Objective We aim to clarify practice patterns of concussion assessment and management at a large tertiary care centre and regional referring hospitals in Southwestern Ontario, Canada to determine the proportion using evidence- based concussion management.

Design Survey.

Setting An academic hospital in London, Ontario, Canada and surrounding community hospitals.

Participants Emergency Medicine Physicians. 75% work in academic settings and 25% in community Emergency Departments.

Outcome Measures The survey asked whether respondents were using validated symptoms assessment scales in patients with suspected concussion for assessment and risk stratification for post concussion syndrome. We also asked whether physicians provide verbal and written discharge instructions and what the instructions include.

Main Results When assessing patients with suspected concussion, 69% of respondents do not routinely use a symptom assessment scale and 31% use part or all of the SCAT-5 questionnaire.19% report not considering risk of post concussion syndrome, whereas 71% report using patient factors such as history of previous concussion or mental health disorders. At time of discharge, 81% of respondents reported giving verbal instructions and 88% give written instructions. 90% give institutional handouts with discharge instructions, while 19% use the SCAT-5 handout and 9% use the Parachute Canada Handout.

Conclusions In Southwestern Ontario, there is variation in the use of validated concussion tools for the diagnosis of concussion as well as for use in risk stratifying patients for post-concussive syndrome. There could be benefit to standardization of concussion management practices, facilitated by a unified concussion management guideline targeting Canadian providers.