Archives for September 2016

Concussion Research

Khalida Itriyeva, MD

Khalida Itriyeva, MD

Conducting Concussion Research with the Help of New York AAP Chapter 2: A Model of Partnership

Dr. Khalida Itriyeva, MD FAAP

(New York Chapter 2 of the American Academy of Pediatrics includes several medical centers with training programs.  In addition to co-sponsoring residency research presentations through our affiliated Brooklyn, Queens and Nassau Pediatric Societies, our chapter can be utilized as a resource to aid members interested in research.  Here Dr. Khalida Itriyeva, MD FAAP discusses how she partnered with NY AAP Chapter 2 to conduct a research project on the management of concussions in primary care which was subsequently presented at a national meeting.)

Concussions, a form of mild traumatic brain injury, are a “hot topic” in sports and medicine, with current studies focusing on the link of repeated concussions on the development of chronic traumatic encephalopathy and other long-term sequelae.  Mild concussions are common in young athletes, and pediatricians see many of these patients in their practices.  Guidelines and recommendations on diagnosis and management of concussion are constantly evolving and come from multiple organizations, resulting in varying practices among providers.

The Committee on Youth and Adolescence (COYA) of New York AAP Chapter 2 sought to survey local primary care pediatricians on their attitudes and practices regarding concussion after reviewing an article by Zonfrillo et al1 in the December 2012 issue of Pediatrics.  Sampling pediatricians in the Philadelphia area, the authors found a majority of providers were referring concussion patients to specialists for reasons such as inadequate time or resources, comfort level, and setting.  They also found that providers had barriers in providing neurocognitive assessments, most notably due to inadequate time and training.

Were the issues and barriers in treating concussions in the primary care setting similar in our area?

The COYA conducted a survey of pediatricians in AAP Chapter 2 to determine whether our pediatricians would present with similar responses.  The COYA membership worked to modify and adapt the same survey used in the original article.  Partnering with AAP New York Chapter 2, we were able to disseminate our questionnaire electronically to all members on their chapter membership email list serve.

We found that most pediatricians were seeing patients with concussion and the majority of providers did feel comfortable educating families about the diagnosis of concussion and recommending the appropriate time to resume school and activities. A little over half (57.4%) of respondents were familiar with the New York State Education Department concussion guidelines.

Yet despite this familiarity with concussion, its symptoms and recommendations from the New York State Education Department (NYSED), most providers were referring some or all of their concussion patients to specialists, most commonly neurologists.  Reasons for referral included lack of comfort with management of concussion, lack of time or resources, and inappropriate setting for follow-up.  The majority of providers (87.1%) also identified completing a neurocognitive assessment as a barrier, most commonly secondary to lack of training.

Most respondents (84.3%) also answered that they would be interested in a webinar for CME credit focused on concussions.

Concussion Poster

Concussion Poster

The abstract for our study was accepted for poster presentation at the Society for Adolescent Health and Medicine 2016 Annual Meeting in Washington, D.C. in March.  Our poster also won 2nd place in the Educational Outcomes Research category at the Northwell Health 2016 Academic Awards Day at the Feinstein Institute in June.  In the future, we hope to develop a webinar for CME credit on concussion diagnosis and management for primary care pediatricians.

A link to NYSED “Guidelines for Concussion Management in the School Setting” is listed in the references below.  The guidelines state that any student suspected of having sustained a concussion must be taken out of the physical activity immediately, and cannot return to physical activities until he/she has been symptom free for a minimum of 24 hours and cleared by a medical provider to initiate a gradual return to play.

The SCAT3TM is a standardized tool that pediatricians can use in their practices to evaluate a patient who has suffered a concussion.  This tool may aid the pediatrician in determining whether an athlete is ready to begin a gradual return to physical activities.

Partnering with our local AAP Chapter was crucial to conducting this work.  Without their input, we would not have been able to send the survey to as many pediatricians and wouldn’t have adequately assessed the local practices regarding concussion management.  Further the Chapter benefitted by allowing us to identify a knowledge gap in the local pediatric community – a gap we hope to address in the creation of our webinar.  We hope this description of how we worked with the local AAP chapter will convince other academic programs to reach out to their local chapters to engage them in mutually-beneficial scholarly work.

References

  1. Zonfrillo MR, Master CL, Grady MF, Winston FK, Callahan JM, Arbogast KB. Pediatric providers’ self-reported knowledge, practices, and attitudes about concussion.  Pediatrics.  2012 Dec;130(6):1120-5. doi: 10.1542/peds.2012-1431.
  2. http://www.p12.nysed.gov/sss/schoolhealth/schoolhealthservices/ConcussionManageGuidelines.pdf
  3. http://bjsm.bmj.com/content/47/5/250/T1.expansion.html