Concussion Management Practice Patterns Among Sports Medicine Physicians

Stache, Stephen; Howell, David R.; Meehan, William P.

doi:10.1097/jsm.0000000000000270

Cited by 31 publications

(28 citation statements)

References 19 publications

(32 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…175 -177 Acetaminophen and nonsteroidal anti-inflammatory medications were the most commonly used. [175][176][177] Emergency department physicians reported high rates of use of ondansetron. 176 Primary care physicians also report a frequent recommendation of melatonin and amitriptyline.…”

Section: Acute Managementmentioning

confidence: 99%

“…176 Primary care physicians also report a frequent recommendation of melatonin and amitriptyline. 175,177 The chronic use of acetaminophen or nonsteroidal anti-inflammatory medications is discouraged because they may contribute to medication overuse headaches. 178 There are currently no medications that are specific to treat concussion.…”

Section: Acute Managementmentioning

confidence: 99%

See 1 more Smart Citation

Sport-Related Concussion in Children and Adolescents

et al. 2018

View full text Add to dashboard Cite

Sport-related concussion is an important topic in nearly all sports and at all levels of sport for children and adolescents. Concussion knowledge and approaches to management have progressed since the American Academy of Pediatrics published its first clinical report on the subject in 2010. Concussion's definition, signs, and symptoms must be understood to diagnose it and rule out more severe intracranial injury. Pediatric health care providers should have a good understanding of diagnostic evaluation and initial management strategies. Effective management can aid recovery and potentially reduce the risk of long-term symptoms and complications. Because concussion symptoms often interfere with school, social life, family relationships, and athletics, a concussion may affect the emotional well-being of the injured athlete. Because every concussion has its own unique spectrum and severity of symptoms, individualized management is appropriate. The reduction, not necessarily elimination, of physical and cognitive activity is the mainstay of treatment. A full return to activity and/ or sport is accomplished by using a stepwise program while evaluating for a return of symptoms. An understanding of prolonged symptoms and complications will help the pediatric health care provider know when to refer to a specialist. Additional research is needed in nearly all aspects of concussion in the young athlete. This report provides education on the current state of sport-related concussion knowledge, diagnosis, and management in children and adolescents.

show abstract

Section: Acute Managementmentioning

confidence: 99%

Section: Acute Managementmentioning

confidence: 99%

Sport-Related Concussion in Children and Adolescents

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Concussion, a mild traumatic brain injury resulting in immediate and transient symptoms, is a common diagnosis seen in the emergency department, as well as primary care and sports medicine offices. Recent studies have shown that visits to emergency rooms for sports‐ and recreation‐related concussion have increased dramatically over the last decade . Earlier studies regarding the epidemiology of concussions have estimated that 300,000–3.8 million concussions occur annually in the United States .…”

Section: Introductionmentioning

confidence: 99%

Gabapentin and Tricyclics in the Treatment of Post‐Concussive Headache, a Retrospective Cohort Study

et al. 2018

View full text Add to dashboard Cite

Objective To examine the association of commonly prescribed post‐concussive medications, namely gabapentin and tricyclic antidepressants (TCAs), with symptom reduction after concussion. Background Concussion is a common diagnosis in modern medicine. Many providers use medication to target the residual symptoms of a concussion, with little evidence supporting their efficacy. Design Retrospective study with longitudinal analysis using mixed‐effects and piecewise regression analyses of 277 patients presenting to an academic sports medicine clinic, all of whom were clinically diagnosed with a concussion. Main outcomes were patient‐reported headache score (quantitative variable; 0–6) and combined symptom score (quantitative variable; 0–132) from the Post‐Concussion Symptom Scale (PCSS). Methods Patients self‐reported their symptom scores on the PCSS at the time of each clinic visit. Gabapentin or TCAs were prescribed to some patients during their follow‐ups for headache treatment, based on physician judgment. Patients were classified into 3 groups: (1) no medication; (2) gabapentin; or (3) TCAs. Follow‐up data were evaluated over 1 year. A mixed‐effects and piecewise regression analysis were performed to assess long‐ and short‐term effects of medication status. Results The mixed‐effects analysis showed a significant decrease in both headache and symptom scores over time in each medication group and in those not receiving medication (P ≤ .014 for all scenarios, B = −0.005 and −0.08, respectively). Although patients in the 2 medication groups showed significantly higher headache and symptom scores (P < .001), neither medication had a significant effect on longitudinal improvements in the outcome scores. The piecewise regression, however, showed short‐term improvements with gabapentin (1.3 points, P = .004) and more sustained improvements with TCAs (3.5 points, P = .006). Conclusions Patients recover from a concussion with time, regardless of medication. Gabapentin and TCAs appear to have immediate effects on improving symptom burden, but long‐term outcomes show similar improvement compared to those who are not prescribed medication. More rigorous prospective studies are required to better elucidate their efficacy.

show abstract

“…Most of these are nonspecific and may also be seen in other medical conditions; therefore, it is important to relate the onset of signs and symptoms to the head injury (4,11,19,20). Some signs and symptoms may appear soon after the concussion, while other may appear over a period of several days to weeks.…”

Section: Clinical Aspectsmentioning

confidence: 99%

“…Management of young athletes with concussion has evolved rapidly over the past decade resulting the development of different guidelines that describe a fundamentally similar approach for the treatment of concussions (1)(2)(3)(4)(19)(20)(21)(22). Concussion severity grading based on various criteria such as the presence or absence and duration of loss of consciousness, confusion and memory are no longer used or found clinically useful (1,5,10).…”

Section: Managementmentioning

confidence: 99%

Evaluation and management of sport-related concussions in adolescent athletes

2017

View full text Add to dashboard Cite

Sport-related concussions in young athletes are common, generally under reported and often go unrecognized. Concussion in sport may result either from a direct impact to the head or from indirect forces transmitted to the brain from impact elsewhere on the body. Concussions may also result from sudden acceleration, deceleration or rotational forces to the brain. The key features of concussion include confusion, impaired memory and reduced speed of information processing. Recovery may occur from a few days to several weeks or months. Both physical and cognitive rests are recommended for recovery.Long-term cognitive and behavioral complications are a concern. Preventive strategies include education, modification of sport rules, use of equipment such as headgears, face masks and mouth guards, and neck muscle training. Evidence is limited to support effectiveness of these preventive measures with the exception of rule modification in some sports. Laws have been enacted that require medical evaluation and clearance prior to return to play; however, evidence thus far does not show that laws have been effective in reducing the incidence of concussions in sport. More research is needed in all areas of preventive measures. Sports participation is a complex personal decision on the part of adolescent and his or her family. They should be provided with all information on inherent risks so that they can make an informed decision.

show abstract

Concussion Management Practice Patterns Among Sports Medicine Physicians

Abstract: Sports medicine physicians seem to have clinical expertise in the management of sport-related concussion.

Cited by 31 publications

References 19 publications

Sport-Related Concussion in Children and Adolescents

Sport-Related Concussion in Children and Adolescents

Gabapentin and Tricyclics in the Treatment of Post‐Concussive Headache, a Retrospective Cohort Study

Evaluation and management of sport-related concussions in adolescent athletes

Contact Info

Product

Resources

About