Existing published recommendations regarding diagnosis/management of concussion are not always translated into practise, particularly the recommendation for cognitive rest; predicating enhanced, innovative CME initiatives.
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.
Natural disasters are on the increase. How healthcare systems respond to their communities' need for medical attention after such events will be very challenging. The situation is even more complicated when such facilities are forced to unexpectedly close and evacuate because they are in harm's way. There are important lessons to be learned from these events, yet people are slow to share what they experienced.
ObjectiveTo identify sport concussion knowledge base, practice patterns and current/preferred methods of Knowledge Transfer and Exchange (KTE) in two distinct populations of family physicians.DesignCross-sectional study, using a survey design.SettingAlberta, Canada (CAN); North/South Dakota, USA (US). Rural (64.4% US, 27.5% CAN; p=<0.001); walk-in/acute care (28.8% CAN, 12.9% US; p=0.008).ParticipantsRecruitment: CAN physicians by mail: 80/3154 responses (2.5%); US physicians: American Academy of Family Physicians database: 109/545 responses (20%).Intervention/InstrumentOn-line survey questionnaire.Outcome MeasuresRelative percentages diagnosing/treating concussions; comparison of management strategies (including return-to-play), and current/preferred KTE.ResultsEtiologies: Sports/recreation (52.5% CAN); organised sports (76.5% US). Tools: Clinical examination (93.8% CAN, 88.1% US); Sport Concussion Assessment Tool (SCAT/SCAT2) (33.8% CAN, 26.7% US); balance testing (25.0% CAN, 26.7% US); concussion grading scales (26.7% US, 8.8% CAN, p=0.002); computerised neurocognitive testing (19.8% US, 1.3% CAN; p≤0.001); Standardised Assessment of Concussion (21.8% US, 7.5% CAN; p=0.008). Treatment: Physical rest (83.8% CAN, 75.5% US); cognitive rest (47.5% CAN, 28.4% US; p=0.008). Return-to-play: Clinical examination (89.1% US, 73.8% CAN; p=0.007); neurocognitive testing (29.7% US, 5.0% CAN; p≤0.001); guidelines (63.4% US, 23.8% CAN; p≤0.001). KTE sources: Colleagues (31.3% CAN, 8.8% US; p≤0.001), websites (27.5% CAN, 15.7% US; p=0.052); medical school (35.0% CAN, 12.7% US; p≤0.001). KTE Preferences: Continuing Medical Education (CME) courses (65.0% CAN, 37.3% US; p≤0.001), and online CME (47.5% Can, 29.4% US; p=0.012).ConclusionsDespite evolution of concussion diagnosis/management guidelines, significant knowledge gaps exist between evidence-based recommendations clinical practice patterns. This predicates enhanced and innovative CME initiatives for KTE.Competing interestsNone.
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