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Canadian pediatric emergency physician knowledge of concussion diagnosis and initial management

  • Roger Zemek (a1), Kaylee Eady (a2), Katherine Moreau (a2), Ken J. Farion (a1), Beverly Solomon (a3), Margaret Weiser (a4) and Carol Dematteo (a5)...
Abstract
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.

Objectif

La pose du diagnostic de commotion cérébrale constitue une étape cruciale de la prise en charge appropriée des traumas crâniens légers. Les auteurs ont émis l’hypothèse selon laquelle il existe des écarts importants de pratique parmi les urgentologues pédiatres dans l’application des recommandations concernant le repos physique et cognitif à la suite d’une commotion cérébrale aiguë.

Méthode

Les auteurs ont élaboré un questionnaire en 35 points comprenant des illustrations de cas dans le but de vérifier les connaissances des urgentologues pédiatres en matière de diagnostic de la commotion cérébrale; de compréhension de la prise en charge initiale, fondée sur des lignes directrices relatives au retour au jeu, à l’école ou au travail; d’application des protocoles existants en ce qui concerne les commotions cérébrales ainsi que d’obstacles perçus relativement à l’application des protocoles. Les auteurs ont envoyé un questionnaire en ligne, selon une version modifiée de la méthode de Dillman, aux membres du Groupe de Recherche en Urgence Pédiatrique du Canada, une association nationale d’urgentologues pédiatres.

Résultats

Sur une possibilité de 176 participants, 115 (65 %) ont répondu au questionnaire, dont 89 % (IC à 95 %: 0,81 – 0,93) ont déclaré diagnostiquer 20 commotions cérébrales ou plus par année. Tandis que 90 % (IC à 95 %: 0,83 – 0,94) des répondants ont bien diagnostiqué la commotion cérébrale, seulement 64 % (IC à 95 %: 0,54 – 0,72) ont appliqué correctement les lignes directrices concernant le retour progressif au jeu. Quant aux recommandations relatives au repos cognitif, elles étaient également peu appliquées dans de nombreux cas: 40 % des répondants (IC à 95 %: 0,31 – 0,49) n’ont pas recommandé l’absence à l’école; 30 % (IC à 95 %: 0,22 – 0,39) n’ont pas recommandé une diminution des travaux scolaires, et 35 % (IC à 95 %: 0,27 – 0,45) n’ont pas recommandé une limitation du temps passé à l’écran. Quatre-vingts pour cent (IC à 95 %: 0,72 – 0,87) des répondants ont indiqué appliquer « souvent » ou « toujours » les lignes directrices pour prendre des décisions d’ordre clinique en ce qui concerne les commotions cérébrales.

Conclusion

Malgré une connaissance approfondie des urgentologues pédiatres en matière de diagnostic de la commotion cérébrale, des écarts importants se dégagent des recommandations en ce qui concerne le retour progressif au jeu et le repos cognitif à la suite d’une commotion cérébrale.

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Copyright
Corresponding author
Correspondence to: Dr. Roger Zemek, Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON K1H 8L1; Email: rzemek@cheo.on.ca
References
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1. Naunheim, RS, Matero, D, Fucetola, R. Assessment of patients with mild concussion in the emergency department. J Head Trauma Rehabil 2008;23(2):116-122.
2. Guskiewicz, KM, Register-Mihalik, J, McCrory, P, et al. Evidence-based approach to revising the SCAT2: introducing the SCAT3. Br J Sports Med 2013;47(5):289-293.
3. McCrea, M, Iverson, GL, Echemendia, RJ, et al. Day of injury assessment of sport-related concussion. Br J Sports Med 2013;47(5):272-284.
4. McCrory, P, Meeuwisse, WH, Echemendia, RJ, et al. What is the lowest threshold to make a diagnosis of concussion? Br J Sports Med 2013;47(5):268-271.
5. McCrory, P, Meeuwisse, WH, Aubry, M, et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Br J Sports Med 2013;47:250-258.
6. Ayr, LK, Yeates, KO, Taylor, HG, et al. Dimensions of postconcussive symptoms in children with mild traumatic brain injuries. J Int Neuropsychol Soc 2009;15(01):19.
7. Ponsford, J, Willmott, C, Rothwell, A, et al. Cognitive and behavioral outcome following mild traumatic brain injury in children. J Head Trauma Rehabil 1999;14(4):360-372.
8. Yeates, KO, Luria, J, Bartkowski, H, et al. Postconcussive symptoms in children with mild closed head injuries. J Head Trauma Rehabil 1999;14(4):337-350.
9. Gioia, GA, Collins, M, Isquith, PK. Improving identification and diagnosis of mild traumatic brain injury with evidence: psychometric support for the acute concussion evaluation. J Head Trauma Rehabil 2008;23(4):230-242.
10. Kashluba, S, Paniak, C, Casey, JE. Persistent symptoms associated with factors identified by the WHO Task Force on mild traumatic brain injury. Clin Neuropsychol 2008;22(2):195-208.
11. Taylor, HG, Dietrich, A, Nuss, K, et al. Post-concussive symptoms in children with mild traumatic brain injury. Neuropsychology 2010;24(2):148-159.
12. Babikian, T, Satz, P, Zaucha, K, et al. The UCLA longitudinal study of neurocognitive outcomes following mild pediatric traumatic brain injury. J Int Neuropsychol Soc 2011;17(05):886-895.
13. Ganesalingam, K, Yeates, KO, Ginn, MS, et al. Family burden and parental distress following mild traumatic brain injury in children and its relationship to post-concussive symptoms. J Pediatr Psychol 2007;33(6):621-629.
14. Carroll, L, Rosner, D. The concussion crisis: anatomy of a silent epidemic. New York Simon & Schuster; 2011.
15. Yeates, KO, Kaizar, E, Rusin, J, et al. Reliable change in postconcussive symptoms and its functional consequences among children with mild traumatic brain injury. Arch Pediatr Adolesc Med 2012;166(7):615-622.
16. Scorza, KA, Raleigh, MF, O’Connor, FG. Current concepts in concussion: evaluation and management. Am Fam Physician 2012;85(2):123-132.
17. Meehan, WP, Bachur, RG. Sport-related concussion. Pediatrics 2009;123(1):114-123.
18. Meehan, WP, Mannix, R. Pediatric concussions in United States Emergency Departments in the years 2002 to 2006. J Pediatr 2010;157(6):889-893.
19. Forsyth, R, Kirkham, F. Predicting outcome after childhood brain injury. CMAJ 2012;184(11):1257-1264.
20. Korinthenberg, R, Schreck, J, Weser, J, et al. Post-traumatic syndrome after minor head injury cannot be predicted by neurological investigations. Brain Dev 2004;26(2):113-117.
21. Marchie, A, Cusimano, MD. Bodychecking and concussions in ice hockey: should our youth pay the price? CMAJ 2003;169(2):124-128.
22. Guskiewicz, K, Marshall, S, Bailes, J, et al. Association between recurrent concussion and late-life cognitive impairment in retired professional football players. Neurosurgery 2005;57(4):719-726.
23. Gaetz, M, Goodman, D, Weinberg, H. Electrophysiological evidence for the cumulative effects of concussion. Brain Injury 2000;14:1077-1088.
24. Gronwall, D, Wrightson, P. Cumulative effects of concussion. Lancet 1975;2:995-997.
25. Matser, EJT, Kessels, AG, Lezak, MD, et al. Cumulative problems with memory and planning in amateur soccer. JAMA 1999;282(10):971-973.
26. Swaine, BR, Tremblay, C, Platt, RW, et al. Previous head injury is risk factor for subsequent head injury in children: a longitudinal cohort study. Pediatrics 2007;119:749-758.
27. Centers for Disease Control (CDC) Atlanta. Heads-up: a toolkit for physicians. Available at: http://www.cdc.gov/concussion/headsup/pdf/Facts_for_Physicians_booklet-a.pdf (accessed October 30, 2013).
28. Purcell, L. Canadian Pediatric Society, Healthy Active Living and Sports Medicine Committee. Evaluation and management of children and adolescents with sports-related concussion. J Paediatr Child Health 2012;17(1):31. Available at: http://www.cps.ca/documents/position/concussion-evaluation-management] (accessed October 30, 2013).
29. Halstead, ME, Walter, KD. American Academy of Pediatrics, Council on Sports Medicine and Fitness. Sport-related concussion in children and adolescents. Pediatrics 2010;126(3):597-615.
30. Giza, CG, Kutcher, JS, Ashwal, S, et al. Summary of evidence-based guideline update: evaluation and management of concussion in sports; Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology 2013;80(24):2250-2257.
31. Canadian Medical Association (CMA). 2011. Head injury and sport. Available at: http://policybase.cma.ca/dbtw-wpd/Policypdf/PD11-10.pdf (accessed October 30, 2012).
32. Marshall, S, Bayley, M, McCullagh, , et al. Clinical practice guidelines for mild traumatic brain injury and persistent symptoms. Can Fam Physician 2012;58(3):257-267.
33. Gilchrist, J, Thomas, KE, Xu, L, et al. Nonfatal traumatic brain injuries related to sports and recreation activities among persons ≤19 years—United States, 2001-2009. MMWR Morb Mortal Wkly Rep 2011;60(39):1337-1342.
34. Burns, KEA, Duffett, M, Kho, ME, et al. A guide for the design and conduct of self-administered surveys of clinicians. CMAJ 2008;179(3):245-252.
35. Inc Ci. FluidSurveys. 4.0 ed. Ottawa2012. p. Online Survey Software.
36. Dillman, D. Mail and Internet surveys: the tailored design method. New York: John Wiley & Sons; 2000.
37. IBM. SPSS Software. 20 ed. Armonk2012. p. Predictive analytics software and solutions.
38. Provvidenza, C, Engebretsen, L, Tator, C, et al. From consensus to action: knowledge transfer, education and influencing policy on sports concussion. Br J Sports Med 2013;47(5):332-338.
39. Valovich McLeod, TC, Schwartz, C, Bay, RC. Sport-related concussion misunderstandings among youth coaches. Clin J Sport Med 2007;17:140-142.
40. Sye, G, Sullivan, J, McCrory, P. High school rugby players’ understanding of concussion and return to play guidelines. Br J Sports Med 2006;40:1003-1005.
41. Zonfrillo, MR, Master, CL, Grady, MF, et al. Pediatric providers’ self-reported knowledge, practices, and attitudes about concussion. Pediatrics 2012;130(6):1120-1125.
42. Boggild, MM, Tator, CH. Concussion knowledge among medical students and neurology/neurosurgery residents. Can J Neurol Sci 2012;39(3):361-368.
43. Lebrun, CM, Mrazik, M, Prasad, AS, et al. Br J Sports Med 2013;47:54-59.
44. Bazarian, JJ, Veenema, T, Brayer, AF, et al. Knowledge of concussion guidelines among practitioners caring for children. Clin Pediatr (Phila) 2001;40:207-212.
45. Giebel, S, Kothari, R, Koestner, A, et al. Factors influencing emergency medicine physicians’ management of sports-related concussions: a community-wide study. J Emerg Med 2011;41(6):649-654.
46. DeMatteo, CA, Hanna, SE, Mahoney, WJ, et al. “My child doesn’t have a brain injury, he only has a concussion. Pediatrics 2010;125(2):327-334.
47. Hill, CA, Fahrney, K, Wheeless, SC, et al. Survey response inducements for registered nurses. West J Nurs Res 2006;28(3):322-334.
48. Ryu, WH, Feinstein, A, Colantonio, A, et al. Early identification and incidence of mild TBI in Ontario. Can J Neurol Sci 2009;36:429-435.
49. Zemek, R, Eady, K, Moreau, K, et al. Knowledge of Paediatric Concussion in Front-Line Primary Care Providers. Paediatr Child Health 2014;19(9):475-480.
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