title: Factors influencing emergency medicine physicians' management of sports-related concussions: a community-wide study.
abstract: BACKGROUND
  Numerous guidelines to grade and manage sports-related concussions have been published. However, little is known about how frequently they are implemented in the emergency department. This study evaluates the current practices of emergency physicians (EPs) in managing sports-related concussions.
  
  
  OBJECTIVE
  To evaluate the current practice of EP evaluation and management of sports-related concussions.
  
  
  METHODS
  All EPs and emergency medicine residents in Kalamazoo County were surveyed regarding their management of sports-related concussions. The surveys obtained demographic data, participants' use of guidelines, and the importance of clinical and non-clinical factors in deciding when to allow a player to return to play.
  
  
  RESULTS
  Of the 73 EP respondents, only 23% used a nationally recognized guideline, with no significant difference between attending and resident EPs. The symptomatic complaints of loss of consciousness, amnesia of the event, and difficulty concentrating were ranked most important by EPs in assessing patients with sports-related concussions. Among non-clinical factors, residents were significantly more likely than attendings to report that medical-legal, parental, and players' concerns were more likely to influence their decision in allowing a patient to return to play.
  
  
  CONCLUSIONS
  EPs take into consideration important clinical factors in assessing patients with sports-related concussion. However, almost 75% do not use any nationally recognized guideline in their evaluation. Residents are more likely than attendings to be influenced by non-clinical factors.
authors.affiliation: Department of Emergency Medicine, Michigan State University/Kalamazoo Center for Medical Studies, Kalamazoo, Michigan, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Giebel
authors.forename: Rashmi
authors.initials: R
authors.lastname: Kothari
authors.forename: Amy
authors.initials: A
authors.lastname: Koestner
authors.forename: Gretchen
authors.initials: G
authors.lastname: Mohney
authors.forename: Robert
authors.initials: R
authors.lastname: Baker
mesh_terms: D000328:Adult; D001265:Athletic Injuries / Q000628:therapy*; D001924:Brain Concussion / Q000175:diagnosis* / Q000628:therapy*; D019468:Disease Management; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008824:Michigan; D008875:Middle Aged; D013178:Sports Medicine / Q000592:standards*