Pediatricians' Knowledge, Attitudes, and Behaviors to Screening Children After Complicated Mild TBI: A Survey

Abstract

Objective To understand pediatricians’ attitudes, knowledge and behaviors about the care of children with complicated mild traumatic brain injury (TBI). Setting and participants 3500 pediatricians randomly selected from the American Medical Association master file. Design Cross-sectional survey Main measures Pediatricians were asked about their attitude toward following children with complicated mild TBI for cognitive and behavioral sequelae; their knowledge of TBI sequelae; and, their usual evaluation and management of children following TBI. Results There were 576 (16.5%) completed responses. Most pediatricians (51%) see one or two patients with complicated mild TBI annually. Most pediatricians do not think that pediatricians are the correct clinician group who should by primarily responsible for following children with complicated mild TBI for cognitive (74%) or behavioral sequelae (54%). Pediatricians report difficulty referring children for cognitive (56%) and behavioral (48%) specialty services. Pediatricians have good knowledge of short-term complications of complicated mild TBI. Conclusion Pediatricians do not think they are the correct clinical group to primarily care for children after hospitalization for complicated mild TBI; yet, other clinicians are frequently not accessible. Pediatricians need educational and referral support to provide surveillance for injury sequelae in this group of children.

Concussion‐Related Health Care Utilization Among Medicaid Insured Children in Ohio: Rural and Urban Differences

“…Further work needs to be done to understand the variations in type of follow‐up care sought by location of residence. Nonetheless, our findings, in line with others, 31,32 highlight the need to formally train PCPs about concussion management and provide them with educational and referral support to care for concussed youth.…”

Changing Healthcare and School Needs in the First Year After Traumatic Brain Injury

“…34 Pediatricians report difficulties in referring children to both SLP and neuropsychology. 5 Families who receive Medicaid insurance find access to these providers particularly challenging due to long waits or unavailability, as many of our families reported. 16,35 Addressing children's health care needs is complicated further by the low rate of primary care follow-up.…”

“…3,4 Physicians report difficulties in referring children for cognitive and behavioral services due to patient insurance limitations and limited availability of providers. 5 While schools are required to provide services for children with TBI under the Individuals with Disability Education Act (IDEA), 6 schools may not have the resources to identify children in need of services, may be unaware of the TBI, or may be unable to provide them appropriate academic or health care supports. [7][8][9] Over a decade ago, Slomine et al reported on the unmet and unrecognized health care needs of over 300 children hospitalized at least overnight for TBI.…”

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“…Variable follow-up of TBI patients exists nationally in the United States, ranging from primary care to surgical subspecialties. Primary care providers report discomfort caring for these patients on follow-up, as well as accessing needed resources for problems that arise in these children [ 23 ]. While concussion clinics are increasing in frequency, children with significant head injury with intracranial pathology are inherently different from the typical concussion patient, with high rates of functional impairment, psychosocial dysfunction, and neurocognitive deficits [ 11 , 13 ].…”