found to be helpful While many sports professionals administer preparticipation assessments utilizing these tools, it is not standard, and those results may not be accessible to the clinician during the initial posttraumatic evaluation Diagnostic Imaging Neuroimaging, whether CT or MRI, is not routinely performed, except as a concern for ciTBI arises As previously discussed, features that warrant emergent neuroimaging include altered mental status, evidence of depressed or basilar skull fracture, posttraumatic seizure, prolonged loss of consciousness, worsening headache, and focal neurologic examination findings CT is widely available and quickly detects significant ciTBI MRI may be preferred to CT to avoid radiation exposure but is not as widely available and time may be of the essence with neurologic deterioration MRI may be performed as an outpatient if the patient has worsening or prolonged duration of symptoms after the initial evaluation Preliminary evidence reveals that functional MRI as well as proton magnetic resonance spectroscopy and diffusion tensor imaging may identify abnormalities associated with cognitive deficits These imaging modalities are quite specific and not currently accessible at most centers Management If the injury occurs during a sporting event, an on-field or sideline evaluation is done to determine disposition If there is no licensed healthcare provider immediately available to make that determination, the patient should be removed from participation This necessitates a complete evaluation by a physician, which may involve an ED visit As with any trauma evaluation, the initial assessment should focus on Airway, Breathing, Circulation, Disability, and Exposure per trauma guidelines Please review Chapter A General Approach to the Ill or Injured Child for additional details After excluding ciTBI or other traumatic injuries, strategic concussion management includes symptomatic relief and restriction of activity with physical and cognitive rest Most authors recommend a graduated return to activities Judicious use of pain medication and antiemetics should be recommended as not to mask symptoms Their use may be necessary, but should be taken into account when recommending return to activities Most consensus statements recommend returning to physical activities once the