.ajem.2026.02.013 https://pubmed.ncbi.nlm.nih.gov/41707328/.
  • Gallaher J, Yohann A, Schneider AB, et al. The use of head computerized tomography in patients with GCS 15 following trauma: Less is more. Injury. 2022;53(5):1645-1651. doi: 10.1016/j.injury.2022.02.007 https://pubmed.ncbi.nlm.nih.gov/35190185/.
  • German A, White K, Broadwin M, et al. Safe local management of mild traumatic brain injury: Reducing unnecessary transfers to higher-level trauma centers. Surgery. 2026;197:110372. doi: 10.1016/j.surg.2026.110372 https://pubmed.ncbi.nlm.nih.gov/42361533/.
  • Halabi C, Norton L, Norton K, et al. Headpulse biometric measures following concussion in young adult athletes. JAMA Netw Open. 2023;6(8):e2328633-e2328633. doi: 10.1001/jamanetworkopen.2023.28633 https://pubmed.ncbi.nlm.nih.gov/37566413/.
  • Helms R. Improving the management of adults with mild traumatic brain injury: An initiative to reduce unnecessary computed tomographic scans in the emergency department. Adv Emerg Nurs J. 2023;45(4):327-340. doi: 10.1097/tme.0000000000000489 https://pubmed.ncbi.nlm.nih.gov/37885087/.
  • Ho VP, Kishawi SK, Hill H, et al. Scanning the aged to minimize missed injury: An EAST multicenter study. J Trauma Acute Care Surg. 2024;doi: 10.1097/ta.0000000000004390 https://pubmed.ncbi.nlm.nih.gov/38797882/.
  • Hoefer LE, Benjamin AJ, Polcari AM, et al. TXA does not affect levels of TBI-related biomarkers in blunt TBI with ICH: A secondary analysis of the prehospital TXA for TBI trial. J Trauma Acute Care Surg. 2024;96(1):94-100. doi: 10.1097/ta.0000000000004130 https://pubmed.ncbi.nlm.nih.gov/37807179/.
  • Joseph B, Obaid O, Dultz L, et al. Validating the Brain Injury Guidelines: Results of an American Association for the Surgery of Trauma prospective multi-institutional trial. J Trauma Acute Care Surg. 2022;93(2):157-165. doi: 10.1097/ta.0000000000003554 https://pubmed.ncbi.nlm.nih.gov/35343931/.
  • Kudu E, Altun M, Danış F, et al. Validating the falls decision rule: optimizing head CT use in older adults with ground-level falls. CJEM. 2025;doi: 10.1007/s43678-025-00937-y https://pubmed.ncbi.nlm.nih.gov/40360963/.
  • Lumba-Brown A, Teramoto M, Bloom OJ, et al. Concussion guidelines step 2: Evidence for subtype classification. Neurosurgery. 2020;86(1):2-13. doi: 10.1093/neuros/nyz332 https://pubmed.ncbi.nlm.nih.gov/31432081/.
  • Madhok DY, Rodriguez RM, Barber J, et al. Outcomes in patients with mild traumatic brain injury without acute intracranial traumatic injury. JAMA Netw Open. 2022;5(8):e2223245-e2223245. doi: 10.1001/jamanetworkopen.2022.23245 https://pubmed.ncbi.nlm.nih.gov/35976650/.
  • Mayes KD, Van Meter TE, Mirshahi N, et al. Age-specific clinical biomarker ranges in acute head injury, non-TBI trauma, and healthy control subjects in the emergency department. Acad Emerg Med. 2026;33(4):e70298. doi: 10.1111/acem.70298 https://pubmed.ncbi.nlm.nih.gov/42048067/.
  • Minoza KG, Brito AM, Loss L, et al. Association between coagulation biomarkers, intracranial hemorrhage types, and tranexamic acid treatments in early traumatic brain injury. J Trauma Acute Care Surg. 2025;99(3):468-476. doi: 10.1097/ta.0000000000004669 https://pubmed.ncbi.nlm.nih.gov/40490870/.
  • Mondello S, Amrein K, Czeiter E, et al. Prognostic value of blood-based protein biomarkers in traumatic brain injury: A living systematic review and meta-analysis. J Neurotrauma. 2025;42(15-16):1256-1286. doi: 10.1089/neu.2024.0620 https://pubmed.ncbi.nlm.nih.gov/40432557/.
  • Nelson BK, Saint SA, Farah LN, et al. Acute neuroimaging findings are associated with poor outcome after mild traumatic brain injury: A systematic review and meta-analysis. J Neurotrauma. 2026:8977151261434925. doi: 10.1177/08977151261434925 https://pubmed.ncbi.nlm.nih.gov/41882969/.
  • Nelson LD, Temkin NR, Dikmen S, et al. Recovery after mild traumatic brain injury in patients presenting to US level I trauma centers: A Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study. JAMA Neurol. 2019;76(9):1049-1059. doi: 10.1001/jamaneurol.2019.1313 https://pubmed.ncbi.nlm.nih.gov/31157856/.
  • Newcombe V, Richter S, Whitehouse DP, et al. Fluid biomarkers and neuroimaging in mild traumatic brain injury: current uses and potential future directions for clinical use in emergency medicine. Emerg Med J. 2023;40(9):671-677. doi: 10.1136/emermed-2023-213111 https://pubmed.ncbi.nlm.nih.gov/37438096/.
  • O’Brien WT, Spitz G, Xie B, et al. Biomarkers of neurobiologic recovery in adults with sport-related concussion. JAMA Netw Open. 2024;7(6):e2415983. doi: 10.1001/jamanetworkopen.2024.15983 https://pubmed.ncbi.nlm.nih.gov/38848061/.
  • Papa L, McKinley WI, Valadka AB, et al. Diagnostic performance of GFAP, UCH-L1, and MAP-2 within 30 and 60 minutes of traumatic brain injury. JAMA Netw Open. 2024;7(9):e2431115. doi: 10.1001/jamanetworkopen.2024.31115 https://pubmed.ncbi.nlm.nih.gov/39230905/.
  • Puravet A, Oris C, Pereira B, et al. Can the association of the biomarkers GFAP and UCH-L1 predict intracranial injury after mild traumatic brain injury in adults? A systematic review and meta-analysis. Ann Emerg Med. 2026;87(2):167-180. doi: 10.1016/j.annemergmed.2025.03.018 https://pubmed.ncbi.nlm.nih.gov/40272329/.
  • Salgado S, Saver V, Sáenz Á, et al. Biomarkers and clinical rules for the management of mild traumatic brain injury: a narrative review. Int J Emerg Med. 2026;19(1):24. doi: 10.1186/s12245-025-01088-8 https://pubmed.ncbi.nlm.nih.gov/41580617/.
  • Sarkarinejad A, Paydar S, Khosrojerdi A, et al. Copeptin: a novel prognostic biomarker in trauma: a review article. J Health Popul Nutr. 2023;42(1):128. doi: 10.1186/s41043-023-00468-1 https://pubmed.ncbi.nlm.nih.gov/37986111/.
  • Seabury SA, Gaudette E, Goldman DP, et al. Assessment of follow-up care after emergency department presentation for mild traumatic brain injury and concussion: Results from the TRACK-TBI study. JAMA Netw Open. 2018;1(1):e180210. doi: 10.1001/jamanetworkopen.2018.0210 https://pubmed.ncbi.nlm.nih.gov/30646055/.
  • Shafie M, Mahmoodkhani M, Salehi I, et al. Clinical predictors of abnormal brain computed tomography findings in mild traumatic brain injury: A cross-sectional study. Medicine (Baltimore). 2023;102(26):e34167. doi: 10.1097/md.0000000000034167 https://pubmed.ncbi.nlm.nih.gov/37390245/.
  • Shahim P, Politis A, van der Merwe A, et al. Time course and diagnostic utility of NfL, tau, GFAp, and UCH-L1 in subacute and chronic TBI. Neurology. 2020;doi: 10.1212/wnl.0000000000009985 https://pubmed.ncbi.nlm.nih.gov/32641529/.
  • Shen A, Mizraki N, Maya M, et al. Reducing low-value interhospital transfers for mild traumatic brain injury. J Trauma Acute Care Surg. 2024;96(6):944-948. doi: 10.1097/ta.0000000000004291 https://pubmed.ncbi.nlm.nih.gov/38523124/.
  • Spaziani G, Rozzi G, Baroni S, et al. Prognostic value of GFAP and UCHL-1 biomarkers in high-risk mild traumatic brain injury: A prospective longitudinal study of short- and long-term outcomes. Am J Emerg Med. 2026;101:41-47. doi: 10.1016/j.ajem.2025.12.021 https://pubmed.ncbi.nlm.nih.gov/41455435/.
  • Taddei G, Pietrantonio A, Petrella G, et al. Timing is everything: A systematic review of optimal repeat computed tomography protocols in traumatic brain injury. J Neurotrauma. 2026;43(3-4):196-208. doi: 10.1177/08977151251401545 https://pubmed.ncbi.nlm.nih.gov/41293885/.
  • Valente JH, Anderson JD, Paolo WF, et al. Clinical policy: Critical issues in the management of adult patients presenting to the emergency department with mild traumatic brain injury (executive summary). Ann Emerg Med. 2023;81(5):621-623. doi: 10.1016/S0196-0644(23)00252-4 https://pubmed.ncbi.nlm.nih.gov/37085214/.
  • Wetmore GC, Beyeler JT, Becker ER, et al. Point of Care UCHL1/GFAP for Rapid Assessment of Undifferentiated Trauma Patients. J Am Coll Surg. 2026;doi: 10.1097/xcs.0000000000002073 https://pubmed.ncbi.nlm.nih.gov/42311103/.

Topic: Post-concussion syndrome

  • Jebbia M, Stopenski S, Grigorian A, et al. Prospective outpatient follow-up of early cognitive impairment in patients with mild traumatic brain injury and intracranial hemorrhage. J Am Coll Surg. 2024;239(4):355-362. doi: 10.1097/xcs.0000000000001101 https://pubmed.ncbi.nlm.nih.gov/38661149/.
  • Peacock WF, Kuehl D, Diaz-Arrastia R, et al. Factors associated with persistent symptoms following mild traumatic brain injury. JAMA Netw Open. 2025;8(10):e2537729. doi: 10.1001/jamanetworkopen.2025.37729 https://pubmed.ncbi.nlm.nih.gov/41105411/.