Sport concussion knowledge base, clinical practices, and needs for continuing medical education: a survey of family physicians and cross-border comparison

Abstract

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.

Zurich 2012: our cohort of ‘concussionologists‘ – conveying consensus

“…Apart from soccer, concussion protocols are not yet widely applied in the sports of rugby union17 18 and ice hockey 19. Dissemination of new protocols into family/general practice takes time; concussion guidelines are not yet widely adopted in that setting 20. Language barriers provide additional challenges—the bulk of literature and dissemination has been in English to date.…”

The Impact of Concussion Education on the Knowledge and Perceived Expertise of Novice Health Care Professionals

“…[9][10] Concussion, on the other hand, is typically managed by sports medicine certified physicians, pediatricians, or athletic trainers. [10][11][12][13] Pediatric residency programs were studied in 2003 and concluded that 24% of the programs did not include formal teaching about concussions in their curriculum. 14 When family physicians and pediatricians are not available, many families will go to the emergency room for concussion visits.…”

Concussion and the neurologist

“…An Internet-based survey of 545 family physicians in North Dakota and South Dakota revealed that 94.5% of these physicians were diagnosing and treating concussions, suggesting that, in fact, the rural setting has providers willing to manage this injury. 7 Athletic trainers, nurse practitioners, and psychologists also play a substantial role in sports concussion management, particularly on the collegiate level. Even with multiple disciplines participating in concussion treatment, it could be argued that with 1.6-3.8 million concussions per year, the lack of access to concussion care may be due to an inadequate supply of providers overall.…”