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Paediatr Child Health. 2014 Nov;19(9):475-80.

Knowledge of paediatric concussion among front-line primary care providers.

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Department of Paediatrics, University of Ottawa; ; Department of Emergency Medicine, University of Ottawa; ; Children's Hospital of Eastern Ontario Research Institute, Ottawa;
Children's Hospital of Eastern Ontario Research Institute, Ottawa;
Department of Paediatrics, University of Ottawa; ; Children's Hospital of Eastern Ontario Research Institute, Ottawa;
Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, Toronto;
Acquired Brain Injury Rehabilitation Program, Western University, London;
School of Rehabilitation Science, McMaster University, Hamilton, Ontario.


in English, French


To assess the knowledge of paediatric concussion diagnosis and management among front-line primary care providers.


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.


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.


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.


Adolescent; Concussion; Guidelines; Multidisciplinary; Practice variation; Youth


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