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Jervis CG, Adams SA, Fawkner S, Griffin SA. Concussion education in medical students studying in Scotland: an assessment of knowledge and future needs. Brain Inj 2022; 36:1196-1203. [PMID: 35996323 DOI: 10.1080/02699052.2022.2115139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Physicians play a key role in ensuring athletes with concussion safely return to sport. Research has shown deficiencies in concussion education amongst physicians and medical students. However, studies have not previously been conducted in UK medical schools. OBJECTIVES To assess students' concussion knowledge and learning in Scottish Medical Schools. DESIGN A survey with 23 questions was distributed to Year 3-6 medical students studying in Scotland in October 2020. The survey included the following: (1) demographics, (2) concussion knowledge, e.g. 'What is the role of headgear in preventing concussion?' (3) concussion learning, 'In which part of the curriculum should concussion be taught?.' Frequencies of responses were calculated for each question. RESULTS 200 students responded (response rate 8%). The average symptoms and management score were 87.3% and 31% respectively. 15% of participants knew that headgear has no role in preventing concussions and one participant identified the minimum "return to sport" timeframes for adults and children. 15% had learnt about concussion at medical school with 92.5% interested in receiving concussion teaching at medical school. CONCLUSION Knowledge gaps exist in managing and preventing sports-related concussion. There is a discrepancy between levels of concussion teaching and the desire and importance placed on concussion education.
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Affiliation(s)
| | - Stephanie A Adams
- Moray House School of Education and Sport, The University of Edinburgh, Edinburgh, UK
| | - Samantha Fawkner
- Moray House School of Education and Sport, The University of Edinburgh, Edinburgh, UK
| | - Steffan A Griffin
- Moray House School of Education and Sport, The University of Edinburgh, Edinburgh, UK.,Medical Services, Rugby Football Union, London, UK.,Centre for Sport and Exercise, The University of Edinburgh, Edinburgh, UK
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A Scoping Review: Mapping the Evidence for Undergraduate Concussion Education and Proposing the Content for Medical Student Concussion Teaching. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074328. [PMID: 35410008 PMCID: PMC8998836 DOI: 10.3390/ijerph19074328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/25/2022] [Accepted: 03/22/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Concussion is a common yet complex condition, with each new case requiring assessment by a medical doctor. Recent research has shown that doctors working in the UK have significant knowledge deficits regarding concussion diagnosis and management. AIM The aim of this scoping review was to map out the evidence about how undergraduate medical students are being educated about concussion. METHOD This scoping review involved seven research papers identified by searching five online databases in October 2020. Search terms relevant to concussion included: brain injuries, post-concussion syndrome, brain concussion and concussion, combined with search criteria for undergraduate education: medical students, undergraduate medical education, or curriculum. RESULTS All seven papers were published in North America, with five papers recruiting medical students from single institutions (n = 590) and two papers surveying universities. Canadian medical schools have shown an upward trend in the quantity of teaching about concussion-specific teaching: from 0.57 to 2.65 h between 2012 and 2018. Lectures were the commonest mode of delivery of teaching, followed by problem-based learning and clinical rotations. The studies reach a common conclusion that medical students are not being adequately prepared for diagnosing and managing concussion, with insufficient undergraduate teaching, particularly exposure during clinical rotations, cited as the cause. CONCLUSIONS Concussion: education of medical students is inadequate in North America. Medical schools should help address this by providing lectures and clinical presentations on concussion to learn from, particularly via problem-based learning. There is a paucity of evidence about concussion education in other geographical areas.
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Ekman L, Alsky T, Baron D. Concussion Education in Medical School. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2021; 45:242-243. [PMID: 33512691 DOI: 10.1007/s40596-021-01405-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 01/12/2021] [Indexed: 06/12/2023]
Affiliation(s)
- Lauren Ekman
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA, USA
| | - Travis Alsky
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA, USA.
| | - David Baron
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA, USA
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Thomas E, Chih H, Gabbe B, Fitzgerald M, Cowen G. A cross-sectional study reporting concussion exposure, assessment and management in Western Australian general practice. BMC FAMILY PRACTICE 2021; 22:46. [PMID: 33653287 PMCID: PMC7927406 DOI: 10.1186/s12875-021-01384-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/31/2021] [Indexed: 11/27/2022]
Abstract
Background General Practitioners (GPs) may be called upon to assess patients who have sustained a concussion despite limited information being available at this assessment. Information relating to how concussion is actually being assessed and managed in General Practice is scarce. This study aimed to identify characteristics of current Western Australian (WA) GP exposure to patients with concussion, factors associated with GPs’ knowledge of concussion, confidence of GPs in diagnosing and managing patients with concussion, typical referral practices and familiarity of GPs with guidelines. Methods In this cross-sectional study, GPs in WA were recruited via the RACGP WA newsletter and shareGP and the consented GPs completed an electronic survey. Associations were performed using Chi-squared tests or Fisher’s Exact test. Results Sixty-six GPs in WA responded to the survey (response rate = 1.7%). Demographics, usual practice, knowledge, confidence, identification of prolonged recovery as well as guideline and resource awareness of GPs who practised in regional and metropolitan areas were comparable (p > 0.05). Characteristics of GPs were similar between those who identified all symptoms of concussion and distractors correctly and those who did not (p > 0.05). However, 84% of the respondents who had never heard of concussion guidelines were less likely to answer all symptoms and distractors correctly (p = 0.039). Whilst 78% of the GPs who were confident in their diagnoses had heard of guidelines (p = 0.029), confidence in managing concussion was not significantly associated with GPs exposure to guidelines. It should be noted that none of the respondents correctly identified signs of concussion and excluded the distractors. Conclusions Knowledge surrounding concussion guidelines, diagnosis and management varied across GPs in WA. Promotion of available concussion guidelines may assist GPs who lack confidence in making a diagnosis. The lack of association between GPs exposure to guidelines and confidence managing concussion highlights that concussion management may be an area where GPs could benefit from additional education and support. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01384-1.
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Affiliation(s)
- Elizabeth Thomas
- School of Public Health, Curtin University, Bentley, Australia.,Division of Surgery, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
| | - HuiJun Chih
- School of Public Health, Curtin University, Bentley, Australia.,Centre for Clinical Research Excellence, Curtin University, Bentley, Australia
| | - Belinda Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, UK
| | - Melinda Fitzgerald
- Curtin Health Innovation Research Institute, Curtin University, Bentley, Australia.,Perron Institute for Neurological and Translational Science, Sarich Neuroscience Research Institute Building, Nedlands, Australia
| | - Gill Cowen
- Curtin Medical School, Curtin University, Bentley, Australia.
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Pietz K, Graves J, Weybright E, Pinkleton B, Klein T. Original Research: Concussions at School: The Experiences and Knowledge of School Nurses. Am J Nurs 2021; 121:28-38. [PMID: 33470615 DOI: 10.1097/01.naj.0000733428.67589.5e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND School nurses' knowledge about and confidence in managing concussions are important to ensure continuity of care between a student's school and home environments. This mixed-methods study explored concussion-related knowledge, confidence, and management experiences among urban and rural school nurses in Washington State. METHODS Public school nurses, identified via state educational service district websites and recruited by e-mail, completed an online survey assessing their concussion knowledge and confidence levels. Following the survey, a subset of respondents participated in semistructured interviews aimed at exploring their confidence in managing concussions. RESULTS Of the 945 school nurses to whom the survey was sent, 315 responded (33% response rate). Most survey respondents held an RN license (89.6%) and were from urban areas (90.8%). Overall, the respondents exhibited accurate concussion knowledge; only one significant difference was noted based on rural-urban status. Correct responses were given for most questions (67.4% to 98.7% correct responses). In interviews with a subset of six school nurses, emergent themes pertained to communication, assessment, and monitoring, and the nurse's role in postconcussion management. Barriers can include a lack of relevant school policies, low concussion awareness among teachers and parents, and limited resources. CONCLUSIONS The study findings suggest that school nurses possess high levels of concussion knowledge and confidence in managing concussions. Continuing education remains important to ensure that current research and evidence inform practice regarding ongoing concussion management among school-age children.
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Affiliation(s)
- Katy Pietz
- Katy Pietz is an instructor and the clinical coordinator of the Athletic Training Program at the College of Education, Washington State University (WSU), Pullman Campus. Janessa Graves is an associate professor at the College of Nursing, WSU, Spokane Campus. Elizabeth Weybright is an associate professor in the Department of Human Development, College of Agricultural, Human, and Natural Resource Sciences at WSU, Pullman Campus. Bruce Pinkleton is a professor and dean of the Edward R. Murrow College of Communication at WSU, Pullman Campus. Tracy Klein is an associate professor in the College of Nursing, WSU, Vancouver Campus. Graves, Weybright, Pinkleton, and Klein are on the faculty of WSU's interdisciplinary Prevention Science program. Contact author: Katy Pietz, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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Babul S, Turcotte K, Lambert M, Hadly G, Sadler K. Delivering Evidence-Based Online Concussion Education to Medical and Healthcare Professionals: The Concussion Awareness Training Tool (CATT). JOURNAL OF SPORTS MEDICINE (HINDAWI PUBLISHING CORPORATION) 2020; 2020:8896601. [PMID: 33426084 PMCID: PMC7773466 DOI: 10.1155/2020/8896601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 12/09/2020] [Accepted: 12/12/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Medical and healthcare professionals report an important gap in their training and knowledge on concussion diagnosis and management. The Concussion Awareness Training Tool (CATT) for medical professionals provides evidenced-based training and resources, representing an important effort to fill this gap. The goal of the current article was to summarize and describe the general uptake of the 2018 relaunch of the CATT for medical professionals and to present results of a quality assurance/quality improvement (QA/QI) assessment including qualitative feedback from medical and healthcare professionals. Methodology. Tracking completions via certificates and Google Analytics were used to measure uptake over the first two years following the 2018 relaunch and promotion of CATT for medical professionals. Medical and healthcare professionals who had completed the CATT from the time of the relaunch on June 11, 2018, to July 31, 2019, were invited via e-mail to participate in the survey-based QA/QI assessment. Both quantitative and qualitative data were collected. RESULTS Year 1 saw 8,072 pageviews for the CATT for medical professionals landing page, increasing to 9,382 in Year 2. Eighty-nine medical and healthcare professionals who had completed the CATT for medical professionals participated in the QA/QI assessment. Results showed that 85% of respondents reported learning new information about concussion; 73% reported changing the way they diagnose, treat, or manage concussion; and 71% reported recommending the CATT to colleagues. Qualitative data also indicated highly favourable opinions and experiences. CONCLUSIONS The CATT for medical professionals has demonstrated promise as a tool to promote knowledge translation practice and help fill the gap in concussion training and knowledge reported by medical and healthcare professionals.
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Affiliation(s)
- Shelina Babul
- BC Injury Research and Prevention Unit, BC Children's Hospital, Vancouver, Canada
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Kate Turcotte
- BC Injury Research and Prevention Unit, BC Children's Hospital, Vancouver, Canada
| | - Maude Lambert
- School of Psychology, Behavioural Neurosciences, University of Ottawa, Ottawa, Canada
| | - Gabrielle Hadly
- BC Injury Research and Prevention Unit, BC Children's Hospital, Vancouver, Canada
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
| | - Karen Sadler
- BC Injury Research and Prevention Unit, BC Children's Hospital, Vancouver, Canada
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Lee KS, Zhang JJ, Alamri A, Chari A. Neurosurgery Education in the Medical School Curriculum: A Scoping Review. World Neurosurg 2020; 144:e631-e642. [DOI: 10.1016/j.wneu.2020.09.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/04/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022]
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Concussion in Motorsport? Experience, Knowledge, Attitudes, and Priorities of Medical Personnel and Drivers. Clin J Sport Med 2020; 30:568-577. [PMID: 30113965 DOI: 10.1097/jsm.0000000000000647] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess concussion experiences, knowledge, and attitudes of motorsport medical personnel and drivers and to determine priority areas regarding concussion within the sport. DESIGN Sequential mixed-method design. Part 1: stakeholder interviews; part 2: cross-sectional online survey. SETTING United Kingdom. PARTICIPANTS Part 1: key motorsport stakeholders (N = 8); part 2: motorsport medical personnel and drivers (N = 209) representing amateur and/or professional 4-wheeled motorsport. MAIN OUTCOME MEASURES Concussion experience, knowledge, attitudes, and perceived priority areas. RESULTS Thirty-one percent of surveyed drivers (age = 37.91 ± 13.49 years: 89% male) reported suffering from concussion in motorsport. Eighty-seven percent of surveyed medical personnel (age = 48.60 ± 10.68 years: 74% male) reported experience with concussed drivers, and 34% reported feeling pressured to clear a driver with concussion. Gaps in knowledge and misperceptions about concussion were reported in both groups, and disparity between concussion attitudes emerged between drivers and medical personnel. Application of assessment and management procedures varied between medical personnel and there was evidence motorsport policy and concussion guidelines may not be directly followed. According to both medical personnel (77%) and drivers (85%), "education and training" is the top priority area for the sport. CONCLUSIONS There is clear evidence of concussions in motorsport, but accurate knowledge about this injury is missing. Concussion education and training for all drivers and medical personnel is required. Additional investigations into concussion attitudes are advised to complement and advance simple educational initiatives. Further investigation is also required to determine how to best support motorsport medical personnel, and general practitioners, who hold significant responsibility in guiding drivers from diagnosis to return to racing, and to support the effective implementation of policy.
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Northam WT, Cools MJ, Chandran A, Alexander A, Mihalik JP, Guskiewicz KM, Carneiro KA. Sports Medicine Fellowship Training Improves Sport-related Concussion Evaluation. Curr Sports Med Rep 2020; 19:272-276. [PMID: 32692063 DOI: 10.1249/jsr.0000000000000730] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Evaluating acute sport-related concussion (SRC) differs among providers, who apply international consensus and national guidelines variably. Retrospective medical record review was completed for 889 outpatients aged 7 to 18 years, diagnosed with SRC from 2014 to 2017. Associations between board-certified sports medicine fellowship (SMF) training status and assessment of concussion-specific history and physical examination items were tested using nonparametric χ tests. Differential odds (by fellowship training status) of using history and physical examination items were assessed using multivariable logistic regression modeling. Each SRC history and physical examination items were assessed in higher proportions by SMFs, as compared with non-SMFs, statistically significant for all tested items with the exception of headache history. SMFs demonstrated higher odds of detailed neurologic examinations and clinical cognitive testing compared with non-SMFs, after adjusting for patient and physician characteristics. Physicians caring for concussed patients should seek continuing education opportunities aligning them with training provided to sports medicine fellows.
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Affiliation(s)
| | | | | | | | | | - Kevin M Guskiewicz
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, NC
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10
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Zalesky CC, Moran TP, Koval RR, Usher J, Ratcliff JJ, Wu D, Wright DW. A prospective cross-sectional study examining the documented evaluation of patients at high risk for mild traumatic brain injury. Am J Emerg Med 2020; 42:150-160. [PMID: 32165070 DOI: 10.1016/j.ajem.2020.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 02/04/2020] [Accepted: 02/12/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES Annually, the CDC reports that 2.5 million Emergency Department (ED) visits occur due to Traumatic Brain Injuries (TBI) with nearly 75% classified as mild TBI (mTBI). Generally, these injuries are thought to be under recognized. This study was done to determine the proportion of patients, who were considered high risk for an mTBI, that had documentation of an mTBI evaluation. METHODS A prospective cross-section of patients was identified using a 3-question screen at the time of triage: did an injury occur; was the mechanism consistent with mTBI; and was there a period of altered mental status. Chart review was completed for these patients who were thought to meet a minimum threshold warranting an evaluation for mTBI. RESULTS 38,621 patients were screened over 16 weeks, of whom 441 (1.14%) were identified as being high risk for having an mTBI and met inclusion criteria. Recommended portions of an mTBI evaluation occurred in fewer than 50% of patients. In total, 98 subjects were diagnosed with an mTBI, and 49 received mTBI discharge instructions. The odds ratio for the subgroup of patients who had documented criteria sufficient for diagnosis revealed that an isolated head injury increased a patient's odds of a documented diagnosis by 2.1 times (95%, 1.3-3.4). CONCLUSIONS Many patients with a possible mTBI did not have significant portions of an mTBI evaluation documented, and roughly half of the patients with a documented mTBI diagnosis did not receive discharge education. Changes in clinicians' approach to mTBI must occur to ensure patients receive appropriate evaluations, management, and education.
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Affiliation(s)
- C Christopher Zalesky
- University of Cincinnati College of Medicine, Department of Emergency Medicine, Cincinnati, OH, United States of America.
| | - Tim P Moran
- Emory University School of Medicine, Department of Emergency Medicine Atlanta, GA, United States of America
| | - Rachel R Koval
- Emory University School of Medicine, Department of Emergency Medicine Atlanta, GA, United States of America
| | - Jasmine Usher
- Grady Memorial Hospital, Atlanta, GA, United States of America
| | - Jonathan J Ratcliff
- Emory University School of Medicine, Department of Emergency Medicine Atlanta, GA, United States of America
| | - Daniel Wu
- Emory University School of Medicine, Department of Emergency Medicine Atlanta, GA, United States of America; Grady Memorial Hospital, Atlanta, GA, United States of America
| | - David W Wright
- Emory University School of Medicine, Department of Emergency Medicine Atlanta, GA, United States of America
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11
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New Zealand Caregiver Knowledge of Paediatric Traumatic Brain Injury. BRAIN IMPAIR 2019. [DOI: 10.1017/brimp.2019.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackground:Traumatic brain injury (TBI) is common among children. However, their caregivers’ knowledge and understanding of symptoms may influence how the injury is managed.Primary objective:To investigate the knowledge of New Zealand (NZ) parents about TBI and concussion.Method and procedures:Parents (n = 205) of children aged 5–13 years completed a pen-and-paper or online survey containing questions examining their knowledge of TBI terminology, TBI symptoms and knowledge about concussion management.Main outcomes and results:A high proportion (61%) of parents did not think that a concussion was the same as a brain injury. Loss of consciousness (LOC) was the most endorsed symptom of TBI. However, 69% of participants were aware that TBI could occur without LOC. On average, parents correctly identified 19.5 (67.3%) of the 29 symptoms of TBI, but also identified 2.0 (11.9%) of the 17 distractor symptoms as being TBI related. Demographic factors and experience of TBI/concussion were associated with TBI symptom identification accuracy and concussion knowledge.Conclusions:Further education of parents is needed to ensure they recognise the signs and symptoms of concussion/mild TBI so that they can make informed decisions on how best to manage their child’s injury.
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Fraser S, Wright AD, van Donkelaar P, Smirl JD. Cross-sectional comparison of spiral versus block integrated curriculums in preparing medical students to diagnose and manage concussions. BMC MEDICAL EDUCATION 2019; 19:17. [PMID: 30626361 PMCID: PMC6327552 DOI: 10.1186/s12909-018-1439-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 12/26/2018] [Indexed: 06/01/2023]
Abstract
BACKGROUND An integrated curriculum is designed to be repetitive yet progressive and the concept has rapidly established itself within medical education. National organizations have recommended a shift to a spiral curriculum design, which uses both vertical and horizontal integration. This study examined differences between the recently implemented integrated spiral (class of 2019) and conventional block (classes of 2016-2018) MD curricula at the University of British Columbia (UBC) with respect to knowledge of concussion. METHODS Cross-sectional online survey (FluidSurveys: Fluidware, Ottawa, ON), distributed via email to UBC medical students during the 2015-2016 academic year. Questions focused on demographic data, knowledge of concussion definition, and management considerations. Differences in responses across the two groups were assessed using chi-square tests. Ordinal Likert-scale data were analyzed using Mann-Whitney U-Tests. Statistical significance was determined a priori at p < 0.05. RESULTS One hundred forty eight medical students (57% female) responded with 78 students in the spiral curriculum and 70 students the block curriculum. Important differences between responses from spiral versus block curricula students included: formal exposure to concussion-related educational material (10.8 h spiral vs. 3.95 h block), understanding concussions can occur without direct head impacts (90% spiral vs. 70% block, X21,148 = 9.41, p = 0.002) and identifying long-term consequences (dementia: 90% spiral vs. 66% block, X21,148 = 12.57, p < 0.0001; second impact syndrome: 80% spiral vs. 57% block, X21,148 = 8.60, p = 0.003; Parkinsonism: 47% spiral vs. 17% block, X21,148 = 14.87, p < 0.001). Block students identified the need for a full neurological exam (X21,148 = 17.63, p < 0.001) and had greater clinical exposure to acute concussion (47% block vs. 14% spiral, X21,148 = 19.27, p < 0.001) and post-concussion syndrome (37% block vs. 19% spiral, X21,148 = 5.91, p = 0.015). CONCLUSIONS The findings from this preliminary study suggest the spiral curriculum design, which emphasizes and revisits clinical competencies, promotes a strong understanding and retention of knowledge in highly prevalent clinical conditions such as concussion.
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Affiliation(s)
- Sarah Fraser
- Southern Medical Program, Reichwald Health Sciences Centre, University of British Columbia Okanagan, Kelowna, BC Canada
| | - Alexander D. Wright
- Southern Medical Program, Reichwald Health Sciences Centre, University of British Columbia Okanagan, Kelowna, BC Canada
- MD/PhD Program, University of British Columbia, Vancouver, BC Canada
- Experimental Medicine Program, Faculty of Medicine, University of British Columbia, Vancouver, BC Canada
- School of Health and Exercise Sciences, University of British Columbia Okanagan, ART 180, 3333 University Way, Kelowna, V1V 1V7 BC Canada
| | - Paul van Donkelaar
- School of Health and Exercise Sciences, University of British Columbia Okanagan, ART 180, 3333 University Way, Kelowna, V1V 1V7 BC Canada
| | - Jonathan D. Smirl
- School of Health and Exercise Sciences, University of British Columbia Okanagan, ART 180, 3333 University Way, Kelowna, V1V 1V7 BC Canada
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Herceg M, Kalcina LL, Lusic I. Concussion knowledge among family physicians in Croatia. Concussion 2018; 3:CNC59. [PMID: 30652013 PMCID: PMC6331701 DOI: 10.2217/cnc-2018-0002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 10/10/2018] [Indexed: 11/21/2022] Open
Abstract
Aim The objective of this study was to administer and analyze results of a survey targeting knowledge about concussion symptoms, diagnosis, treatment and expected recovery among family medicine specialists in the Split-Dalmatia County of Croatia. Methods An electronic survey questionnaire was developed utilizing concepts from previously published studies on concussion knowledge, attitudes and beliefs completed by physicians. The survey was intended to briefly and broadly assess concussion knowledge of Croatian healthcare providers. The first section of the survey included five questions clarifying professional practice, years of experience and experience with concussions; the second section included 15 questions about typical concussion symptoms; the third section included 12 questions focused upon three primary components of concussion knowledge: concussion diagnosis, treatment and recovery. Results Out of 242 surveys mailed, 81 questionnaires (33%) were completed while 161 respondents (67%) did not answer. Out of the 81 completed surveys, 76 (94%) were returned by family physicians specialist and five (6%) by resident physicians in training. 39 (48%) had treated less than ten patients with concussion during last year: 40 (49%) treated 11-20 patients with concussion; and two (3%) treated greater than 20 patients with concussion during last year. While most responses did accurately reflect knowledge of common symptoms (90-100% correct), there was significant lack of knowledge in three areas: only 19% of participants stated that diagnosis of concussion does not require loss of consciousness; three quarters of respondents believed that a diagnosis of concussion requires direct contact to the head and 83% of the respondents believed that persistent subjective complaints are always the result of a more severe initial injury. Discussion This is the first investigation conducted in Croatia to examine knowledge of concussion diagnosis, as well as the management practices held by medical professionals. Overall, the findings suggest that the knowledge and management practices among family doctors in the region are not consistent with current worldwide views and recommendations. There was not an accurate knowledge of concussion diagnosis, treatment, recovery and prognosis among family physicians. Continued education of medical staff to better identify concussion and increased reliance on objective methods for managing concussion will improve patient management and outcome.
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Affiliation(s)
- Marko Herceg
- Phelps Hospital, Northwell Health, Sleepy Hollow, NY 10591 USA, School of Public Health, New York Medical College, Valhalla, NY 10595 USA.,Phelps Hospital, Northwell Health, Sleepy Hollow, NY 10591 USA, School of Public Health, New York Medical College, Valhalla, NY 10595 USA
| | - Linda Lusic Kalcina
- Department of Neuroscience, University Hospital of Split, University of Split School of Medicine, Soltanska 2, 2100, Spilt, Croatia.,Department of Neuroscience, University Hospital of Split, University of Split School of Medicine, Soltanska 2, 2100, Spilt, Croatia
| | - Ivo Lusic
- Department of Neurology, University of Split School of Medicine, Soltanska 2, 2100, Split, Croatia.,Department of Neurology, University of Split School of Medicine, Soltanska 2, 2100, Split, Croatia
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Sirisena D, Walter J, Ong JH, Probert J. Pilot single-centre cross-sectional study to determine emergency physicians' knowledge and management of sports concussion: an experience from Singapore. Singapore Med J 2018; 59:322-326. [PMID: 29167908 PMCID: PMC6024222 DOI: 10.11622/smedj.2017104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Sports concussion remains challenging to manage despite changes to policy and practice since the 2012 International Consensus Conference on Concussion in Sport. Emergency physicians (EPs) are usually the first line of medical care for athletes in amateur and youth collision sports. This single-centre cross-sectional study aimed to establish EPs' understanding and management of concussion in Singapore. METHODS An anonymised, 17-item online questionnaire was sent to EPs requesting for information on their clinical experience, training, exposure to concussion cases in the emergency department (ED) and assessed knowledge of the condition. RESULTS Out of 65 EPs, 52 (80%) responded, 25 (48.1%) of whom were medical officers. Over 90% had not received formal training in concussion management, and 73.1% regularly assessed concussion. 40 (76.9%) EPs recognised that loss of consciousness was not essential for diagnosis and only 24 (46.2%) knew the most common symptom. 26 (50.0%) incorrectly reported that they would perform brain imaging. Among those who indicated onward referral, 29 (55.8%) would refer concussed patients to neurosurgery. There were no significant differences between clinical grade or training in concussion and positive responses for definition, imaging modality or most common symptom of concussion. CONCLUSION Concussion is a common presentation to EDs in Singapore. However, understanding of the condition, its clinical diagnosis, investigation and onward management is limited. Although EPs reported training in concussion, it is likely to be insufficient. Commencing relevant education programmes for undergraduate and postgraduate medical students may enable progressive acquisition of knowledge and thereby improve patient management in the future.
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Affiliation(s)
- Dinesh Sirisena
- Sports Medicine Centre, Khoo Teck Puat Hospital, Singapore
- Singapore Rugby Union, Singapore
| | | | - Joo Haw Ong
- Sports Medicine Centre, Khoo Teck Puat Hospital, Singapore
| | - Joanne Probert
- Sports Medicine Centre, Khoo Teck Puat Hospital, Singapore
- Singapore Rugby Union, Singapore
- Emergency Department, Khoo Teck Puat Hospital, Singapore
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15
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Dierijck JK, Wright AD, Smirl JD, Bryk K, van Donkelaar P. Sub-concussive trauma, acute concussion, and history of multiple concussions: Effects on quiet stance postural control stability. Int J Psychophysiol 2018. [PMID: 29526776 DOI: 10.1016/j.ijpsycho.2018.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Although balance control has been studied extensively following acute concussion, little is known regarding repetitive sub-concussive head impacts or chronic exposure to multiple concussive events. Quiet stance postural control was characterized in contact sport athletes at pre-season (n = 135) and post-season (n = 48) to evaluate the effects of subconcussive trauma to the head. To determine the impact of acute concussion on postural control, athletes diagnosed with a concussion during the season (n = 12) were tested at 72-h, 2-weeks, and 1-month post-injury. Because only 4 of the concussed athletes completed baseline testing, control athletes (n = 12) matched for sport, age, body mass index (BMI), and previous concussion history served as a comparison group. Finally, the effects of previous concussion history on quiet stance postural control were determined by comparing pre-season data in contact sport athletes with either zero (Hx0, n = 50) or three or more (Hx3+, n = 25) previous concussions. A force plate was used to compare changes in centre-of-pressure root-mean-square displacement (RMSdisp) and mean-velocity (COPvel) in the anterior/posterior (AP) and medial/lateral (ML) directions. One-minute trials were performed with feet hip-width apart, hands-on-hips, and A) eyes-open and B) eyes-closed. Biomechanical head-impact exposure (impacts over 10 g) was indexed over the season using mastoid-fixed impact sensors. In acutely injured athletes, repeated-measures ANOVA revealed a significant effect of time for RMSdisp AP with increased displacement at 2 weeks compared to 72 h (p = 0.008, 95% CI: -0.180, -0.310 cm). No other COP variables were affected by acute concussion. Moreover, there was no effect of concussion history or repeated sub-concussive impacts on any quiet stance metric. Additionally, head-impact exposure metrics were not correlated with COP metrics. Taken together, the data suggests alterations in COP sway during quiet stance persist in the acute 2-week period after injury. These findings were not present with either a history of multiple concussions or exposure to sub-concussive head impacts indicating acute concussion does not have appear to have long term effects for these measures.
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Affiliation(s)
- J K Dierijck
- School of Health and Exercise Sciences, University of British Columbia, ART 360 - 3333 University Way, Kelowna, BC V1V 1V7, Canada
| | - A D Wright
- School of Health and Exercise Sciences, University of British Columbia, ART 360 - 3333 University Way, Kelowna, BC V1V 1V7, Canada; MD/PhD Program, University of British Columbia, 2894 Detwiller Pavilion, 2255 Wesbrook Mall, Vancouver, BC V6T 2A1, Canada; Southern Medical Program, Reichwald Health Sciences Centre, University of British Columbia Okanagan, 1088 Discovery Avenue, Kelowna, BC V1V 1V7, Canada; Experimental Medicine Program, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - J D Smirl
- School of Health and Exercise Sciences, University of British Columbia, ART 360 - 3333 University Way, Kelowna, BC V1V 1V7, Canada
| | - K Bryk
- School of Health and Exercise Sciences, University of British Columbia, ART 360 - 3333 University Way, Kelowna, BC V1V 1V7, Canada; Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | - P van Donkelaar
- School of Health and Exercise Sciences, University of British Columbia, ART 360 - 3333 University Way, Kelowna, BC V1V 1V7, Canada.
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16
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Salisbury D, Kolessar M, Callender L, Bennett M. Concussion knowledge among rehabilitation staff. Proc (Bayl Univ Med Cent) 2017; 30:33-37. [PMID: 28127126 DOI: 10.1080/08998280.2017.11929519] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
A concussion knowledge survey was completed by 561 rehabilitation professionals across a wide range of disciplines in a nationwide rehabilitation hospital system. Item questions were structured to reflect key areas of concussion knowledge targeted in a prior consensus statement. The vast majority of staff provided responses consistent with the current concussion literature regarding concussion diagnosis and symptom presentation immediately after concussion. Greater variability was seen for items assessing beliefs about the typical recovery from concussion, best care practices, and long-term effects from concussion. Factors such as profession, years of experience, and work with concussion or traumatic brain injury were not consistently related to better performance on the survey. Prior concussion-focused education/training was related to better survey performance. This survey highlights the pressing need to educate frontline health providers regarding concussion recovery and best care practices.
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Affiliation(s)
- David Salisbury
- Baylor Institute for Rehabilitation (Salisbury, Kolessar, Callender) and Baylor Scott & White Health (Bennett), Dallas, Texas
| | - Michael Kolessar
- Baylor Institute for Rehabilitation (Salisbury, Kolessar, Callender) and Baylor Scott & White Health (Bennett), Dallas, Texas
| | - Librada Callender
- Baylor Institute for Rehabilitation (Salisbury, Kolessar, Callender) and Baylor Scott & White Health (Bennett), Dallas, Texas
| | - Monica Bennett
- Baylor Institute for Rehabilitation (Salisbury, Kolessar, Callender) and Baylor Scott & White Health (Bennett), Dallas, Texas
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17
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Haider MN, Leddy JJ, Baker JG, Kiel JM, Tiso M, Ziermann KA, Willer BS. Concussion management knowledge among residents and students and how to improve it. Concussion 2017; 2:CNC40. [PMID: 30202581 PMCID: PMC6093773 DOI: 10.2217/cnc-2017-0001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 03/15/2017] [Indexed: 11/30/2022] Open
Abstract
Aim: Recognition and management of concussion is an area of growing importance. The objective was to measure concussion knowledge among residents and medical students (MS). Methods: Baseline knowledge was assessed by a standardized questionnaire. Control group (family medicine [FM], pediatric medicine [PM] and emergency medicine) residents were given reading material, and intervention group rotated in a clinic (sports medicine residents and MS). Subjects were retested after 36.82 (16.1) days. Pre- and post-intervention test scores were compared. Results: The average baseline knowledge scores were 79.2% for emergency medicine residents, 61.4% for FM, 68.5% for PM, 71.7% for sports medicine residents and 68.0% for MS. Knowledge increase for control group was 1.16% compared with 14.41% for the clinical rotation group (p < 0.0001). Conclusion: PM and FM residents can benefit from more focused education about concussion.
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Affiliation(s)
- Mohammad N Haider
- Department of Psychiatry, Jacobs School of Medicine, SUNY at Buffalo, NY, 14214, USA.,Department of Orthopedics & Sports Medicine, Jacobs School of Medicine, SUNY at Buffalo, NY, 14214, USA.,Department of Psychiatry, Jacobs School of Medicine, SUNY at Buffalo, NY, 14214, USA.,Department of Orthopedics & Sports Medicine, Jacobs School of Medicine, SUNY at Buffalo, NY, 14214, USA
| | - John J Leddy
- Department of Orthopedics & Sports Medicine, Jacobs School of Medicine, SUNY at Buffalo, NY, 14214, USA.,Department of Orthopedics & Sports Medicine, Jacobs School of Medicine, SUNY at Buffalo, NY, 14214, USA
| | - John G Baker
- Department of Orthopedics & Sports Medicine, Jacobs School of Medicine, SUNY at Buffalo, NY, 14214, USA.,Department of Nuclear Medicine, Jacobs School of Medicine, SUNY at Buffalo, NY, 14214, USA.,Department of Orthopedics & Sports Medicine, Jacobs School of Medicine, SUNY at Buffalo, NY, 14214, USA.,Department of Nuclear Medicine, Jacobs School of Medicine, SUNY at Buffalo, NY, 14214, USA
| | - John M Kiel
- Department of Emergency Medicine, Jacobs School of Medicine, SUNY at Buffalo, NY, 14214, USA.,Department of Emergency Medicine, Jacobs School of Medicine, SUNY at Buffalo, NY, 14214, USA
| | - Michael Tiso
- Department of Internal Medicine & Sports Medicine, Ohio State University, Columbus, OH, 43210, USA.,Department of Internal Medicine & Sports Medicine, Ohio State University, Columbus, OH, 43210, USA
| | - Karl A Ziermann
- Department of Sports Medicine, Wilmington Health Primary Care, Jacksonville, NC, 28546, USA.,Department of Sports Medicine, Wilmington Health Primary Care, Jacksonville, NC, 28546, USA
| | - Barry S Willer
- Department of Psychiatry, Jacobs School of Medicine, SUNY at Buffalo, NY, 14214, USA.,Department of Psychiatry, Jacobs School of Medicine, SUNY at Buffalo, NY, 14214, USA
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Hodax JD, Sobel AD, DeFroda S, Chambers AB, Hulstyn MJ. Orthopaedic Resident Preparation and Confidence in Treating On-Field Injuries. Orthop J Sports Med 2017; 5:2325967117708286. [PMID: 28607940 PMCID: PMC5455864 DOI: 10.1177/2325967117708286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Orthopaedic surgery residents may cover athletic events, although the training provided to prepare residents for this role and oversight from attending physicians during these activities is not well understood. PURPOSE To survey orthopaedic residents about the training provided by their residency program for on-field athletic coverage and to understand their levels of preparation for this role and confidence in treating commonly encountered on-field conditions. STUDY DESIGN Descriptive epidemiology study. METHODS An anonymous survey was emailed to residents in all American College of Graduate Medical Education-accredited, allopathic, nonmilitary orthopaedic surgery residency programs. This survey queried residents about their demographics, the opportunities their residencies require or allow for athletic coverage, their level of preparation for serving an on-field physician, and their comfort level with treating a number of on-field conditions. Likert-type scales were used to assess resident comfort level for treating 13 orthopaedic and nonorthopaedic conditions as well as their perceived level of preparedness. RESULTS Of 148 residency programs contacted, 57 programs responded (39%). Of the 57 programs responding, 51 (89.5%) allowed or required residents to cover athletic events, and 27 of 51 (52.9%) reported that training to prepare for this role was provided. Only 6 of 24 programs without training available (25%) had direct attending supervision of residents at all athletic events. Residents who answered that their residency programs mandate training prior to their participation in athletic coverage activities reported a higher level of preparation for this role than those with no training, optional training, or those who were unsure of their training requirement (P < .0001, P = .035, and P = .013, respectively). In addition, the more senior the resident was, the higher the level of confidence was in treating all orthopaedic and some nonorthopaedic conditions. Residents who had mandatory training displayed a higher comfort level in treating on-field orthopaedic and nonorthopaedic conditions than those without training. CONCLUSION Formal training of orthopaedic residents prior to their covering athletic events can improve confidence in treating orthopaedic and nonorthopaedic conditions. Many programs do not ensure that residents are familiar with key and potentially life-saving equipment. An opportunity exists to improve resident education.
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Affiliation(s)
- Jonathan D Hodax
- Department of Orthopaedics, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Andrew D Sobel
- Department of Orthopaedics, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Steven DeFroda
- Department of Orthopaedics, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Alison B Chambers
- Lifespan Biostatistics Core, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Michael J Hulstyn
- Department of Orthopaedics, Rhode Island Hospital, Providence, Rhode Island, USA
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Taylor DN, Ponce FJ, Dyess SJ. Survey of Primary Contact Medical and Chiropractic Clinicians on Self-Reported Knowledge and Recognition of Mild Traumatic Brain Injuries: A Pilot Study. J Chiropr Med 2017; 16:19-30. [PMID: 28228694 PMCID: PMC5310953 DOI: 10.1016/j.jcm.2016.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 08/12/2016] [Accepted: 10/11/2016] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- David N. Taylor
- Clinical Sciences Department, Texas Chiropractic College, Pasadena, Texas
| | | | - Stephen J. Dyess
- Clinical Sciences Department, Texas Chiropractic College, Pasadena, Texas
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20
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Donaworth MA, Grandhi RK, Logan K, Gubanich PJ, Myer GD. Is current medical education adequately preparing future physicians to manage concussion: an initial evaluation. PHYSICIAN SPORTSMED 2016; 44:1-7. [PMID: 26758683 DOI: 10.1080/00913847.2016.1135039] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES In 2010, there were 2.5 million hospitalizations, emergency room visits, or deaths associated with concussions in the United States.[1] Knowledge deficits exist among physicians regarding concussion management, which can lead to severe repercussions, including poor patient outcomes, poor patient satisfaction, and potential medical-legal issues. While concussion is a prevalent condition evaluated in the medical field, medical students continue to have a knowledge deficit regarding concussion diagnosis, prognosis, medical management, and return to play guidelines. METHODS Medical students from a mid-western medical school completed a survey on concussion diagnosis, prognosis, medical management, and return to play guidelines. RESULTS The response rate was 40%. The data suggests that the vast majority of medical students are able to define concussion; however, most reported never having a lecture dedicated to concussion during medical school and also lacked clinical experience with acute concussion and post-concussive syndrome. There are clear areas of deficiency as noted by the inability of students to correctly identify symptoms and appropriate management of concussion. CONCLUSION The current study indicates that at an individual, mid-western, top 50 medical school, current medical trainees may not be adequately educated to identify and manage concussion. Future research is warranted to determine the optimal guidelines to educate future physicians as it pertains to concussion diagnosis, management, prognosis, and return to play guidelines.
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Affiliation(s)
- Michael A Donaworth
- a Department of Orthopaedic Surgery , University of Cincinnati , Cincinnati , OH , USA.,b University of Cincinnati College of Medicine , Cincinnati , OH , USA
| | - Ravi K Grandhi
- b University of Cincinnati College of Medicine , Cincinnati , OH , USA
| | - Kelsey Logan
- b University of Cincinnati College of Medicine , Cincinnati , OH , USA.,c Division of Sports Medicine, Cincinnati Children's Hospital Medical Center , Cincinnati , OH , USA.,d Department of Pediatrics , University of Cincinnati , Cincinnati , OH , USA
| | - Paul J Gubanich
- b University of Cincinnati College of Medicine , Cincinnati , OH , USA.,c Division of Sports Medicine, Cincinnati Children's Hospital Medical Center , Cincinnati , OH , USA.,d Department of Pediatrics , University of Cincinnati , Cincinnati , OH , USA
| | - Gregory D Myer
- a Department of Orthopaedic Surgery , University of Cincinnati , Cincinnati , OH , USA.,b University of Cincinnati College of Medicine , Cincinnati , OH , USA.,c Division of Sports Medicine, Cincinnati Children's Hospital Medical Center , Cincinnati , OH , USA.,d Department of Pediatrics , University of Cincinnati , Cincinnati , OH , USA.,e The Micheli Center for Sports Injury Prevention , Waltham , MA , USA.,f Department of Orthopaedics , University of Pennsylvania , Philadelphia , PA , USA
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McLendon LA, Kralik SF, Grayson PA, Golomb MR. The Controversial Second Impact Syndrome: A Review of the Literature. Pediatr Neurol 2016; 62:9-17. [PMID: 27421756 DOI: 10.1016/j.pediatrneurol.2016.03.009] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 03/11/2016] [Accepted: 03/18/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND Second impact syndrome is a devastating injury that primarily affects athletic children and young adults. It occurs when a second concussion occurs before symptoms from the first concussion have resolved. Diffuse and often catastrophic cerebral edema results. Reports of second impact syndrome are few, and some argue that second impact syndrome is simply diffuse cerebral swelling unrelated to the first concussion. METHODS Ovid and PubMed were searched from years 1946 to 2015 using the terms "second impact syndrome," "repeat concussion," and "catastrophic brain injury." In addition, review articles were found using a combination of the terms, "concussion," "second impact syndrome," and "repetitive head trauma." RESULTS Seventeen patients in seven publications met the criteria of having two witnessed hits and persistent symptoms from the first to the second concussion. Ten of the 17 (59%) included individuals were football players. All were male. Ages ranged from 13 to 23 years. All children with poor outcomes (death or permanent disability) were younger than 20 years, while four of the five players with good outcomes were older than 19 years. The lag time from first to second concussion ranged from one hour to four weeks, and in many cases, at least one of the two hits appeared minor. CONCLUSIONS American football, male gender, and young age appear to be associated with second impact syndrome. Controversies surrounding this syndrome are discussed. There is a need for prospective studies to clarify risk factors and outcomes of second impact syndrome to guide return-to-play recommendations for young athletes.
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Affiliation(s)
- Loren A McLendon
- Division of Pediatric Neurology, Department of Neurology, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
| | - Stephen F Kralik
- Division of Pediatric Neuroradiology, Department of Radiology, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
| | - Patricia A Grayson
- Division of Pediatric Neurology, Department of Neurology, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
| | - Meredith R Golomb
- Division of Pediatric Neurology, Department of Neurology, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana.
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Sport Concussion Knowledge and Clinical Practices: A Survey of Doctors of Chiropractic With Sports Certification. J Chiropr Med 2015; 14:169-75. [PMID: 26778930 DOI: 10.1016/j.jcm.2015.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 08/20/2015] [Accepted: 08/23/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The purpose of this study is to describe the knowledge base and clinical practices regarding concussion by sports-certified doctors of chiropractic. METHODS A 21-item survey was distributed to the 312 attendees of the 2014 American Chiropractic Board of Sports Physicians Sports Sciences Symposium. Results were measured by frequency analysis and descriptive statistics for all surveys completed by sports-certified chiropractors. RESULTS Seventy-six surveys were returned by sports-certified doctors of chiropractic. All (N = 76) 100% of respondents believe that the evaluation of concussion should be performed by a health care provider with training in concussion. The respondents actively assess and manage concussion in adults (96%), adolescents (95%), and children (75%). A majority (79%) of respondents believe that the Sideline Concussion Assessment Tool-3 represents a current standard of care for the sideline evaluation of the athlete who possibly has sustained a sport concussion. Most respondents agreed or strongly agreed that manual therapies may be appropriate in certain circumstances in adults (80%) and minors (80%). CONCLUSION This cross section of certified sports chiropractors strongly believes that the evaluation of concussion should be performed by a health care provider with specific training in concussion. A high percentage of the sports-certified chiropractors who responded assess and manage sport concussion in their practice, and many of them endorse the use of the Sideline Concussion Assessment Tool-3 as a sideline assessment tool.
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Mrazik M, Dennison CR, Brooks BL, Yeates KO, Babul S, Naidu D. A qualitative review of sports concussion education: prime time for evidence-based knowledge translation. Br J Sports Med 2015; 49:1548-53. [DOI: 10.1136/bjsports-2015-094848] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2015] [Indexed: 11/03/2022]
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26
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Canadian pediatric emergency physician knowledge of concussion diagnosis and initial management. CAN J EMERG MED 2015; 17:115-22. [DOI: 10.1017/cem.2014.38] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractIntroductionThe 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.MethodsThe 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.ResultsOf 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.ConclusionDespite 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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Raukar NP, Zonfrillo MR, Kane K, Davenport M, Espinoza TR, Weiland J, Franco V, Vaca FE. Gender- and sex-specific sports-related injury research in emergency medicine: a consensus on future research direction and focused application. Acad Emerg Med 2014; 21:1370-9. [PMID: 25420669 DOI: 10.1111/acem.12535] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 07/27/2014] [Accepted: 07/29/2014] [Indexed: 12/13/2022]
Abstract
Title IX, the commercialization of sports, the social change in sports participation, and the response to the obesity epidemic have contributed to the rapid proliferation of participation in both competitive organized sports and nontraditional athletic events. As a consequence, emergency physicians are regularly involved in the acute diagnosis, management, disposition, and counseling of a broad range of sports-related pathology. Three important and highly publicized mechanisms of injury in sports relevant to emergency medicine (EM) include concussion, heat illness, and sudden cardiac death. In conjunction with the 2014 Academic Emergency Medicine consensus conference "Gender-specific Research in Emergency Care: Investigate, Understand, and Translate How Gender Affects Patient Outcomes," a consensus group consisting of experts in EM, emergency neurology, sports medicine, and public health convened to deliberate and develop research questions that could ultimately advance the field of sports medicine and allow for meaningful application in the emergency department (ED) clinical setting. Sex differences in injury risk, diagnosis, ED treatment, and counseling are identified in each of these themes. This article presents the consensus-based priority research agenda.
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Affiliation(s)
- Neha P. Raukar
- Department of Emergency Medicine; Warren Alpert Medical School of Brown University; Providence RI
| | - Mark R. Zonfrillo
- Division of Emergency Medicine and Center for Injury Research and Prevention; Children's Hospital of Philadelphia; Philadelphia PA
| | - Kathleen Kane
- Department of Emergency Medicine; Lehigh Valley Hospital/USF Morsani College of Medicine; Allentown PA
| | - Moira Davenport
- Department of Emergency Medicine; Allegheny General Hospital; Pittsburgh PA
| | | | - Jessica Weiland
- Department of Emergency Medicine; Lehigh Valley Hospital/USF Morsani College of Medicine; Allentown PA
| | - Vanessa Franco
- Department of Emergency Medicine; University of California at Los Angeles; Los Angeles CA
| | - Federico E. Vaca
- Department of Emergency Medicine; Yale University School of Medicine; New Haven CT
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Williamson RW, Gerhardstein D, Cardenas J, Michael DB, Theodore N, Rosseau N. Concussion 101. Neurosurgery 2014; 75 Suppl 4:S131-5. [DOI: 10.1227/neu.0000000000000482] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Head Injury in the Elderly: Is Our Health Care System Ready for the Fall(s)? Can J Neurol Sci 2014; 41:407-8. [DOI: 10.1017/s0317167100018400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Donaldson A, Newton J, McCrory P, White P, Davis G, Makdissi M, Finch CF. Translating Guidelines for the Diagnosis and Management of Sports-Related Concussion Into Practice. Am J Lifestyle Med 2014; 10:120-135. [PMID: 30202266 DOI: 10.1177/1559827614538751] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 01/20/2014] [Accepted: 03/06/2014] [Indexed: 11/15/2022] Open
Abstract
Sports injuries are a significant clinical and public health concern. There is a growing call to improve the translation of available evidence-based and expert-informed sports injury prevention interventions into sustained use in practice by physicians and others (eg, athletic trainers, coaches, and parents) who care for injured athletes. This article provides a brief overview of the current sport injury prevention implementation literature before focusing specifically on the translation of guidelines (including consensus and position statements) developed to assist physicians and others diagnose and manage athletes with sport-related concussion and the associated return-to-play decisions. The outcomes of more than 20 published studies indicate that physician, athletic trainer, coach, parent, and athlete knowledge, use of, and compliance with sport-related concussion guidelines are limited. More concerted, coordinated, and theory-informed efforts are required to facilitate the widespread dissemination, translation, and implementation of such guidelines. An example is provided of how implementation drivers could be used to inform the development of a comprehensive, multilevel implementation strategy targeting the individual, organizational, and system-level changes necessary to support the translation of available sport-related concussion guidelines in both the clinical and sports settings.
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Affiliation(s)
- Alex Donaldson
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Victoria, Australia (AD, PW, CFF, PM).,Deakin University, Burwood, Victoria, Australia (JN).,The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, Victoria, Australia (PM, GD, MM).,Department of Neurosurgery, Cabrini Hospital, Malvern, Victoria, Australia (GD)
| | - Joshua Newton
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Victoria, Australia (AD, PW, CFF, PM).,Deakin University, Burwood, Victoria, Australia (JN).,The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, Victoria, Australia (PM, GD, MM).,Department of Neurosurgery, Cabrini Hospital, Malvern, Victoria, Australia (GD)
| | - Paul McCrory
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Victoria, Australia (AD, PW, CFF, PM).,Deakin University, Burwood, Victoria, Australia (JN).,The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, Victoria, Australia (PM, GD, MM).,Department of Neurosurgery, Cabrini Hospital, Malvern, Victoria, Australia (GD)
| | - Peta White
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Victoria, Australia (AD, PW, CFF, PM).,Deakin University, Burwood, Victoria, Australia (JN).,The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, Victoria, Australia (PM, GD, MM).,Department of Neurosurgery, Cabrini Hospital, Malvern, Victoria, Australia (GD)
| | - Gavin Davis
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Victoria, Australia (AD, PW, CFF, PM).,Deakin University, Burwood, Victoria, Australia (JN).,The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, Victoria, Australia (PM, GD, MM).,Department of Neurosurgery, Cabrini Hospital, Malvern, Victoria, Australia (GD)
| | - Michael Makdissi
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Victoria, Australia (AD, PW, CFF, PM).,Deakin University, Burwood, Victoria, Australia (JN).,The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, Victoria, Australia (PM, GD, MM).,Department of Neurosurgery, Cabrini Hospital, Malvern, Victoria, Australia (GD)
| | - Caroline F Finch
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Victoria, Australia (AD, PW, CFF, PM).,Deakin University, Burwood, Victoria, Australia (JN).,The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, Victoria, Australia (PM, GD, MM).,Department of Neurosurgery, Cabrini Hospital, Malvern, Victoria, Australia (GD)
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Moser RS, Schatz P, Lichtenstein JD. The Importance of Proper Administration and Interpretation of Neuropsychological Baseline and Postconcussion Computerized Testing. APPLIED NEUROPSYCHOLOGY-CHILD 2013; 4:41-8. [DOI: 10.1080/21622965.2013.791825] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
BACKGROUND Recent reports raise concern that physician knowledge of the identification and management of concussion may be deficient. There is little information known about the adequacy of concussion education provided to physicians or medical students. The present study assesses the concussion curriculum offered at medical schools in Canada. METHODS We asked all 17 Canadian medical schools to complete a questionnaire on their concussion curriculum, including the following: year of medical school offered; format/setting; and estimated teaching hours. The responses were organized into three categories: (1) concussion-specific education; (2) head injury education incorporating a concussion component; and (3) no concussion education. RESULTS Replies were received from 14 (82%) of the 17 medical schools in Canada. Of the 14 responding schools, four (29%) provided concussion-specific education, six (43%) offered head injury education that incorporated a concussion component, and four (29%) reported no concussion teaching in their curriculum. CONCLUSION We found deficiencies in the concussion education curriculum provided in the majority of Canadian medical schools. To address this issue, we recommend that all medical schools should, at a minimum, include a one-hour formal concussion-specific teaching session in an early year of their curriculum to be followed by clinical exposure to concussed patients in the later years of medical school. Future studies will be necessary to evaluate if these recommended curricular enhancements are effective in remedying the reported gaps in physicians' concussion knowledge and whether the improved curriculum translates into better care for patients suffering concussion.
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