Pediatricians may lack training in concussion care

Pediatricians and pediatric nurses often see young patients with concussions, but a new survey suggests they may lack the tools and training to diagnose and treat them.

Researchers found 127 out of 145 pediatric primary and emergency care providers had referred at least one concussion patient to another doctor in the last three months, even though many concussions can be handled in primary care settings. And 16 percent of the providers said they didn't have the right training to tell families about their child's diagnosis.

"It was very revealing in that we need to make sure providers are educated about all the signs and symptoms of concussions," said lead author Dr. Mark Zonfrillo, an emergency physician and injury researcher at the Children's Hospital of Philadelphia Center for Injury Research and Prevention.

The findings come amid increasing awareness and concern about the long-term consequences of concussions in kids, especially in young athletes playing contact sports.

Zonfrillo said the survey was done as a way for his healthcare network to evaluate the needs of its doctors and nurses who treat kids with concussions.

"We weren't sure what to expect. I think the thing that stood out is that the providers were very honest with us in describing what their needs are," he said.

Zonfrillo and his colleagues, who published their results in the journal Pediatrics, emailed surveys to 276 pediatric healthcare providers in the Children's Hospital of Philadelphia Care Network and Emergency Department, including doctors, nurses and physician assistants.

The survey asked providers about their knowledge of concussion symptoms and treatments and what may stand in their way of helping patients.

Just over half of the surveys were returned. They showed 91 percent of respondents had treated at least one child with a concussion in the last three months.

The majority of those providers referred their concussion patients to another doctor. When the researchers asked why, 49 percent of primary care providers - such as family doctors - said they were not comfortable treating a concussion and 47 percent said they did not have the resources.

Doctors and nurses working in the emergency room had another reason for referring their patients to other doctors. Specifically, 68 percent of those providers said it is not appropriate to treat a concussion in an emergency setting.

Zonfrillo said it's understandable for ER workers to refer patients, but his team's goal is for primary care providers to treat the majority of concussions.

"Reserving their referrals to a concussion specialist to (patients) who have prolonged symptoms or pre-existing conditions would sort of help in broader healthcare management and resource management," he added.

Not 'up to snuff'

The researchers also included two scenarios in their survey, which asked the providers about which symptoms are or are not needed to diagnose a child with a concussion.

One scenario described a patient with an obvious concussion and the other described subtler symptoms. Almost all of the providers correctly diagnosed each patient with a concussion, but some missed certain symptoms.

About one in six did not think a patient's inability to follow a finger with their eyes was relevant to a concussion diagnosis, along with one in 10 who did not think trouble concentrating was relevant.

"What the study says is that we need to get the frontline people up to snuff," said brain injury researcher Paul Comper, from the University of Toronto, who added that he didn't think there's anything "Earth shattering" in the new study.

The providers in the study seemed to agree that they needed help. All doctors and nurses without specific discharge instructions for concussion patients said that type of tool would be helpful, and 96 percent of those who did not already have tools to help diagnose or treat concussions said that would help them.

Zonfrillo said his healthcare network used the information to create a new set of tools for its providers to standardize diagnosis and management of concussions. From July to mid-October, he said the tools were used over 850 times.

Comper and the researchers warned, however, that this is only the experience of one system in the U.S., and may not represent what's happening at other hospitals and doctors' offices around the country.

"As long as people are using up-to-date evidence and implementing that in their care network, that can make a big difference," said Zonfrillo.