title: Physicians' Management Practices and Perceived Health Risks When Postconcussion Symptoms Persist.
abstract: BACKGROUND
  Concussion guidelines recommend physical and cognitive rest until all postconcussion symptoms resolve, in part because of potential health risks, including catastrophic injury related to a second impact. However, when postconcussion symptoms persist for weeks or months, these risks are poorly characterized.
  
  
  OBJECTIVE
  Physicians' perceived health risks and management strategies for patients with persistent postconcussion symptoms will vary.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Level 3.
  
  
  METHODS
  A survey of the physician members of the American College of Sports Medicine assessed the perceived health risks related to advancing activity, the indications for neuroimaging, and the referral patterns for patients with persistent postconcussion symptoms.
  
  
  RESULTS
  A total of 572 physicians completed the survey (response rate, 27.2%). The majority of physicians recommended physical rest (97.4%) and cognitive rest (93.8%) within the first week of injury. Perceived health risks related to advancing activity in the symptomatic patient differed at 2 weeks versus 3 months after injury (P < 0.001 for all comparisons). Respondents from the United States were more likely to list second impact syndrome as a potential health risk at 2 weeks compared with respondents from other countries (P = 0.04). The majority (56%) responded that the risk of second impact syndrome remains until all symptoms resolve. When postconcussion symptoms persist beyond 1 month, 61.9% of physicians responded that neuroimaging is indicated. Approximately 60% of respondents had access to a multidisciplinary concussion clinic within 60 miles of their practice.
  
  
  CONCLUSIONS
  When postconcussion symptoms persist, the perceived health risks, management practices, and access to multidisciplinary care vary among physicians.
authors.affiliation: Division of Pediatric Neurology, Nationwide Children's Hospital, and Department of Neurology, The Ohio State University, Columbus, Ohio.
authors.forename: Sean C
authors.initials: SC
authors.lastname: Rose
authors.affiliation: Division of Sports Medicine, Nationwide Children's Hospital, and Department of Pediatrics, The Ohio State University, Columbus, Ohio.
authors.forename: Anastasia N
authors.initials: AN
authors.lastname: Fischer
authors.affiliation: Division of Pediatric Neurology, Nationwide Children's Hospital, and Department of Neurology, The Ohio State University, Columbus, Ohio geoffrey.heyer@nationwidechildrens.org.
authors.forename: Geoffrey L
authors.initials: GL
authors.lastname: Heyer
mesh_terms: D001265:Athletic Injuries / Q000503:physiopathology / Q000534:rehabilitation* / Q000628:therapy; D001510:Bed Rest; D003430:Cross-Sectional Studies; D019317:Evidence-Based Medicine; D006801:Humans; D059906:Neuroimaging / Q000379:methods; D038223:Post-Concussion Syndrome / Q000503:physiopathology / Q000534:rehabilitation* / Q000628:therapy; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D020127:Recovery of Function; D014481:United States / Q000453:epidemiology
keywords: concussion; management; mild traumatic brain injury; postconcussion syndrome; survey