Paediatric Mild Traumatic Brain Injury (TBI (including Concussion)

PAEDIATRIC

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Severe neck pain with suspected spinal involvement
    • Patients with severe symptoms with recent concussion indicating potential life-threatening complications or immediate neurological risks, such as:
      • Rapidly deteriorating consciousness or sudden confusion
      • ­Increasingly restless, agitated, or combative behaviours
      • ­Acute neurological change (e.g. weakness, hypertonicity, sensory changes)
      • ­Seizures or uncontrollable vomiting
      • ­Signs of raised intracranial pressure (severe headache, vision changes, unequal pupils)
    • Refer to HealthPathways for assessment and management recommendations.
    • Adolescents and Young Adults (AYA) Considerations (16–18 years):
      • Given the diversity within this age group, inclusion in adult rehabilitation services should be based on functional context rather than age alone. AYAs aged 16–18 who are engaged in adult lifestyles or activities (e.g. employment, apprenticeships) are best suited to adult rehabilitation pathways.
      • Eighteen-year-olds in their final year of school should not be automatically excluded from adult rehabilitation services, as input from paediatric rehabilitation (e.g. QPRS) would likely be short-term due to limited time remaining at school. In exceptional cases, QPRS may assist with outpatient rehabilitation for 18-year-olds with brain or spinal cord injuries where goals are specifically related to return-to-school outcomes. This is only done via direct referral from adult rehabilitation specialists, who retain primary responsibility for ongoing rehabilitation.
    • New symptoms post-concussion: Identify symptoms within these domains:
      • ­Physical complaints: Refer early to cocussion service or vestibular physiotherapy for symptoms like headaches, whiplash, balance changes, physical fatigue, dizziness, visual changes or sleep disturbances.
      • ­Emotional concerns: Consider concomitant MHCP if there is evidence of high emotional distress, concurrent stressors, or new mental health concerns following the injury.
      • ­Cognitive concerns: Note any cognitive difficulties affecting work or daily activities or causing frustration or distress such as photophobia, hyperacusis, difficulty concentrating, memory changes, or cognitive fatigue

    Request for advice

    • GPs may use the Request for Advice (RFA) pathway when patients present with, stable conditions that does not meet criteria for urgent referral. This allows specialist input while supporting ongoing management in primary care and avoiding unnecessary waitlisting.
Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
  • All children (age < 18) with mild Traumatic brain injury / concussion (accepted within 12 months of injury) will be triaged category 1 for phone consultation by experienced nursing staff to provide early advice, prevention, and management strategies

    • NB: For adolescents aged 16–18 who are engaged in adult roles (e.g. apprenticeships or employment), referral to adult rehabilitation services may be more appropriate, and referral pathways should be considered accordingly.
Category 2
(appointment within 90 calendar days)
  • No category 2 criteria
Category 3
(appointment within 365 calendar days)
  • No category 3 criteria

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • Date, circumstance, and description of injury (e.g., mechanism of injury such as a fall, sports impact, car accident).
  • If available, Injury Classification Markers: Include Post-Traumatic Amnesia (PTA), Glasgow Coma Scale (GCS) score, Loss of Consciousness (LOC), and any post-traumatic seizures.

3. Additional referral information Useful for processing the referral

  • Summary of any diagnostic tests or imaging performed to date.
  • Medical history including history of prior brain injuries, concussions, neurodevelopmental issues (e.g., ADHD), chronic pain, sleep disturbances, migraines, and psychological history.
  • Current medications including doses.
  • List symptoms with consideration of physical, cognitive, and emotional domains, including any formal screening results (e.g.  Rivermead Post Concussion Symptom Questionnaire, Sport Concussion Assessment Tool, 6th Edition or online, Post Concussion Symptom Scale)
  • Describe effects on daily activities and schooling.
  • Outline potential rehabilitation goals, such as support with returning to school or recreational activities.
  • Note patient’s response to symptoms, including any signs of distress and coping strategies used.

4. Request

  • Patient's demographic details

    • Full name (including aliases)
    • Date of birth
    • Residential and postal address
    • Telephone contact number/s – home, mobile and alternative
    • Medicare number (where eligible)
    • Name of the parent or caregiver (if appropriate)
    • Preferred language and interpreter requirements
    • Identifies as Aboriginal and/or Torres Strait Islander

    Referring practitioner details

    • Full name
    • Full address
    • Contact details – telephone, fax, email
    • Provider number
    • Date of referral
    • Signature

    Relevant clinical information about the condition

    • Presenting symptoms (evolution and duration)
    • Physical findings
    • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
    • Body mass index (BMI)
    • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
    • Current medications and dosages
    • Drug allergies
    • Alcohol, tobacco and other drugs use

    Reason for request

    • To establish a diagnosis
    • For treatment or intervention
    • For advice and management
    • For specialist to take over management
    • Reassurance for GP/second opinion
    • For a specified test/investigation the GP can't order, or the patient can't afford or access
    • Reassurance for the patient/family
    • For other reason (e.g. rapidly accelerating disease progression)
    • Clinical judgement indicates a referral for specialist review is necessary

    Clinical modifiers

    • Impact on employment
    • Impact on education
    • Impact on home
    • Impact on activities of daily living
    • Impact on ability to care for others
    • Impact on personal frailty or safety
    • Identifies as Aboriginal and/or Torres Strait Islander

    Other relevant information

    • Willingness to have surgery (where surgery is a likely intervention)
    • Choice to be treated as a public or private patient
    • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
    • A change in patient circumstance (such as condition deteriorating or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.
    • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Last updated: 5 May 2026

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