Broshek DK., Samples H., Beard H., Goodkin HP. J Child Neurol. ahead of print; 2012.
The American Academy of Neurology issued a statement indicating that neurologists should be consulted on return-to-play decisions following a concussion. Therefore, pediatric neurologists are playing an increasingly important role in concussion management. This study’s objective was to assess pediatric neurologists’ current clinical practice for returning athletes to play. The authors developed the survey based on literature, personal practice, and the Zurich Guidelines. Survey questions targeted respondent demographics, clinical practice variables (e.g., years of practice), perceived adequacy of training, continuing education of sports concussion, diagnostic issues in concussion injuries (e.g., isolated headaches after injury), knowledge of continuing education, and clinical practice tools for use in concussion management. One thousand-one hundred active members of the Child Neurology Society were emailed a link to the survey. Two hundred and thirty-nine responded and were included in the study (~22% response rate). Many of the respondents had been in practice for over 25 years (25.9%) or were in practice for less than 5 years (21.8%). Those who saw more concussed pediatric patients were more likely to complete continuing pediatric concussion education. However, only 10.6% used neurocognitive tests on a regular basis. The majority of the respondents (90.9%) believe that a pediatric neurologist with concussion management training should provide follow-up care for children who have sustained a concussion; however, there was concern about the supply of available neurologists to provide care. Only about 36% of respondents somewhat agreed that they had adequate training in managing pediatric concussion, whereas 38.3% somewhat or strongly disagreed. Approximately half (50.4%) of respondents somewhat agreed that adequate continuing pediatric concussion education resources are available; however, 68.6% had not completed continuing education related to pediatric concussion care. Furthermore, over half (56%) of the respondents exclusively used the outdated American Academy of Neurology’s 1997 Practice Parameters, few used the Zurich guidelines, and 8.2% responded that they do not use any guidelines. Respondents who have been in practice longer relied more on the American Academy of Neurology’s 1997 Practice Parameters instead of the Zurich Guidelines. Respondents with more concussion education were more likely to use the Zurich guidelines.
Children under the age of 14 years are one of the age groups most at risk for concussion and recent research indicates cognitive symptoms may persist for a year after a concussion within this population. Persistent concussion symptoms are associated with lower quality of life and functional impairments in daily activities. Therefore, it is imperative that the pediatric population receives expert care. Most pediatric neurologists believe that they should be involved in the follow-up care of a pediatric concussed patient but many are not confident in their training. Only half of the respondents believed that appropriate continuing education programs exist and many are not using them. This is unfortunate since pediatric neurologists who completed continuing education had a greater understanding of the most recent concussion guidelines. The authors believe that there is a need for more continuing education on concussion management and return-to-play practices specific for pediatric neurologists. With so many states and countries passing laws about which medical professional(s) should be responsible for diagnosing and managing concussions it is imperative that whoever is responsible for these decisions be properly trained based on the latest practice protocols. Do you feel that you have received adequate training to manage pediatric concussions?
Written by: Jane McDevitt, MS, ATC, CSCS
Reviewed: Jeffrey Driban
Related Posts:Broshek DK, Samples H, Beard J, & Goodkin HP (2012). Current Practices of the Child Neurologist in Managing Sports Concussion. Journal of Child Neurology PMID: 23143716