Background It is critical that physicians understand concussion management.
Objective Identify practice patterns/knowledge base in two physician populations.
Design On-line survey.
Setting Ontario, Canada.
Participants Physicians from Sections: Sport and Exercise Medicine (SEM), General and Family Practice (SGFP).
Interventions Emailed survey, 2 reminders.
Main utcome measurements: Practice patterns/knowledge base, learning methods: current/preferred.
Results Participants: SEM 92/594 (15.5%), SGFP 270/12,168 (2.2%); urban practice (90.2% SEM, 71.5% SFGP; P<.001). In preceding 3 months, 84.8% of SEM and 65.6% of SFGP had managed patients with concussion. More SEM than SGFP physicians saw >5 children under 18 with concussions per month (40.2% SEM, 9.5% SGFP; P<001). Tools: Clinical examination (92.4% SEM, 93.7% SFGP); Sport Concussion Assessment Tool (SCAT/SCAT2) (68.4% SEM, 34.1% SFGP; P<.001); balance testing (56.5% SEM, 37.4% SFGP; P=.001); computerized neurocognitive testing (23.9% SEM, 1.9% SFGP; P<.001); concussion grading scales (9.8% SEM, 14.1% SFGP; P<.001). Management: Complete physical rest (65.2% SEM, 68.5% SFGP); absolute cognitive rest (46.7% SEM, 51.9% SFGP); modified school/work until symptom resolution (50.0% SEM, 38.5% SFGP; P=.026); no cognitive rest (3.2% SEM, 9.6% SGFP; P=.026). Return-to-play: Clinical examination (87.0% SEM, 82.6% SFGP); SCAT/SCAT2 (60.8% SEM, 29.6% SFGP; P<.001); balance testing (56.5% SEM, 37.4% SFGP; P<.001); computerized neurocognitive testing (35.9% SEM, 2.2% SFGP; P<.001); concussion grading scales (7.6% SEM, 9.6% SFGP). Current learning sources: colleagues (55.4% SEM, 27.8% SFGP; P<.001); specialists (33.7% SEM, 23.7% SFGP; P=.030); continuing medical education (CME) courses/conferences (67.4% SEM, 54.7% SFGP; P=.017); journals/publications (48.9% SEM, 25.2% SFGP; P<.001); websites (35.8% SEM, 32.2% SFGP); medical school/residency training (19.6% SEM, 17.4% SFGP). Preferred learning sources: CME courses/conferences (85.9% SEM, 73.9% SFGP; P=.006); websites (35.9% SEM, 47.8%, SFGP; P=.024); medical school/residency training (37.0% SEM, 47.8% SFGP).
Conclusions Gaps exist between consensus-based recommendations regarding concussions and current clinical practice patterns. Enhanced training in medical school/residency and additional CME initiatives are recommended.
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