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

Lebrun, Constance M.; Mrázik, Martin; Prasad, Abhaya S; Tjarks, B Joel; Dorman, Jason C.; Bergeron, Michael F.; Munce, Thayne A.; Valentine, Verle D.

doi:10.1136/bjsports-2012-091480

Cited by 64 publications

(40 citation statements)

References 51 publications

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“…Johnson et al's study concludes with the need for DCs to become more aware of current guidelines and assessment tools. 37 This study concurs with Lebrun et al 36 regarding the need for better dissemination and knowledge transfer of assessment tools and current guidelines to first-contact medical physicians. This pilot study found prospective professional differences in particular aspects of recognition of the TBI patient, but was statistically inconclusive, indicating a need for further study.…”

Section: Discussionsupporting

confidence: 71%

“…36 Studies of medical students and neurology/neurosurgery residents revealed that 32% were either sure they never learned about concussions or could not remember if they had ever learned about concussions in their undergraduate medical education, 29 whereas other studies indicated that 63% of neurologists did not receive the MTBI education. 19 The Zurich guidelines acknowledge the need for more knowledge transfer, 21,38 and others report that it is critical for evidence-informed practices to implement new information and make the best clinical decisions.…”

Section: Discussionmentioning

confidence: 99%

“…The majority found it necessary to take continuing education credits to obtain the knowledge. 36 Lebrun et al reported in 2012 that one-third of Canadian family physicians received their concussion knowledge primarily from colleagues, websites, and medical school training.…”

Section: Discussionmentioning

confidence: 99%

“…26,[32][33][34][35][36] Specific questions were devised to provide insight into the baseline MTBI knowledge and clinical process of first-contact chiropractic and medical physicians in their evaluation and care of TBI patients. The questions were devised to reflect current concepts, guidelines, and clinical practice.…”

Section: Instrument Developmentmentioning

confidence: 99%

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Survey of Primary Contact Medical and Chiropractic Clinicians on Self-Reported Knowledge and Recognition of Mild Traumatic Brain Injuries: A Pilot Study

Taylor

Ponce²,

Dyess

2017

Journal of Chiropractic Medicine

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Objective: The purpose of this study was to assess the self-reported knowledge of concussion recognition and treatment with first-contact family medical and chiropractic practitioners by means of a pilot study of the need, construct validity, and feasibility for further investigation of mild traumatic brain injury (MTBI) knowledge base. Methods: Two hundred forty-eight practicing chiropractic and 120 medical physicians in the south and northeastern sections of the United States were contacted by e-mail, telephone, and postal mail to answer an 18-item survey on knowledge, diagnosis, and common practice with respect to traumatic brain injury patients. Descriptive analysis was used to assess common trends. Results: Twenty-three chiropractic and 11 medical primary care practitioners returned completed surveys, making this a low-power pilot study. The majority claimed confidence in diagnosis of MTBI, but a lack of knowledge of many of the assessment tools and the international guidelines. Chiropractic and medical clinicians revealed similar competencies and differing deficiencies. Both groups admitted infrequent diagnosis of MTBI in practice. There was recognition of major TBI signs, but lack of recognition or inquiry for subtle MTBI signs. Conclusions: There is a need and feasibility for further study of the knowledge transfer to the chiropractic physician with a larger population. These findings correlate with similar medical practitioner studies, and may also support previous findings of underreporting of the prevalence of MTBI. The survey instrument appears to provide valid data on knowledge of MTBIs, with some modifications. (J Chiropr Med 2017;16:19-30)

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Instrument Developmentmentioning

confidence: 99%

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Survey of Primary Contact Medical and Chiropractic Clinicians on Self-Reported Knowledge and Recognition of Mild Traumatic Brain Injuries: A Pilot Study

Taylor

Ponce²,

Dyess

2017

Journal of Chiropractic Medicine

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“…42 Lebrun et al found that family physicians in Alberta and North Dakota rarely recommended cognitive rest (47.5% and 28%, respectively), despite existing guidelines. 43 Bazarian et al examined pediatric, family, and emergency providers in Rochester, New York, on their knowledge of concussion grading and similarly found that the correct application of return-to-play guidelines was below 57%. That study examined knowledge of the pre-2002 definition of concussion.…”

Section: Discussionmentioning

confidence: 99%

Canadian pediatric emergency physician knowledge of concussion diagnosis and initial management

Zemek

Eady

Farion

et al. 2015

CJEM

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Introduction: The diagnosis of concussion is a critical step in the appropriate management of patients following minor head trauma. The authors hypothesized that wide practice variation exists among pediatric emergency medicine physicians in the application of physical and cognitive rest recommendations following an acute concussion. Methods: The authors developed a 35-item questionnaire incorporating case vignettes to examine pediatric emergency physician knowledge of concussion diagnosis, understanding of initial management using return-to-play/school/work guidelines, use of existing concussion protocols, and perceived barriers to protocol use. Using a modified Dillman technique, the authors distributed an online survey to members of Pediatric Emergency Research Canada, a national association of pediatric emergency physicians. Results: Of 176 potential participants, 115 (65%) responded to the questionnaire, 89% (95% confidence interval [CI]: 0.81, 0.93) of whom reported having diagnosed 20 or more concussions annually. Although 90% (95% CI: 0.83, 0.94) of respondents adequately diagnosed concussion, only 64% (95% CI: 0.54, 0.72) correctly applied graduated return-to-play guidelines. Cognitive rest recommendations were also frequently limited: 40% (95% CI: 0.31, 0.49) did not recommend school absence, 30% (95% CI: 0.22, 0.39) did not recommend schoolwork reduction, and 35% (95% CI: 0.27, 0.45) did not recommend limiting screen time. Eighty percent (95% CI: 0.72, 0.87) of respondents reported having used guidelines frequently or always to guide clinical decisions regarding concussion. Conclusion: Despite a proficiency in the diagnosis of concussion, pediatric emergency physicians exhibit wide variation in recommending the graduated return to play and cognitive rest following concussion.

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Emergency Physician Training on Mild Traumatic Brain Injury: A Systematic Review

Patrick

Gaudet

Krebs

et al. 2017

AEM Education and Training

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Objectives: Mild traumatic brain injury (mTBI) is the most common emergency department (ED) brain injury presentation worldwide. Despite its frequency, practice variation and care gaps exist among emergency physicians (EPs) in diagnosing and appropriately managing mTBI in the ED. The objective of this review was to identify mTBI-specific training undertaken to improve the detection and management of mTBIs by EPs and its impact on practice.Methods: A comprehensive search strategy utilized four bibliographic databases, the gray literature and the keywords concussion, mild traumatic brain injury, medical education, and continuing medical education (CME). To be included, studies were required to report on mTBI training received by practicing EPs at any point during their medical education or career. Studies examining clinical practice guidelines or use of diagnostic tools without active implementation or formal training were not included. Two reviewers screened unique citations for relevance and reviewed the full texts of relevant articles. Two independent researchers extracted data and assessed methodologic quality. At all stages, a third independent reviewer adjudicated discrepancies. Results:Overall, five studies were included from 409 unique results. None of the included studies were of high quality. Identified training on mTBI consisted of three training toolkits, conference presentations and academic journal articles, and pediatric fellowship training. Training primarily occurred as CME and focused on awareness of and management of mTBI; three studies reported physician practice changes, including increases in the use of evidence-based return-to-school and return-to-activity recommendations. Conclusions:The few studies identified addressing mTBI training targeting EPs demonstrate the limited attention given to this issue. The current evidence-to-practice gap in mTBI management places patients at risk for suboptimal care in the ED, and existing mTBI knowledge translation, including education, requires optimization to effectively address the current gap in evidence-based practice for mTBI diagnosis and management in the ED.

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

Abstract: 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.

Cited by 64 publications

References 51 publications

Survey of Primary Contact Medical and Chiropractic Clinicians on Self-Reported Knowledge and Recognition of Mild Traumatic Brain Injuries: A Pilot Study

Survey of Primary Contact Medical and Chiropractic Clinicians on Self-Reported Knowledge and Recognition of Mild Traumatic Brain Injuries: A Pilot Study

Canadian pediatric emergency physician knowledge of concussion diagnosis and initial management

Emergency Physician Training on Mild Traumatic Brain Injury: A Systematic Review

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