Doctors need guidelines and tools to help them properly manage concussions, according to a recent study.
“A study of physicians’ knowledge of and attitudes toward concussion management practices points to the need for improved concussion-specific training and infrastructure to support optimal patient care,” The Children’s Hospital of Philadelphia (CHOP) said in a press release.
CHOP led the research, whose findings were recently published online in Pediatrics.
The study, conducted by researchers at Children’s Hospital’s Center for Injury Research and Prevention (CIRP), surveyed 145 emergency medicine and primary care providers. Of that group, 91 percent had cared for at least one concussion patient, while 92 percent had referred at least one patient to a concussion specialist in the prior three months.
“We have seen concussion visits within our emergency department, primary care, and specialty care network at CHOP quadruple since 2009, to a current total of more than 6,700 each year,” said lead author and CIRP researcher Dr. Mark Zonfrillo said in a statement.
The way to manage a concussion in the first weeks following the injury involves “using a systematic, clinical assessment to determine if concussion symptoms are resolving, and adhering to a step-by-step program of gradual return-to-learn and return-to-play,”‘ according to the hospital press release. “However, the study found inconsistent clinical assessment and inconsistent prescribing of the ‘return’ protocols in discharge instructions.”
The study also found some variability in how respondents recognized the signs, symptoms and physical-exam findings for concussion, the hospital said. The takeaway is that “continuing medical education training for primary care and emergency medicine clinicians, coupled with standardized clinical decision support tools and patient education tools,” is required for proper concussion care.
In fact, study participants agreed that standardized evaluation and decision-making tools, and training in their use, would increase their comfort with diagnosing and managing concussions.
Based in their input, concussion specialists at “CHOP have developed a novel infrastructure, which offers diagnostic and patient education support tools, that is now delivered through CHOP’s electronic medical record system,” the hospital said.
“We adapted state-of-the-science protocols used by concussion specialists into an electronic interactive form that is part of the patient’s medical record,” Zonfrillo said. “This form, which is specific to concussion, provides a guide for the primary care provider for the systematic evaluation of concussion patients, including potential symptoms and physical exam findings.”
Doctors can also print out fact sheets that “walk the parents through the return-to-learn and return-to-play process, as well as a letter intended for the child’s school that explains the diagnosis and treatment,” the hospital said.
The interactive form indicates when a patient should be referred to a specialist if, for example, they have certain pre-existing conditions or for persistent symptoms.
Previously Children’s Hospital concussion experts provided special training to more than 100 providers across the CHOP Care Network, which comprises more than 30 primary care locations across the Philadelphia area. The goal is for t Children’s Hospital’s new Medical Home model for concussion management to eventually be applied to other health systems.