Canadian pediatric emergency physician knowledge of concussion diagnosis and initial management

Zemek, Roger; Eady, Kaylee; Farion, Ken; Solomon, Beverly; Weiser, Margaret; DeMatteo, Carol

doi:10.1017/cem.2014.38

Cited by 40 publications

(30 citation statements)

References 42 publications

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“…National and international guidelines recommend that youth with a suspected concussion undergo urgent medical assessment and obtain medical clearance prior to returning to full sport activities (46, 50) However, a retrospective population-based study in Ontario from 2003 to 2013 found that only one third of youth sought medical follow-up or clearance following an initial visit for concussion (56). Although the responsibility to provide medical assessment and clearance for youth with concussion generally falls upon primary care providers, surveys conducted among Canadian family medicine physicians, pediatricians and emergency department physicians demonstrate considerable knowledge gaps with a significant proportion failing to provide proper post-injury guidance and care (57–60).…”

Section: Current State Of Concussion Care In Canadamentioning

confidence: 99%

The Potential of Telemedicine to Improve Pediatric Concussion Care in Rural and Remote Communities in Canada

Ellis

Russell

2019

Front. Neurol.

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Concussion is a form of mild traumatic brain injury that affects thousands of Canadian children and adolescents annually. Despite national efforts to harmonize the recognition and management of pediatric concussion in Canada, timely access to primary and specialized care following this injury remains a challenge for many patients especially those who live in rural and remote communities. To address similar challenges facing patients with stroke and other neurological disorders, physicians have begun to leverage advances in telemedicine to improve the delivery of specialized neurological care to those living in medically underserved regions. Preliminary studies suggest that telemedicine may be a safe and cost-effective approach to assist in the medical care of select patients with acute concussion and persistent post-concussion symptoms. Here we provide an overview of telemedicine, teleneurology, the principles of concussion assessment and management, as well as the current state of concussion care in Canada. Utilizing preliminary evidence from studies of telemedicine in concussion and experience from comprehensive systems of care for stroke, we outline steps that must be taken to evaluate the potential of telemedicine-based concussion networks to improve the care of pediatric concussion patients living in underserved rural and remote communities in Canada.

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Section: Current State Of Concussion Care In Canadamentioning

confidence: 99%

The Potential of Telemedicine to Improve Pediatric Concussion Care in Rural and Remote Communities in Canada

Ellis

Russell

2019

Front. Neurol.

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“…Despite the existence of the five different training resources identified in this review, their weak implementation and unknown fidelity and/or effectiveness limits their potential application . Practice variation and evidence‐to‐practice gaps among EPs management of mTBI has been documented, and suboptimal implementation strategies have previously been held responsible for this variation . In this review, the measurement of both knowledge‐based and patient‐centered outcomes was suboptimal; thus, the most effective methods for EP knowledge uptake and practice change remain to be identified.…”

Section: Discussionmentioning

confidence: 97%

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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“…117,118 The pediatric version of the ONF guidelines published in 2014 also included a targeted, subject-specific evaluation for patients with symptoms lasting more than 1 month. 119 …”

Section: Summary Of the Current Approach To Treating Concussionsmentioning

confidence: 99%

Statements of Agreement From the Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion Meeting Held in Pittsburgh, October 15-16, 2015

et al. 2016

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Background Conventional management for concussion involves prescribed rest and progressive return to activity. Recent evidence challenges this notion and suggests that active approaches may be effective for some patients. Previous concussion consensus statements provide limited guidance regarding active treatment. Objective To describe the current landscape of treatment for concussion and provide summary agreements related to treatment in order to assist clinicians in the treatment of concussion. Methods On October 14–16, 2015, the Targeted Evaluation & Active Management (TEAM) Approaches To Treating Concussion meeting was convened in Pittsburgh, Pennsylvania, USA. 37 concussion experts from neuropsychology, neurology, neurosurgery, sports medicine, physical medicine and rehabilitation, physical therapy, athletic training, and research, and 12 individuals representing sport, military, and public health organizations attended the meeting. The 37 experts indicated their agreement on a series of statements using an audience response system clicker device. Results A total of 16 statements of agreement were supported covering: 1) Summary of the Current Approach to Treating Concussion, 2) Heterogeneity and Evolving Clinical Profiles of Concussion, 3) Targeted Evaluation and Active Management Approach to Concussion Treatment: Specific Strategies, and 4) Future Directions: A Call to Research. Support (ie, response of agree or somewhat agree) for the statements ranged from to 97–100%. Conclusion Concussions are characterized by diverse symptoms and impairments and evolving clinical profiles; recovery varies based on modifying factors, injury severity, and treatments. Active and targeted treatments may enhance recovery following concussion. Research is needed on concussion clinical profiles, biomarkers, and the effectiveness and timing of treatments.

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Canadian pediatric emergency physician knowledge of concussion diagnosis and initial management

Cited by 40 publications

References 42 publications

The Potential of Telemedicine to Improve Pediatric Concussion Care in Rural and Remote Communities in Canada

The Potential of Telemedicine to Improve Pediatric Concussion Care in Rural and Remote Communities in Canada

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

Statements of Agreement From the Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion Meeting Held in Pittsburgh, October 15-16, 2015

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