Concussion management by paediatricians: a national survey of Canadian paediatricians

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Abstract

Objective

To determine: (a) concussion/mTBI guideline use, (b) criteria used in initiating return to play (RTP), and (c) the management of RTP by Canadian paediatricians.

Design

Cross-sectional survey.

Subjects

Sample of 2599 Canadian paediatric specialists and subspecialists.

Methods

The Canadian Paediatric Surveillance Program provided the sampling frame and survey management. Potential participants were sent a seven-item survey inquiring whether they managed children with concussion, and if so, which guidelines they used, and their initiating RTP criteria and duration.

Results

809 paediatricians responded (31%), with 503 eligible for the study by indicating that they managed children/youth with newly diagnosed with concussion/mTBI. They reported collectively managing approximately 6700 children/youth within the last 12 months (2010–2011). They reported using many concussion/mTBI guidelines: Canadian Paediatric Society (n=244), American Academy of Paediatrics (n=101), Concussion in Sport Group (n=68), Canadian Academy of Sport and Exercise Medicine (n=58), and the American Academy of Neurology (n=25). Similarly, different criteria were used to determine asymptomatic status. Most common were: free from all concussion symptoms, by patient report (n=323), by proxy report (parent/other) (n=269), and free from continuous daily (unremitting) headache (n=162). Of those reporting, most (∼85%) indicated that they did not initiate RTP immediately after their patients became asymptomatic. The median recommend time before initiating RTP was 7 days.

Conclusions

Concussions/mTBI are frequently encountered by Canadian paediatricians. There is heterogeneity in the guidelines used and the criteria used to determine when patients become asymptomatic with most recommending asymptomatic time before starting RTP.

Competing interests

None.

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