***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: This study explored the diagnostic utility of the composite scores of Immediate Post-Concussion Assessment and Cognitive Testing ( ImPACT ) and Post Concussion Symptom Scale scores ( PCSS ) . Recently concussed high school athletes ( N=72 ) were tested within 72 h of sustaining a concussion , and data were compared to non-concussed high school athletes with no history of concussion ( N=66 ) . Between-groups MANOVA revealed a significant multivariate effect of concussion on test performance ( p<.001 ) ; univariate ANOVAS revealed all six measures contributed to the between-groups differences . A discriminant function analyses was conducted to measure the ability of the five ImPACT composite scores , as well as the PCSS to classify concussion status . One discriminant function was identified that consisted of the Visual Memory , Processing Speed , and Impulse Control composite scores PCSS , which correctly classified 85.5 % of the cases . Approximately 82 % of participants in the concussion group and 89 % of participants in the control group were correctly classified . Using these data , the sensitivity of ImPACT was 81.9 % , and the specificity was 89.4 % . As part of a formal concussion management program , ImPACT is a useful tool for the assessment of the neurocognitive and neurobehavioral sequelae of concussion , and can also provide post-injury cognitive and symptom data that can assist a practitioner in making safer return to play decisions STUDY OBJECTIVE To assess clinical features that might reliably predict the need for computed tomography ( CT ) imaging in pediatric head trauma . DESIGN / SETTING /TYPE OF PARTICIPANT : Prospect i ve cohort of 324 head CT scans performed on 322 consecutive trauma patients at an urban children 's hospital . RESULTS Sixty-two percent of patients were male . The mean age was 7.1 years ( 10 days to 20.6 years ) ; half were less than 5 years of age . The two most frequent mechanisms of injury were falls ( 32 % ) and motor vehicle accidents ( 25 % ) . Abnormalities were detected in 74 scans . Intracranial injuries were apparent in 39 patients ( 12 % ) ; 16 had a concomitant fracture . An isolated cranial abnormality was observed on 35 scans ( 11 % ) . Loss of consciousness , amnesia for the event , a Glasgow Coma Scale ( GCS ) of less than 15 , and the presence of a neurologic deficit were more common in children with intracranial injury ( P < .05 ) . Vomiting , seizures , and headache were not discriminating clinical features . No single characteristic consistently identified the children with an intracranial injury . Of the 195 children who were neurologically intact ( GCS , 15 ) at the time of presentation , 11 ( 5 % ) had evidence of intracranial pathology on CT scan . CONCLUSION This study demonstrates a poor correlation between the clinical symptoms of significant traumatic brain injury and findings on CT Objective Compare the visuomotor response times of children after a mild traumatic brain injury ( mTBI ) with those of noninjured children matched for age , sex , and premorbid level of physical activity . Design Prospect i ve cohort study . Setting Pediatric trauma center . Participants Thirty-eight children aged 7 to 16 years in each group . Children with mTBI had a mean Glasgow Coma Scale score of 14.8 and were considered normal on a neurological assessment carried out at the time of hospital discharge . Noninjured children were friends of those with mTBI . Intervention Assessment s of  response time  were conducted at 1 , 4 , and 12 weeks after mTBI and at corresponding time intervals for the control children . Main Outcome Measures The response speed subtest of the Bruininks-Oseretsky Test of Motor Proficiency ( BOTMP ) ; reaction and movement time for upper and lower extremities , for simple , choice , and reversed choice response time paradigms . Results Over the assessment period , children with mTBI performed worse than the control group only on the response speed subtest of the BOTMP . The mTBI children however tended to have slower movement times 1 week postinjury for the reversed choice response time paradigm for the lower extremities . Conclusions Some children with mTBI may have some problems in response time persisting until 12 weeks postinjury . Further research is required to better identify and underst and the severity of these problems and determine their impact , if any , on participation in physical activities STUDY OBJECTIVE We evaluate the diagnostic accuracy of clinical decision rules and physician judgment for identifying clinical ly important traumatic brain injuries in children with minor head injuries presenting to the emergency department . METHODS We prospect ively enrolled children younger than 18 years and with minor head injury ( Glasgow Coma Scale score 13 to 15 ) , presenting within 24 hours of their injuries . We assessed the ability of 3 clinical decision rules ( Canadian Assessment of Tomography for Childhood Head Injury [ CATCH ] , Children 's Head Injury Algorithm for the Prediction of Important Clinical Events [ CHALICE ] , and Pediatric Emergency Care Applied Research Network [ PECARN ] ) and 2 measures of physician judgment ( estimated of < 1 % risk of traumatic brain injury and actual computed tomography ordering practice ) to predict clinical ly important traumatic brain injury , as defined by death from traumatic brain injury , need for neurosurgery , intubation greater than 24 hours for traumatic brain injury , or hospital admission greater than 2 nights for traumatic brain injury . RESULTS Among the 1,009 children , 21 ( 2 % ; 95 % confidence interval [ CI ] 1 % to 3 % ) had clinical ly important traumatic brain injuries . Only physician practice and PECARN identified all clinical ly important traumatic brain injuries , with ranked sensitivities as follows : physician practice and PECARN each 100 % ( 95 % CI 84 % to 100 % ) , physician estimates 95 % ( 95 % CI 76 % to 100 % ) , CATCH 91 % ( 95 % CI 70 % to 99 % ) , and CHALICE 84 % ( 95 % CI 60 % to 97 % ) . Ranked specificities were as follows : CHALICE 85 % ( 95 % CI 82 % to 87 % ) , physician estimates 68 % ( 95 % CI 65 % to 71 % ) , PECARN 62 % ( 95 % CI 59 % to 66 % ) , physician practice 50 % ( 95 % CI 47 % to 53 % ) , and CATCH 44 % ( 95 % CI 41 % to 47 % ) . CONCLUSION Of the 5 modalities studied , only physician practice and PECARN identified all clinical ly important traumatic brain injuries , with PECARN being slightly more specific . CHALICE was incompletely sensitive but the most specific of all rules . CATCH was incompletely sensitive and had the poorest specificity of all modalities OBJECTIVE Despite the frequent occurrence of head injury in children , there is no agreement about clinical screening criteria that indicate the need for imaging studies . This study was undertaken to provide information relevant to the choice of imaging modalities in children with acute head trauma . METHODOLOGY A prospect i ve cohort of 322 children seeking care consecutively in an urban pediatric emergency department for nontrivial head injury was assembled . Skull radiographs , head computed tomography , and data forms including mechanism of injury , symptoms , and physical findings were completed for each child . RESULTS Intracranial injury occurred in 27 children ( 8 % ) , whereas 50 ( 16 % ) had skull fractures . Of those with intracranial injury , 16 ( 59 % ) had normal mental status and no focal abnormalities , and 1 of those 16 required surgery for evacuation of an epidural hematoma . Six ( 38 % ) of the 16 were younger than 1 year , 5 of whom had scalp contusion or hematoma without other symptoms . Findings not significantly associated with intracranial injury were scalp contusion , laceration , hematoma , abrasion , headache , vomiting , seizure , drowsiness , amnesia , and loss of consciousness for less than 5 minutes . Findings associated with intracranial injury were skull fracture , signs of a basilar skull fracture , loss of consciousness for more than 5 minutes , altered mental status , and focal neurologic abnormality . CONCLUSIONS Intracranial injury may occur with few or subtle signs and symptoms , especially in infants younger than 1 year . The relative risk for intracranial injury is increased almost fourfold in the presence of a skull fracture , although the absence of a skull fracture does not rule out intracranial injury . The significance of nonsurgical intracranial injury in neurologically normal children needs further study Background : A quarter of all patients presenting to emergency departments are children . Although there are several large , well-conducted studies on adults enabling accurate selection of patients with head injury at high risk for computed tomography scanning  , no such study has derived a rule for children . Aim : To conduct a prospect i ve multicentre diagnostic cohort study to provide a rule for selection of high-risk children with head injury for computed tomography scanning .  Design : All children presenting to the emergency departments of 10 hospitals in the northwest of Engl and with any severity of head injury were recruited . A tailor-made proforma was used to collect data on around 40 clinical variables for each child . These variables were defined from a literature review , and a pilot study was conducted before the children ’s head injury algorithm for the prediction of important clinical events ( CHALICE ) study . All children who had a clinical ly significant head injury ( death , need for neurosurgical intervention or abnormality on a computed tomography scan ) were identified . Recursive partitioning was used to create a highly sensitive rule for the prediction of significant intracranial pathology . Results : 22 772 children were recruited over 2½ years . 65 % of these were boys and 56 % were < 5 years old . 281 children showed  an abnormality on the computed tomography scan  , 137 had a neurosurgical operation and 15 died . The CHALICE rule was derived with a sensitivity of 98 % ( 95 % confidence interval ( CI ) 96 % to 100 % ) and a specificity of 87 % ( 95 % CI 86 % to 87 % ) for the prediction of clinical ly significant head injury , and requires a computed tomography scan rate of 14 % . Conclusion : A highly sensitive clinical decision rule is derived for the identification of children who should undergo computed tomography scanning after head injury . This rule has the potential to improve and st and ardise the care of children presenting with head injuries . Validation of this rule in new cohorts of patients should now be undertaken Objectives 1 ) To identify clinical features indicating a high risk of skull fracture ( SF ) and associated intracranial injury ( ICI ) in asymptomatic head-injured infants . 2 ) To develop a clinical decision rule to determine which asymptomatic head-injured infants require head imaging . Methods We performed a prospect i ve cohort study of all asymptomatic head-injured infants 0–24 months of age presenting to the emergency department of an urban children ’s hospital . Infants were considered asymptomatic if they had no clinical signs of brain injury , or of basilar or depressed SF . Among subjects who had head imaging  , we assessed the utility of age , scalp hematoma size , and scalp hematoma location for predicting SF and ICI . Results Of 422 study patients , 45 ( 11 % ) were diagnosed with SF and 13 ( 3 % ) with ICI . In the 172 subjects who had head imaging , there was a stepwise relationship between hematoma size and likelihood of SF . Parietal and temporal hematomas were highly associated with SF ; frontal hematomas were not . There was a trend toward higher rates of SF in younger patients . Both large scalp hematoma and parietal hematoma were associated with ICI . Using these data , we developed a clinical decision rule to determine which asymptomatic infants need head imaging .  In our study population , this rule has a sensitivity of 0.98 and specificity of 0.49 for SF , and it detects all 13 cases of ICI . The clinical rule calls for imaging in 146/422 ( 35 % ) study subjects . Conclusions Among asymptomatic head-injured infants , the risk of SF and associated ICI is correlated with scalp hematoma size , hematoma location , and weakly with patient age . We propose a clinical decision rule that could identify most cases of SF and ICI while not requiring head imaging for most patients . This decision rule should be vali date d in other study population OBJECTIVE To examine the incidence and neuropsychological , behavioral , and neuroimaging correlates of postconcussive symptoms ( PCS ) in children with mild closed head injuries ( CHI ) . DESIGN 26 Children with mild CHI and 8 of their uninjured siblings , from 8 to 15 years old , were recruited prospect ively and assessed at baseline ( ie , within 7 days of injury ) and at 3 months postinjury . Parents rated PCS , motivation and affective lability , and behavioral adjustment . Baseline ratings assessed premorbid functioning retrospectively , and follow-up ratings assessed postinjury status . On both occasions , children completed neuropsychological testing , and those with mild CHI also underwent magnetic resonance imaging ( MRI ) . RESULTS Children with mild CHI did not differ from siblings in baseline ratings of premorbid PCS but displayed higher ratings on several PCS at 3 months postinjury . Thirty- 
    Output:
    
Findings Vali date d tools are available to assist clinicians in the diagnosis and management of pediatric mTBI .
A significant body of research exists to identify features that are associated with more serious TBI-associated intracranial injury , delayed recovery from mTBI , and long-term sequelae .
Conclusions and Relevance This systematic review was used to develop an evidence -based clinical guideline for the diagnosis and management of pediatric mTBI .