Article

Sport concussion knowledge base, clinical practises and needs for continuing medical education: A survey of family physicians and cross-border comparison

Department of Family Medicine, Faculty of Medicine & Dentistry, Glen Sather Sports Medicine Clinic, Edmonton Clinic, Level 2, 11400 University Avenue, University of Alberta, Edmonton, Alberta, Canada.
British Journal of Sports Medicine (Impact Factor: 5.03). 11/2012; 47(1). DOI: 10.1136/bjsports-2012-091480
Source: PubMed

ABSTRACT CONTEXT: Evolving concussion diagnosis/management tools and guidelines make Knowledge Transfer and Exchange (KTE) to practitioners challenging. OBJECTIVE: Identify sports concussion knowledge base and practise patterns in two family physician populations; explore current/preferred methods of KTE. DESIGN: A cross-sectional study. SETTING: Family physicians in Alberta, Canada (CAN) and North/South Dakota, USA. PARTICIPANTS: CAN physicians were recruited by mail: 2.5% response rate (80/3154); US physicians through a database: 20% response rate (109/545). INTERVENTION/INSTRUMENT: Online survey. MAIN AND SECONDARY OUTCOME MEASURES: Diagnosis/management strategies for concussions, and current/preferred KTE. RESULTS: Main reported aetiologies: sports/recreation (52.5% CAN); organised sports (76.5% US). Most physicians used clinical examination (93.8% CAN, 88.1% US); far fewer used the Sport Concussion Assessment Tool (SCAT1/SCAT2) and balance testing. More US physicians initially used concussion-grading scales (26.7% vs 8.8% CAN, p=0.002); computerised neurocognitive testing (19.8% vs 1.3% CAN; p<0.001) and Standardised Assessment of Concussion (SAC) (21.8% vs 7.5% CAN; p=0.008). Most prescribed physical rest (83.8% CAN, 75.5% US), while fewer recommended cognitive rest (47.5% CAN, 28.4% US; p=0.008). Return-to-play decisions were based primarily on clinical examination (89.1% US, 73.8% CAN; p=0.007); US physicians relied more on neurocognitive testing (29.7% vs 5.0% CAN; p<0.001) and recognised guidelines (63.4% vs 23.8% CAN; p<0.001). One-third of Canadian physicians received KTE from colleagues, websites and medical school training. Leading KTE preferences included Continuing Medical Education (CME) courses and online CME. CONCLUSIONS: Existing published recommendations regarding diagnosis/management of concussion are not always translated into practise, particularly the recommendation for cognitive rest; predicating enhanced, innovative CME initiatives.

Download full-text

Full-text

Available from: Jason Dorman, Jan 08, 2015
1 Follower
 · 
107 Views
 · 
30 Downloads
  • [Show abstract] [Hide abstract]
    ABSTRACT: AIM: To assess management strategies for pediatric patients suffering from concussions. METHODS: A 17-item questionnaire was distributed to 1,305 section members of the American Academy of Pediatrics Sections on Adolescent Health, Sports Medicine and Fitness, Community Pediatrics, and School Health. The use of medications, neuropsychological testing, neuroimaging, and published guidelines in concussion management was queried. RESULTS: Two hundred and twenty respondents (17%) completed the questionnaire, of which 64% had been an attending for greater than 10 years. A majority of respondents (92%) managed patients with concussions, with 26% treating more than 24 patients per year. Most pediatricians (84%) reported using a published guideline. The majority of respondents (89%) manage the symptoms of concussed patients with medications, most commonly acetaminophen (62%) or non-steroidal anti-inflammatory medications (54%). The use of prescriptions medications such as tricyclic anti-depressants (23%), amantadine (10%), and methylphenidate (8%) were also commonly reported. Pediatricians treating >16 patients per year with concussion were more likely to prescribe tricyclic antidepressants, stimulants, and agents used for sleep disturbance. CONCLUSION: Pediatricians nationwide routinely use medications when managing patients with concussions. The pharmacological agents used differ according to number of patients treated per year. In addition, most pediatricians use published guidelines in concussion management. This article is protected by copyright. All rights reserved.
    Acta Paediatrica 06/2013; 102(9). DOI:10.1111/apa.12315 · 1.84 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Sport-related concussions are a subset of mild traumatic brain injuries and are a concern for many sporting activities worldwide. To review and update the literature in regard to the history, pathophysiology, recognition, assessment, management and knowledge of concussion. Searches of electronic literature databases were performed to identify studies published up until April 2013. 292 publications focussing on concussion met the inclusion criteria, and so they were quality rated and reviewed. Concussion is hard to recognize and diagnose. Initial sideline assessment via the Sports Concussion Assessment Tool 3 (SCAT3), Child-SCAT3 or King-Devick test should be undertaken to identify athletes with concussion as part of a continuum of assessment modalities and athlete management. Sports medicine practitioners should be cognisant of the definition, extent and nature of concussion, and should work with coaches, athletes and trainers to identify and manage concussions. The most common reason for variations in management of concussion is lack of awareness of-and confusion about-the many available published guidelines for concussion. Future research should focus on better systems and tools for recognition, assessment and management of concussion. Sport participants' knowledge of concussion should be evaluated more rigorously, with interventions for sports where there is little knowledge of recognition, assessment and appropriate management of concussion.
    01/2014; 44(4). DOI:10.1007/s40279-013-0134-x
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Objective: To assess the use of concussion/mild traumatic brain injury (mTBI) guidelines, criteria used in the initiation of return-to-play (RTP) and management of RTP for brain injured children and youth by Canadian paediatricians. Methods: A cross-sectional survey was mailed through the Canadian Paediatric Surveillance Program to ∼2600 paediatric specialists and sub-specialists. Results: Of 809 respondents (31%), 503 encountered newly diagnosed paediatric concussion/mTBI within the past 12 months, reporting ∼6900 cases. Of the respondents, 96.7% (95% CI = 94.7-98.6%) reported using one or more of the presented concussion/mTBI guidelines in the management of their patients. The most frequently reported criteria (>50%) used to determine asymptomatic status were: free from all concussion symptoms, by patient report (92%), by proxy report (76%), normal physical examination (65%), in school full-time, with usual school performance (53%). Most respondents (84.9%) did not initiate RTP immediately after their patients became asymptomatic. The median time waiting before initiating RTP was 7 days. The median duration of the RTP sequence was 7 days, with considerable variation reported. Conclusions: Canadian paediatricians frequently encounter patients with concussion/mTBI. Their concussion/mTBI care appears to be consistent with current guidelines, but also shows practice variation, particularly when current guidelines become less proscriptive.
    Brain Injury 03/2014; 28(3):311-7. DOI:10.3109/02699052.2013.862740 · 1.86 Impact Factor
Show more