Citation

Flaherty MR, Raybould T, Jamal-Allial A, Kaafarani HM, Lee J, Gervasini A, Ginsburg R, Mandell M, Donelan K, Masiakos PT. J. Pediatr. 2016; 178: 268-274.

Affiliation

Harvard Medical School, Boston, MA; Department of Pediatric Surgery, Massachusetts General Hospital, Boston, MA.

Copyright

(Copyright © 2016, Elsevier Publishing)

DOI

10.1016/j.jpeds.2016.08.025

PMID

27597735

Abstract

OBJECTIVE: To determine physician-reported adherence to and support of the 2010 Massachusetts youth concussion law, as well as barriers to care and clinical practice in the context of legislation. STUDY DESIGN: Primary care physicians (n = 272) in a large pediatric network were eligible for a cross-sectional survey in 2014. Survey questions addressed key policy and practice provisions: concussion knowledge, state regulations and training, practice patterns, referrals, patient characteristics, and barriers to care. Analyses explored relationships between practice and policy, adjusting for physician demographic and practice characteristics.

RESULTS: The survey response rate was 64% among all responders (173 of 272). A total of 146 respondents who had evaluated, treated, or referred patients with a suspected sports-related concussion in the previous year were eligible for analysis. The vast majority (90%) of providers agreed that the current Massachusetts laws regarding sports concussions are necessary and support the major provisions. Three-quarters (74%) had taken a required clinician training course on concussions. Those who took training courses were significantly more likely to develop individualized treatment plans (OR, 3.6; 95% CI, 1.1-11.0). Physician training did not improve screening of youth with concussion for depression or substance use. Most physicians (77%) advised patients to refrain from computer, telephone, or television for various time periods. Physicians reported limited communication with schools.

CONCLUSIONS: Primary care physicians report being comfortable with the diagnosis and management of concussions, and support statewide regulations; however, adherence to mandated training and specific legal requirements varied. Broader and more frequent training may be necessary to align current best evidence with clinical care and state-mandated practice.

Copyright © 2016 Elsevier Inc. All rights reserved.

Language: en