Pilot single-centre cross-sectional study to determine emergency physicians' knowledge and management of sports concussion: an experience from Singapore

Heads up for concussion, what do emergency physicians know? A scoping review

INTRODUCTION

Concussion is a common condition, with sources estimating between 1.2% and 6.6% of all ED presentations are related to head injury, and concussion has significant healthcare costs. In April 2023, the UK Government published guidelines for diagnosis and management of concussions in grassroots sport, recommending anyone that has sustained a suspected concussion has a same day review by an appropriate healthcare professional. It is therefore essential that emergency medicine physicians have the required knowledge and use current clinical practice guidelines in managing suspected concussions presenting to their departments. This scoping review aims to review the current literature regarding concussion knowledge, diagnosis and management amongst emergency physicians.

MATERIALS AND METHODS

This scoping review was conducted using the six-step process laid out by Arksey and O'Malley and included 17 papers from January 2012 to February 2023, identified by searching 5 online databases (MEDLINE, Embase, Web of Science, Scopus and Google Scholar) in February 2023 alongside a hand search of references. Search terms relevant to concussion, emergency medicine and medical education were used.

RESULTS

14 of the 17 papers originated from North America, all studies utilised either an online survey or chart review methodology. 3 papers included an educational intervention. 12 studies looked at all grades of EMPs. 14 of the studies highlighted knowledge gaps amongst EMPs, the 3 that did not specifically mention this were the 3 interventional studies.

CONCLUSION

EMPs have large knowledge gaps regarding concussion and limited adherence to current guidelines. Efforts should be made at improving these results amongst EMPs. Further research is needed to find the most beneficial and cost-effective approach to improving concussion knowledge of concussion diagnosis and management in EDs, particularly within the UK.

Time to expand the circle of care - General practitioners' experiences of managing concussion in the community

New Zealand Rugby (NZR) implemented a concussion management pathway (CMP), aimed at improving management at community level. General Practitioners (GPs) played a large role in the design of this process. The objective of this study was to explore GPs' perceptions of barriers and facilitators of the CMP and rugby-related concussion management in the community. A descriptive qualitative approach using interviews and focus groups was employed. Four themes were derived: i) GPs' existing knowledge and confidence around concussion management; ii) Operational resources: time, remuneration and pathway guidance; iii) Standardising concussion care and iv) Expanding the circle of care - the need for multi-disciplinary healthcare team. These themes described how GP's concussion knowledge, and the efficiency and availability of operational resources affected their experience and ability to fulfil their tasks within the CMP. GPs found NZR's CMP especially valuable, as it provided guidance and structure. Expanding the role of other healthcare providers was seen as critical to reduce the burden on GPs, while also delivering a more holistic experience to improve clinical outcomes. Addressing the identified barriers and expanding the network of care will help to improve the ongoing development of NZR's CMP, while supporting continued engagement with all stakeholders.

Concussion education in medical students studying in Scotland: an assessment of knowledge and future needs

BACKGROUND

Physicians play a key role in ensuring athletes with concussion safely return to sport. Research has shown deficiencies in concussion education amongst physicians and medical students. However, studies have not previously been conducted in UK medical schools.

OBJECTIVES

To assess students' concussion knowledge and learning in Scottish Medical Schools.

DESIGN

A survey with 23 questions was distributed to Year 3-6 medical students studying in Scotland in October 2020. The survey included the following: (1) demographics, (2) concussion knowledge, e.g. 'What is the role of headgear in preventing concussion?' (3) concussion learning, 'In which part of the curriculum should concussion be taught?.' Frequencies of responses were calculated for each question.

RESULTS

200 students responded (response rate 8%). The average symptoms and management score were 87.3% and 31% respectively. 15% of participants knew that headgear has no role in preventing concussions and one participant identified the minimum "return to sport" timeframes for adults and children. 15% had learnt about concussion at medical school with 92.5% interested in receiving concussion teaching at medical school.

CONCLUSION

Knowledge gaps exist in managing and preventing sports-related concussion. There is a discrepancy between levels of concussion teaching and the desire and importance placed on concussion education.