State of Knowledge of Health Care Providers with Regards to Diagnosis and Initial Management – Survey
In 2012, health care providers were surveyed to investigate their concussion knowledge and application of guidelines with regards to diagnosis and initial management. Health care provider respondents included emergency departments, physicians, family physicians, pediatricians, nurse practitioners and physician assistants.
The survey focused on the following domains: (A) knowledge of concussion diagnosis, (B) understanding of initial management using return to play/school/work guidelines, (C) use of existing concussion guidelines, and (D) opinions about perceived barriers to protocol use. Three case vignettes were developed based on common clinical scenarios, and for these, respondents answered four closed-ended, knowledge-based questions. The respondents were also asked a series of demographic questions at the end of the survey. A total of 851 health care providers responded.
- Physicians and non-physicians (nurse practitioners, physician assistants) are equally likely to recognize concussions.
- For management of children, just 41% of physicians correctly applied return-to-play guidelines, 50% did not recommend school absence, 37% did not recommend schoolwork reduction and 31% did not suggest limiting screen time.
- Twenty five percent of respondents make use of concussion scoring scales, and 71% reported using guidelines “frequently” or “always” to guide clinical decisions with regards to concussion.
- Large gaps in knowledge and broad practice variation were found in recommending graduated return-to-play and cognitive rest following concussion across provider type and sub-specialty practice.
The information gained from the surveys played a significant role in the development of the Guidelines for Diagnosing and Managing Pediatric Concussion. The project team, ONF, and partners are also working on knowledge translation strategies with users and other stakeholders to enahnce the guideline use.
Reference: Zemek R, Eady K, Moreau K, Farion KJ, Solomon B, Weiser M, Dematteo C. Knowledge of paediatric concussion among front-line primary care providers. Paediatric Child Health. 2014 Nov;19(9):475-80.