title: Sport concussion knowledge base, clinical practises and needs for continuing medical education: a survey of family physicians and cross-border comparison.
abstract: BACKGROUND
  Evolving concussion diagnosis/management tools and guidelines make Knowledge Transfer and Exchange (KTE) to practitioners challenging.
  
  
  OBJECTIVE
  Identify sports concussion knowledge base and practise patterns in two family physician populations; explore current/preferred methods of KTE.
  
  
  METHODS
  A cross-sectional study.
  
  
  METHODS
  Family physicians in Alberta, Canada (CAN) and North/South Dakota, USA.
  
  
  METHODS
  CAN physicians were recruited by mail: 2.5% response rate (80/3154); US physicians through a database: 20% response rate (109/545).   INTERVENTION/INSTRUMENT:  Online survey.   MAIN AND SECONDARY OUTCOME MEASURES:  Diagnosis/management strategies for concussions, and current/preferred KTE.
  
  
  RESULTS
  Main reported aetiologies: sports/recreation (52.5% CAN); organised sports (76.5% US). Most physicians used clinical examination (93.8% CAN, 88.1% US); far fewer used the Sport Concussion Assessment Tool (SCAT1/SCAT2) and balance testing. More US physicians initially used concussion-grading scales (26.7% vs 8.8% CAN, p=0.002); computerised neurocognitive testing (19.8% vs 1.3% CAN; p<0.001) and Standardised Assessment of Concussion (SAC) (21.8% vs 7.5% CAN; p=0.008). Most prescribed physical rest (83.8% CAN, 75.5% US), while fewer recommended cognitive rest (47.5% CAN, 28.4% US; p=0.008). Return-to-play decisions were based primarily on clinical examination (89.1% US, 73.8% CAN; p=0.007); US physicians relied more on neurocognitive testing (29.7% vs 5.0% CAN; p<0.001) and recognised guidelines (63.4% vs 23.8% CAN; p<0.001). One-third of Canadian physicians received KTE from colleagues, websites and medical school training. Leading KTE preferences included Continuing Medical Education (CME) courses and online CME.
  
  
  CONCLUSIONS
  Existing published recommendations regarding diagnosis/management of concussion are not always translated into practise, particularly the recommendation for cognitive rest; predicating enhanced, innovative CME initiatives.
authors.affiliation: Department of Family Medicine, Faculty of Medicine & Dentistry, Glen Sather Sports Medicine Clinic, Edmonton Clinic, Level 2, 11400 University Avenue, University of Alberta, Edmonton, Alberta, Canada T6G 1Z1. ConnieLebrun@med.ualberta.ca
authors.forename: Constance M
authors.initials: CM
authors.lastname: Lebrun
authors.forename: Martin
authors.initials: M
authors.lastname: Mrazik
authors.forename: Abhaya S
authors.initials: AS
authors.lastname: Prasad
authors.forename: B Joel
authors.initials: BJ
authors.lastname: Tjarks
authors.forename: Jason C
authors.initials: JC
authors.lastname: Dorman
authors.forename: Michael F
authors.initials: MF
authors.lastname: Bergeron
authors.forename: Thayne A
authors.initials: TA
authors.lastname: Munce
authors.forename: Verle D
authors.initials: VD
authors.lastname: Valentine
mesh_terms: D000293:Adolescent; D000328:Adult; D000416:Alberta; D001265:Athletic Injuries / Q000175:diagnosis / Q000628:therapy*; D001924:Brain Concussion / Q000175:diagnosis / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003657:Decision Making; D004502:Education, Medical, Continuing / Q000379:methods*; D005194:Family Practice / Q000193:education*; D006801:Humans; D007223:Infant; D009658:North Dakota; D010821:Physicians, Family / Q000193:education*; D010818:Practice Patterns, Physicians'; D020127:Recovery of Function; D013023:South Dakota; D013178:Sports Medicine / Q000193:education*; D055815:Young Adult