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SPORT CONCUSSION KNOWLEDGE BASE AND CURRENT PRACTICE– A SURVEY OF PHYSICIAN SECTIONS FROM THE ONTARIO MEDICAL ASSOCIATION
  1. C Lebrun1,
  2. M Mrazik1,
  3. A Prasad1,
  4. T Taylor2,
  5. T Jevremovic3
  1. 1University of Alberta, Edmonton, Canada
  2. 2Carleton University, Ottawa, Canada
  3. 3Western University, London, Canada

Abstract

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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