Current practices of
the child neurologist in managing sports concussion

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used the outdated American Academy of Neurology’s 1997 Practice Parameters, few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.

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?

by: Jane McDevitt, MS, ATC, CSCS
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