Concussion Care Practices and Utilization of Evidence-Based Guidelines in the Evaluation and Management of Concussion: A Survey of New England Emergency Departments.
Evidence-based clinical practice guidelines can facilitate proper evaluation and management of concussions in the emergency department (ED), often the initial and primary point of contact for concussion care. There is no universally adopted set of guidelines for concussion management, and extant evidence suggests that there may be variability in concussion care practices and limited application of clinical practice guidelines in the ED. This study surveyed EDs throughout New England to examine current practices of concussion care and utilization of evidence-based clinical practice guidelines in the evaluation and management of concussions. In 2013, a 32-item online survey was e-mailed to 149/168 EDs throughout New England (Connecticut, Rhode Island, Massachusetts, Vermont, New Hampshire, Maine). Respondents included senior administrators asked to report on their EDs use of clinical practice guidelines, neuroimaging decision-making, and discharge instructions for concussion management. Of the 72/78 respondents included, 35% reported absence of clinical practice guidelines, and 57% reported inconsistency in the type of guidelines used. Practitioner preference guided neuroimaging decision-making for 57%. Although 94% provided written discharge instructions, there was inconsistency in the recommended time frame for follow-up care (13% provided no specific time frame), the referral specialist to be seen (25% did not recommend any specialist), and return to activity instructions were inconsistent. There is much variability in concussion care practices and application of evidence-based clinical practice guidelines in the evaluation and management of concussions in New England EDs. Knowledge translational efforts will be critical to improve concussion management in the ED setting.
1 Boston University Alzheimer's Disease and CTE Center; Departments of Neurology, Neurosurgery, and Anatomy and Neurobiology, Boston University School of Medicine , Boston, Massachusetts.
Robert A
RA
Stern
2 Boston University Alzheimer's Disease and CTE Center , Boston, Massachusetts.
Daniel
D
Seichepine
3 Department of Neurosurgery, Boston University School of Medicine , Boston, Massachusetts.
Christine
C
Tschoe
2 Boston University Alzheimer's Disease and CTE Center , Boston, Massachusetts.
Nathan G
NG
Fritts
4 Boston University Alzheimer's Disease and CTE Center, Department of Neurology, Boston University School of Medicine , Boston, Massachusetts.
Michael L
ML
Alosco
5 Departments of Neurosurgery and Medicine, Boston University School of Medicine , Boston, Massachusetts.
Oren
O
Berkowitz
6 Section of Acute Care & Trauma Surgery, Division of General Surgery, Department of Surgery, Boston Medical Center, Boston University School of Medicine , Boston, Massachusetts.
Peter
P
Burke
7 Injury Prevention Center, Boston Medical Center; Department of Emergency Medicine, Boston University School of Medicine , Boston, Massachusetts.
Jonathan
J
Howland
8 Department of Emergency Medicine, Boston University School of Medicine; Department of Emergency Medicine , Boston Medical Center, Boston, Massachusetts.
Jonathan
J
Olshaker
9 Boston University Alzheimer's Disease and CTE Center, Departments of Neurology and Neurosurgery, Boston University School of Medicine , Boston, Massachusetts.
Robert C
RC
Cantu
10 Boston University Alzheimer's Disease and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts; Interfaculty Initiative in Health Policy, Harvard University , Cambridge, Massachusetts.
Christine M
CM
Baugh
3 Department of Neurosurgery, Boston University School of Medicine , Boston, Massachusetts.
James W
JW
Holsapple
D001924:Brain Concussion / Q000175:diagnosis* / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D019317:Evidence-Based Medicine / Q000592:standards*; D006801:Humans; D009511:New England; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*
New England; clinical practice guidelines; concussion; emergency department; traumatic brain injury