title: Pediatric providers' self-reported knowledge, practices, and attitudes about concussion.
abstract: OBJECTIVE
  To determine the self-reported practices and attitudes surrounding concussion diagnosis and management in a single, large pediatric care network.
  
  
  METHODS
  A cross-sectional survey was distributed to pediatric primary care and emergency medicine providers in a single, large pediatric care network. For all survey participants, practices and attitudes about concussion diagnosis and treatment were queried.
  
  
  RESULTS
  There were 145 responses from 276 eligible providers, resulting in a 53% response rate, of which 91% (95% confidence interval [CI]: 86%-95%) had cared for at least 1 concussion patient in the previous 3 months. A Likert scale from 1 "not a barrier" to 5 "significant barrier" was used to assess providers' barriers to educating families about the diagnosis of concussion. Providers selected 4 or 5 on the scale for the following barriers and frequencies: inadequate training to educate 16% (95% CI: 11%-23%), inadequate time to educate 15% (95% CI: 12%-24%), and not my role to educate 1% (95% CI: 0.4%-5%). Ninety-six percent (95% CI: 91%-98%) of providers without a provider decision support tool (such as a clinical pathway or protocol) specific to concussion, and 100% (95% CI: 94%-100%) of providers without discharge instructions specific to concussion believed these resources would be helpful.
  
  
  CONCLUSIONS
  Although pediatric primary care and emergency medicine providers regularly care for concussion patients, they may not have adequate training or infrastructure to systematically diagnose and manage these patients. Specific provider education, decision support tools, and patient information could help enhance and standardize concussion management.
authors.affiliation: Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA. zonfrillo@email.chop.edu
authors.forename: Mark R
authors.initials: MR
authors.lastname: Zonfrillo
authors.forename: Christina L
authors.initials: CL
authors.lastname: Master
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Grady
authors.forename: Flaura K
authors.initials: FK
authors.lastname: Winston
authors.forename: James M
authors.initials: JM
authors.lastname: Callahan
authors.forename: Kristy B
authors.initials: KB
authors.lastname: Arbogast
mesh_terms: D001291:Attitude of Health Personnel; D001924:Brain Concussion / Q000175:diagnosis* / Q000628:therapy*; D020208:Brain Injury, Chronic / Q000175:diagnosis / Q000628:therapy; D017028:Caregivers / Q000193:education; D002648:Child; D002983:Clinical Competence; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D003661:Decision Support Techniques; D004632:Emergency Medical Services; D019317:Evidence-Based Medicine; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D033183:Interdisciplinary Communication; D010348:Patient Care Team; D010372:Pediatrics; D011320:Primary Health Care; D011785:Quality Assurance, Health Care; D012017:Referral and Consultation