title: Knowledge of paediatric concussion among front-line primary care providers.
abstract: OBJECTIVE
  To assess the knowledge of paediatric concussion diagnosis and management among front-line primary care providers.
  
  
  METHODS
  Experts from the Concussions Ontario Diagnosis and Early Education Working Group developed a 34-item survey incorporating case vignettes with the collaboration of experts in medical education. Electronic surveys were distributed via FluidSurveys using a modified version of Dillman's tailored design method. The survey was distributed to five Ontario professional associations. The target participants were front-line health care providers (family physicians, emergency medicine physicians, general paediatricians, nurse practitioners and physician assistants) in Ontario; only providers who diagnose and/or manage paediatric concussions were eligible to participate.
  
  
  RESULTS
  The survey was fully completed by 577 health care providers who treat paediatric concussion. Of the respondents, 78% (95% CI 74% to 81%) reported diagnosing ≥5 concussions annually. Physicians and nonphysicians equally recognized concussion (90% [95% CI 86% to 92%]; 85% [95% CI 77% to 90%], respectively). Only 37% (95% CI 32% to 41%) of physicians correctly applied graduated return to play guidelines. Return to learn recommendations were also insufficient: 53% (95% CI 49% to 58%) neglected to recommend school absence and 40% (95% CI (35% to 44%) did not recommend schoolwork accommodations. Only 26% (95% CI 22% to 30%) of physicians reported regular use of concussion scoring scales.
  
  
  CONCLUSIONS
  Considerable gaps in knowledge exist in front-line primary care providers with inadequate application of graduated return to play and return to learn following concussion, as demonstrated by the present broad population-based survey. Consistent application of best evidence-based management using comprehensive guidelines may help to reduce the impact of concussion and persistent postconcussive problems in children and adolescents.
authors.affiliation: Department of Paediatrics, University of Ottawa; ; Department of Emergency Medicine, University of Ottawa; ; Children's Hospital of Eastern Ontario Research Institute, Ottawa;
authors.forename: Roger
authors.initials: R
authors.lastname: Zemek
authors.affiliation: Children's Hospital of Eastern Ontario Research Institute, Ottawa;
authors.forename: Kaylee
authors.initials: K
authors.lastname: Eady
authors.affiliation: Department of Paediatrics, University of Ottawa; ; Children's Hospital of Eastern Ontario Research Institute, Ottawa;
authors.forename: Katherine
authors.initials: K
authors.lastname: Moreau
authors.affiliation: Department of Paediatrics, University of Ottawa; ; Department of Emergency Medicine, University of Ottawa; ; Children's Hospital of Eastern Ontario Research Institute, Ottawa;
authors.forename: Ken J
authors.initials: KJ
authors.lastname: Farion
authors.affiliation: Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, Toronto;
authors.forename: Beverly
authors.initials: B
authors.lastname: Solomon
authors.affiliation: Acquired Brain Injury Rehabilitation Program, Western University, London;
authors.forename: Margaret
authors.initials: M
authors.lastname: Weiser
authors.affiliation: School of Rehabilitation Science, McMaster University, Hamilton, Ontario.
authors.forename: Carol
authors.initials: C
authors.lastname: Dematteo
keywords: Adolescent; Concussion; Guidelines; Multidisciplinary; Practice variation; Youth