Objective To compare the rates of diagnostic imaging and therapy referrals of sports medicine (SM) physicians and other outpatient clinic (OC) physicians (pediatrics, family medicine, internal medicine, neurology and physiatry) for the evaluation and treatment of concussion.

Design Retrospective cohort

Setting Large US metropolitan healthcare system.

Participants Patients presenting with concussion seeking care from 2014–2019.

Interventions (or Assessment of Risk Factors) Patients with the following ICD-10 CM discharge diagnosis codes were included: S09.9 – Head Injury (unspecified), S06.0 – Concussion, F07.81 – Post-Concussion Syndrome, G44.3 – Post Traumatic Headache. Orders for therapy included physical therapy (PT), occupational therapy (OT), speech therapy, and neuropsychology. Radiology orders included 38 imaging modalities for the head, brain and neck.

Outcome Measures Rates of therapy and imaging orders were compared between OC and SM medicine physicians; rate ratios (RRs) and 95%CI were calculated.

Main Results 9747 individual patients were identified; 39% were treated by SM physicians. SM physicians ordered fewer imaging studies (4.6%) than OC physicians (7.6%, RR=0.60; 95%CI=0.51, 0.71) and more overall therapy/neuropsychology (39.9%) than OC physicians (17.8%, RR=2.24; 95%CI=2.09, 2.39). Specifically, neuropsychology referrals were ordered far more frequently by SM physicians (13.2% vs. 2.7%, RR=4.84; 95%CI=4.08, 5.75). PT was ordered most frequently by both groups (SM: 36.2%; OC: 15.9%; p<0.0001).

Conclusions SM physicians had lower rates of orders for diagnostic imaging studies and higher rates of therapy and neuropsychology referrals than OC physicians for patients presenting with concussion. Further education and resources should be provided to physicians in all outpatient settings to optimize concussion care.