Award: AAP/SONS Award, Kenneth Shulman Award
Authors: Weston Northam, MD; Michael Cools; Avinash Chandran; Andrew Alexander; Jason Mihalik; Kevin Guskiewicz; Kevin Carneiro; Carolyn Quinsey (Chapel Hill, NC)
Pediatric neurosurgeons are commonly expected by the public and the medical community to effectively evaluate and manage concussion. Evaluating acute sport-related concussion (SRC) differs among providers, who apply international consensus and national guidelines variably. This study compares providers with and without sports medicine training in using supported concussion-specific history and physical examination techniques, to help guide future education for concussion providers.
Retrospective medical record review was completed for outpatients aged 7-18 years, diagnosed with SRC at a single academic medical system from 2014-2017. Patient and provider characteristics, as well as concussion-specific history and physical exam practices were recorded. Associations between board certified sports medicine fellowship training status and assessment of concussion-specific history and physical exam items were tested using non-parametric χ2 tests. Differential odds (by fellowship training status) of using history and physical exam items were assessed using multivariable logistic regression modeling.
Of 889 patients, 399 (44.9%) were examined by sports medicine fellowship trained providers (SMF), and 490 (55.1%) by providers without fellowship training (non-SMF). Each of the 15 SRC history and physical exam items were assessed in higher proportions by SMFs, as compared with non-SMFs, and the differential practice was statistically significant for all tested items with the exception of headache history. Additionally, SMFs demonstrated a higher odds of providing detailed neurologic exams including vestibulo-ocular (OR= 14.74; 95%CI= [8.66, 25.06]), and clinical cognitive testing (OR= 11.71; 95%CI= [6.73, 20.38]) compared with non-SMFs, after adjusting for patient and injury characteristics as well as physician residency training type.
Sports medicine fellowship trained providers consistently conducted more comprehensive, consensus and guideline-based SRC evaluations compared to non-SMFs. Future educational projects should focus on distilling the training imparted by sports medicine fellowships to optimize concussion evaluation for pediatric neurosurgeons.