Factors Influencing Emergency Medicine Physicians’ Management of Sports-related Concussions: A Community-wide Study

Abstract

Background

Numerous guidelines to grade and manage sports-related concussions have been published. However, little is known about how frequently they are implemented in the emergency department. This study evaluates the current practices of emergency physicians (EPs) in managing sports-related concussions.

Objectives

To evaluate the current practice of EP evaluation and management of sports-related concussions.

Methods

All EPs and emergency medicine residents in Kalamazoo County were surveyed regarding their management of sports-related concussions. The surveys obtained demographic data, participants’ use of guidelines, and the importance of clinical and non-clinical factors in deciding when to allow a player to return to play.

Results

Of the 73 EP respondents, only 23% used a nationally recognized guideline, with no significant difference between attending and resident EPs. The symptomatic complaints of loss of consciousness, amnesia of the event, and difficulty concentrating were ranked most important by EPs in assessing patients with sports-related concussions. Among non-clinical factors, residents were significantly more likely than attendings to report that medical-legal, parental, and players’ concerns were more likely to influence their decision in allowing a patient to return to play.

Conclusion

EPs take into consideration important clinical factors in assessing patients with sports-related concussion. However, almost 75% do not use any nationally recognized guideline in their evaluation. Residents are more likely than attendings to be influenced by non-clinical factors.

Introduction

The recent focus on head injuries and concussions in professional sports by Congress and the National Football League has increased the public awareness of this problem in amateur and professional athletics. The Centers for Disease Control and Prevention estimates that there are approximately 1.6–3.8 million sports-related traumatic brain injuries per year in the United States. Of those, approximately 200,000 were treated in emergency departments (EDs) (1). The majority of these are “mild concussions” without loss of consciousness, yet many of these injuries are not without consequences 2, 3. Recent studies suggest that even minor concussions can have significant neurological sequelae, and adolescents are especially susceptible (4). These sequelae include permanent neurological deficits, disturbances in concentration and memory, and behavioral changes, to name just a few.

To date, there are at least 17 guidelines that have been established to grade the severity of concussion and provide parameters for athletes to return to play (5). However, there are few data regarding what is currently being practiced in the community and what clinical and non-clinical factors play a role in the management of these patients by emergency physicians (EPs). The purpose of this study is to evaluate the use of formal guidelines and current local practice patterns with return-to-play strategies utilized by EPs. A secondary aim of this study was to determine what clinical and non-clinical factors are important to EPs making decisions for athletes to return to play and to determine if this varies between emergency medicine (EM) residents and attending EPs. Assessing current practice variations as well as the factors that are deemed important to EPs will provide information allowing for enhanced education of physicians on new management principles.