Pediatric Mild Traumatic Brain Injury and Concussion: Modern Pathophysiological Insights, Diagnostic Advances, and Active Management Protocols.

Abstract

Traumatic brain injury and pediatric concussion represent major global public health concerns. This narrative review aims to provide an updated overview of pediatric concussion by integrating current evidence regarding pathophysiology, diagnostic advances, neuroimaging, biomarkers, and evidence-based management strategies. Concussion pathophysiology involves a complex neurometabolic cascade characterized by ionic imbalance, mitochondrial dysfunction, cerebral blood flow alterations, diffuse axonal injury, and neuroinflammation. In pediatric populations, unique neurodevelopmental vulnerabilities (higher head-to-torso ratio, weaker cervical musculature, ongoing myelination) magnify these disturbances. Contemporary management has evolved from prolonged rest to early active recovery, incorporating brief initial rest (24-48 h) followed by sub-symptom threshold aerobic exercise, structured return-to-learn accommodations, and stepped return-to-sport protocols. Emerging diagnostic tools include the Child SCAT6/Child SCOAT6, vestibular/ocular motor screening, and blood biomarkers (GFAP, UCH-L1, NfL). Future research should focus on standardizing pediatric biomarker thresholds and validating multimodal diagnostic algorithms through prospective multicenter studies.