Roger Zemek1, Kaylee Eady2, Katherine Moreau2, Ken J Farion1, Beverly Solomon3, Margaret Weiser4, Carol Dematteo5. 1. *Departments of Pediatrics and Emergency Medicine,Children's Hospital of Eastern Ontario,University of Ottawa,ON. 2. †Clinical Research Unit,Children's Hospital of Eastern Ontario Research Institute,University of Ottawa,ON. 3. ‡Holland Bloorview Kids Rehabilitation Hospital,Toronto,ON. 4. §Acquired Brain Injury Program,Parkwood Hospital;Department of Psychology,Western University,London,ON. 5. ¶School of Rehabilitation Science,CanChild Centre for Childhood Disability Research,McMaster University,Hamilton,ON.
Abstract
UNLABELLED: 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.
UNLABELLED: 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.
Authors: Jessica Wallace; Brian Q Hou; Katherine Hajdu; Alan R Tang; Alan Z Grusky; Timothy Lee; Scott L Zuckerman; Aaron M Yengo-Kahn Journal: J Athl Train Date: 2022-04-01 Impact factor: 3.824
Authors: Anh Ly; Roger Zemek; Bruce Wright; Jennifer Zwicker; Kathryn Schneider; Angelo Mikrogianakis; Alf Conradi; David Johnson; Brenda Clark; Karen Barlow; Joseph Burey; Ash Kolstad; Keith Owen Yeates Journal: BMC Health Serv Res Date: 2021-02-05 Impact factor: 2.655