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Langer LK, Bayley MT, Levy C, Munce SEP, Lawrence DW, Tam A, de Oliveira C. Medical Care Among Individuals with a Concussion in Ontario: A Population-based Study. Can J Neurol Sci 2024; 51:87-97. [PMID: 36537153 DOI: 10.1017/cjn.2022.346] [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: 12/24/2022]
Abstract
BACKGROUND Concussion affects 1.2% of the population annually; rural regions and children have higher rates of concussion. METHODS Using administrative health care linked databases, all residents of Ontario with a physician diagnosed concussion were identified using ICD-9 code 850 or ICD-10 code S06. Cases were tracked for 2 years for concussion-related health care utilization with relevant specialist physicians (i.e., neurology, otolaryngology, physiatry, psychiatry, ophthalmology). Billing codes, specialist codes, and time from index to visit were analyzed. Factors associated with increased specialist visits were also examined. RESULTS In total, 1,022,588 cases were identified between 2008 and 2014 with 2 years of post-concussion health care utilization available. Follow-up by physician within 3 days of injury occurred in only 14% of cases. Mean time between ED diagnosis and follow-up by a physician was 83.9 days, whereas for rural regions it was >100 days. About half of adults (51.9%) and children (50.3%) had at least 1 specialist visit following concussion. Mean time between injury and first specialist visit was 203.8 (SD 192.9) days for adults, 213.5 (SD 201.0) days for rural adults, and 276.0 (SD 202.6) days for children. There were 67,420 neurology visits, 70,404 psychiatry visits, 13,571 neurosurgery visits, 19,780 physiatry visits, 101,788 ENT visits, and 103,417 ophthalmology visits in the 2 years tracking period. Factors associated with more specialist use included age > 18 years, urban residence, and pre-injury psychiatric history. CONCLUSIONS There are discrepancies in post-concussion health care utilization based on age group and rural/urban residence. Addressing these risk factors could improve concussion care access.
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Affiliation(s)
| | - Mark Thedore Bayley
- KITE Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
- Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
- Faculty of Medicine, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Charissa Levy
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Toronto ABI Network, Toronto, Canada
| | - Sarah Elizabeth Patricia Munce
- KITE Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
| | - David Wyndham Lawrence
- Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
- Mt Sinai Hospital, New York, USA
| | - Alan Tam
- Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Claire de Oliveira
- ICES, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Canada
- Centre for Health Economics and Hull York Medical School, University of York, UK
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Salmon DM, Badenhorst M, Falvey É, Kerr ZY, Brown J, Walters S, Sole G, Sullivan SJ, Whatman C, Register-Mihalik J, Murphy I. Time to expand the circle of care - General practitioners' experiences of managing concussion in the community. J Sports Sci 2022; 40:2102-2117. [PMID: 36399490 DOI: 10.1080/02640414.2022.2130586] [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: 11/19/2022]
Abstract
New Zealand Rugby (NZR) implemented a concussion management pathway (CMP), aimed at improving management at community level. General Practitioners (GPs) played a large role in the design of this process. The objective of this study was to explore GPs' perceptions of barriers and facilitators of the CMP and rugby-related concussion management in the community. A descriptive qualitative approach using interviews and focus groups was employed. Four themes were derived: i) GPs' existing knowledge and confidence around concussion management; ii) Operational resources: time, remuneration and pathway guidance; iii) Standardising concussion care and iv) Expanding the circle of care - the need for multi-disciplinary healthcare team. These themes described how GP's concussion knowledge, and the efficiency and availability of operational resources affected their experience and ability to fulfil their tasks within the CMP. GPs found NZR's CMP especially valuable, as it provided guidance and structure. Expanding the role of other healthcare providers was seen as critical to reduce the burden on GPs, while also delivering a more holistic experience to improve clinical outcomes. Addressing the identified barriers and expanding the network of care will help to improve the ongoing development of NZR's CMP, while supporting continued engagement with all stakeholders.
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Affiliation(s)
- Danielle M Salmon
- Injury Prevention and Player Welfare, New Zealand Rugby, Wellington, New Zealand
| | - Marelise Badenhorst
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
| | - Éanna Falvey
- World Rugby House, Pembroke Street Lower, Dublin.,College of Medicine & Health, University College Cork, Cork, Ireland
| | - Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - James Brown
- The Institute of Sport and Exercise Medicine, Stellenbosch University, Cape Town, South Africa
| | - Simon Walters
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
| | - Gisela Sole
- Centre of Health, Activity, Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, Newzeland
| | - S John Sullivan
- Injury Prevention and Player Welfare, New Zealand Rugby, Wellington, New Zealand
| | - Chris Whatman
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
| | - Johna Register-Mihalik
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ian Murphy
- Injury Prevention and Player Welfare, New Zealand Rugby, Wellington, New Zealand
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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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Zhao QJ, Cupido N, Whitehead CR, Mylopoulos M. What role can education play in integrated care? Lessons from the ECHO (Extensions for Community Health Outcomes) Concussion program. JOURNAL OF INTEGRATED CARE 2022. [DOI: 10.1108/jica-01-2022-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeDesign, implementation, and evaluation are all important for integrated care. However, they miss one critical factor: education. The authors define “integrated care education” as meaningful learning that purposefully supports collaboration and the development of adaptive expertise in integrated care. The ECHO (Extensions for Community Health Outcomes) model is a novel digital health solution that uses technology-enabled learning (TEL) to facilitate, support, and model integrated care education. Using ECHO Concussion as a case study, the authors describe the effects of technology-enabled integrated care education on the micro-, meso-, and macro-dimensions of integrated care.Design/methodology/approachThis case study was constructed using data extracted from ECHO Concussion from video-archived sessions, participant observation, and internal program evaluation memos. The research team met regularly to discuss the development of relevant themes to the dimensions of integrated care.FindingsOn the micro-level, clinical integration occurs through case-based learning and the development of adaptive expertise. On the meso-level, professional integration is achieved through the development of the “specialist generalist,” professional networks and empathy. Finally, on the macro-level, ECHO Concussion and the ECHO model achieve vertical and horizontal system integration in the delivery of integrated care. Vertical integration is achieved through ECHO by educating and connecting providers across sectors from primary to quaternary levels of care. Horizontal integration is achieved through the establishment of lateral peer-based networks across sectors as a result of participation in ECHO sessions with a focus on population-level health.Originality/valueThis case study examines the role of education in the delivery of integrated care through one program, ECHO Concussion. Using the three dimensions of integrated care on the micro-, meso-, and macro-levels, this case study is the first explicit operationalization of ECHO as a means of delivering integrated care education and supporting integrated care delivery.
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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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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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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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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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Mathieu F, Ellis MJ, Tator CH. Concussion education in Canadian medical schools: a 5 year follow-up survey. BMC MEDICAL EDUCATION 2018; 18:316. [PMID: 30572879 PMCID: PMC6302298 DOI: 10.1186/s12909-018-1416-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 12/03/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Despite concussion now being recognized as a public health priority in Canada, recent studies-including our 2012 survey of Canadian medical schools-have revealed major gaps in concussion education at the undergraduate medical school level. METHODS We re-surveyed all 17 Canadian medical schools using a questionnaire divided in two categories: (1) concussion-specific education (2) head injury education incorporating a concussion component to determine whether there have been any improvements in concussion education at the medical school level during the last five years. For each year of medical school, respondents were asked to provide the estimated number of hours and teaching format for each category. RESULTS We received replies from 13 of the 17 medical schools (76%). 11 of the 13 (85%) medical schools now reported providing concussion-specific education compared to 29% in our 2012 survey. The mean number of hours dedicated to category 1 learning in 2017 was 2.65 h compared to 0.57 in 2012, and the mean number of hours of category 2 increased to 7.5 from 1.54. CONCLUSION Our follow-up study reveals increased exposure to concussion-related teaching in Canadian medical schools during the last five years. Persistent deficiencies in a minority of schools are highlighted. These should be addressed by reiterating the importance of concussion education for undergraduate medical students and by developing clear concussion-specific objectives at the national licensure level.
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Affiliation(s)
- François Mathieu
- Division of Neurosurgery, Department of Surgery, University of Toronto, 399 Bathurst St, Toronto, ON M5T2S8 Canada
| | - Michael J. Ellis
- Pan Am Clinic, Section of Neurosurgery, University of Manitoba, 75 Poseidon Bay, Winnipeg, MB R3M3E4 Canada
| | - Charles H. Tator
- Canadian Concussion Center, Division of Neurosurgery, University Health Network, Toronto Western Hospital, 399 Bathurst St, Toronto, ON M5T2S8 Canada
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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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11
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Knowledge, Attitudes and Concussion Information Sources Among First Nations in Ontario. Can J Neurol Sci 2018; 45:283-289. [PMID: 29552994 DOI: 10.1017/cjn.2017.299] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Hockey is a popular sport played by many First Nation youth. Concussion frequently goes unrecognized and unreported in youth hockey. Unintentional injuries among Indigenous youth occur at rates three to four times the national Canadian average. The study sought to examine knowledge, attitudes and sources of concussion information among First Nations people attending a provincial hockey tournament. METHODS A cross-sectional survey was undertaken. The survey by Mzazik et al. were modified to use in this study. Participants included youth (6-18 years) hockey players (n=75), parents (n=248) and coaches (n=68). The main outcome measure was total knowledge index (TKI) which consisted of the sum of correct responses to 15 multiple choice questions. Additional data gathered included demographics, concussion history, attitudes toward concussion and sources of information. Descriptive statistics included proportion comparisons. Variables were tested using χ 2 and analysis of variance. RESULTS Overall TKI scores (out of a total of 15) were low; players (5.9±2.8), parents (7.5±2.6) and coaches (7.9±2.6). Participants with higher knowledge scores reported more appreciation of the seriousness of concussion. Sources of information about concussion differed by study group, suggesting the need for multiple knowledge translation strategies to reach youth, parents and coaches. CONCLUSIONS Future initiatives are urgently needed to improve education and prevention of concussion in First Nations youth hockey. Collaborating and engaging with communities can help to ensure an Indigenous lens for culturally safe interventions.
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Rowe BH, Eliyahu L, Lowes J, Gaudet LA, Beach J, Mrazik M, Cummings G, Voaklander D. Concussion diagnoses among adults presenting to three Canadian emergency departments: Missed opportunities. Am J Emerg Med 2018; 36:2144-2151. [PMID: 29636295 DOI: 10.1016/j.ajem.2018.03.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 03/09/2018] [Accepted: 03/19/2018] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Patients with concussion commonly present to the emergency department (ED) for assessment. Misdiagnosis of concussion has been documented in children and likely impacts treatment and discharge instructions. This study aimed to examine diagnosis of concussion in a general adult population. METHODS Patients >17years old presenting meeting the World Health Organization's definition of concussion were recruited in one academic (Hospital 1) and two community (Hospitals 2 and 3) EDs in a Canadian city. A physician questionnaire and patient interviews documented recommendations given by emergency physicians. Bi-variable comparisons are reported using chi-square tests, t-tests or Mann-Whitney tests, as appropriate. Multivariate analyses were performed using logistic regression methods. RESULTS Overall, the study enrolled 250 patients. The median age was 35 (IQR: 23 to 49) and 52% were female. A variety of concussion causes were documented. Forty-one (16%) patients were not diagnosed with a concussion despite meeting criteria. Concussion diagnosis was less likely with a longer ED length of stay (OR=0.71; 95% CI: 0.60 to 0.83), presenting to the non-academic centers (Hospital 2: OR=0.21, 95% CI: 0.08 to 0.58; Hospital 3: OR=0.07, 95% CI: 0.02 to 0.24), or involvement in a motor vehicle collision (OR=0.11; 95% CI: 0.03 to 0.46). CONCLUSION One in six patients with concussion signs and symptoms were misdiagnosed in the ED. Misdiagnosis was related to injury mechanism, length of stay, and enrolment site. Closer examination of institutional factors is needed to identify effective strategies to promote accurate diagnosis of concussion.
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Affiliation(s)
- Brian H Rowe
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.
| | - Leeor Eliyahu
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Justin Lowes
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Lindsay A Gaudet
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Jeremy Beach
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Division of Preventive Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; College of Physicians and Surgeons of Alberta, Edmonton, Alberta, Canada
| | - Martin Mrazik
- Department of Educational Psychology, Faculty of Education, University of Alberta, Edmonton, Alberta, Canada
| | - Garnet Cummings
- Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Donald Voaklander
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Patrick SP, Gaudet LA, Krebs LD, Chambers T, Rowe BH. Emergency Physician Training on Mild Traumatic Brain Injury: A Systematic Review. AEM EDUCATION AND TRAINING 2017; 1:346-356. [PMID: 30051054 PMCID: PMC6001600 DOI: 10.1002/aet2.10053] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/14/2017] [Accepted: 07/19/2017] [Indexed: 06/08/2023]
Abstract
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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Affiliation(s)
- Sean P. Patrick
- Faculty of MedicineUniversity of OttawaOttawaONCanada
- Department of Emergency MedicineUniversity of AlbertaEdmontonABCanada
| | - Lindsay A. Gaudet
- Department of Emergency MedicineUniversity of AlbertaEdmontonABCanada
| | - Lynette D. Krebs
- Department of Emergency MedicineUniversity of AlbertaEdmontonABCanada
| | - Thane Chambers
- J. W. Scott Health Sciences LibraryUniversity of AlbertaEdmontonABCanada
| | - Brian H. Rowe
- Department of Emergency MedicineUniversity of AlbertaEdmontonABCanada
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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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Elkington LJ, Hughes DC. Australian Institute of Sport and Australian Medical Association position statement on concussion in sport. Med J Aust 2017; 206:46-50. [DOI: 10.5694/mja16.00741] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 09/20/2016] [Indexed: 11/17/2022]
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16
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Legislation for Youth Sport Concussion in Canada: Review, Conceptual Framework, and Recommendations. Can J Neurol Sci 2017; 44:225-234. [PMID: 28069082 DOI: 10.1017/cjn.2016.423] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In this article, we conduct a review of introduced and enacted youth concussion legislation in Canada and present a conceptual framework and recommendations for future youth sport concussion laws. We conducted online searches of federal, provincial, and territorial legislatures to identify youth concussion bills that were introduced or successfully enacted into law. Internet searches were carried out from July 26 and 27, 2016. Online searches identified six youth concussion bills that were introduced in provincial legislatures, including two in Ontario and Nova Scotia and one each in British Columbia and Quebec. One of these bills (Ontario Bill 149, Rowan's Law Advisory Committee Act, 2016) was enacted into provincial law; it is not actual concussion legislation, but rather a framework for possible enactment of legislation. Two bills have been introduced in federal parliament but neither bill has been enacted into law. At present, there is no provincial or federal concussion legislation that directly legislates concussion education, prevention, management, or policy in youth sports in Canada. The conceptual framework and recommendations presented here should be used to guide the design and implementation of future youth sport concussion laws in Canada.
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Recognizing the Symptoms of Mental Illness following Concussions in the Sports Community: A Need for Improvement. PLoS One 2015; 10:e0141699. [PMID: 26536016 PMCID: PMC4633152 DOI: 10.1371/journal.pone.0141699] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 10/12/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate the awareness of concussion-related symptoms amongst members of the sports community in Canada. METHODS A cross-sectional national electronic survey was conducted. Youth athletes, parents, coaches and medical professionals across Canada were recruited through mailing lists from sports-related opt-in marketing databases. Participants were asked to identify, from a list of options, the symptoms of a concussion. The proportion of identified symptoms (categorized as physical, cognitive, mental health-related and overall) as well as participant factors associated with symptom recognition were analyzed. RESULTS The survey elicited 6,937 responses. Most of the respondents (92.1%) completed the English language survey, were male (57.7%), 35-54 years of age (61.7%), with post-secondary education (58.2%), or high reported yearly household income (>$80,000; 53.0%). There were respondents from all provinces and territories with the majority of respondents from Ontario (35.2%) or British Columbia (19.1%). While participants identified most of the physical (mean = 84.2% of symptoms) and cognitive (mean = 91.2% of symptoms), they on average only identified 53.5% of the mental health-related symptoms of concussions. Respondents who were older, with higher education and household income, or resided in the Northwest Territories or Alberta identified significantly more of the mental health-related symptoms listed. INTERPRETATION While Canadian youth athletes, parents, coaches and medical professionals are able to identify most of the physical and cognitive symptoms associated with concussion, identification of mental health-related symptoms of concussion is still lagging.
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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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Echlin PS, Johnson AM, Holmes JD, Tichenoff A, Gray S, Gatavackas H, Walsh J, Middlebro T, Blignaut A, MacIntyre M, Anderson C, Fredman E, Mayinger M, Skopelja EN, Sasaki T, Bouix S, Pasternak O, Helmer KG, Koerte IK, Shenton ME, Forwell LA. The Sport Concussion Education Project. A brief report on an educational initiative: from concept to curriculum. J Neurosurg 2014; 121:1331-6. [PMID: 25280091 DOI: 10.3171/2014.8.jns132804] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Current research on concussion is primarily focused on injury identification and treatment. Prevention initiatives are, however, important for reducing the incidence of brain injury. This report examines the development and implementation of an interactive electronic teaching program (an e-module) that is designed specifically for concussion education within an adolescent population. This learning tool and the accompanying consolidation rubric demonstrate that significant engagement occurs in addition to the knowledge gained among participants when it is used in a school curriculum setting.
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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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Mutch WAC, Ellis MJ, Graham MR, Wourms V, Raban R, Fisher JA, Mikulis D, Leiter J, Ryner L. Brain MRI CO2 stress testing: a pilot study in patients with concussion. PLoS One 2014; 9:e102181. [PMID: 25032707 PMCID: PMC4102518 DOI: 10.1371/journal.pone.0102181] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 06/15/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND There is a real need for quantifiable neuro-imaging biomarkers in concussion. Here we outline a brain BOLD-MRI CO2 stress test to assess the condition. METHODS This study was approved by the REB at the University of Manitoba. A group of volunteers without prior concussion were compared to post-concussion syndrome (PCS) patients--both symptomatic and recovered asymptomatic. Five 3-minute periods of BOLD imaging at 3.0 T were studied--baseline 1 (BL1--at basal CO2 tension), hypocapnia (CO2 decreased ∼5 mmHg), BL2, hypercapnia (CO2 increased ∼10 mmHg) and BL3. Data were processed using statistical parametric mapping (SPM) for 1st level analysis to compare each subject's response to the CO2 stress at the p = 0.001 level. A 2nd level analysis compared each PCS patient's response to the mean response of the control subjects at the p = 0.05 level. RESULTS We report on 5 control subjects, 8 symptomatic and 4 asymptomatic PCS patients. Both increased and decreased response to CO2 was seen in all PCS patients in the 2nd level analysis. The responses were quantified as reactive voxel counts: whole brain voxel counts (2.0±1.6%, p = 0.012 for symptomatic patients for CO2 response < controls and 3.0±5.1%, p = 0.139 for CO2 response > controls: 0.49±0.31%, p = 0.053 for asymptomatic patients for CO2 response < controls and 4.4±6.8%, p = 0.281 for CO2 response > controls). CONCLUSIONS Quantifiable alterations in regional cerebrovascular responsiveness are present in concussion patients during provocative CO2 challenge and BOLD MRI and not in healthy controls. Future longitudinal studies must aim to clarify the relationship between CO2 responsiveness and individual patient symptoms and outcomes.
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Affiliation(s)
- W. Alan C. Mutch
- Department of Anesthesia and Perioperative Medicine, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael J. Ellis
- Department of Surgery, Section of Neurosurgery, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - M. Ruth Graham
- Department of Anesthesia and Perioperative Medicine, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Vincent Wourms
- Department of Anesthesia and Perioperative Medicine, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Roshan Raban
- Department of Anesthesia and Perioperative Medicine, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Joseph A. Fisher
- Department of Anesthesia and Pain Management, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - David Mikulis
- Department of Radiology, Section of Neuroimaging, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey Leiter
- Department of Surgery, Pan Am Clinic, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lawrence Ryner
- Department of Physics and Astronomy, University of Manitoba, Winnipeg, Manitoba, Canada
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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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