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Concussion Management Practice Patterns Among Sports Medicine Physicians

Stache, Stephen MD; Howell, David PhD; Meehan, William P. III MD

Clinical Journal of Sport Medicine: September 2016 - Volume 26 - Issue 5 - p 381–385
doi: 10.1097/JSM.0000000000000270
Original Research
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Objective: The primary purpose of this study was to examine concussion management practice patterns among sports medicine physicians in the United States.

Design: Cross-sectional study using a web-based survey.

Participants: Members of the American Medical Society for Sports Medicine (AMSSM).

Main Outcome Measures: We distributed a questionnaire to physician members of the AMSSM assessing the current practices for evaluating and managing concussions sustained during sports. Specifically, we asked respondents about their use of management guidelines, medications, balance assessments, neuropsychological tests, and return-to-play strategies.

Results: Of the 3591 members emailed, 425 (11.8%) respondents responded. Ninety-seven percent of respondents reported basing current management of sport-related concussion on a published set of criteria, with a majority (91.9%) following the guidelines provided by the Fourth International Conference on Concussion in Sport. Seventy-six percent of respondents reported using medication beyond 48 hours postinjury. Acetaminophen was reported as the most commonly administered medication, although tricyclic antidepressants and amantadine were also commonly administered. Vitamins, minerals, and dietary supplements were also reported as commonly administered. Most respondents reported using a form of neuropsychological testing (87.1%). A majority of respondents (88.6%) reported allowing athletes to return to competition after concussion only once the athlete becomes symptom free and completes a return-to-play protocol.

Conclusions: Most sports medicine physicians seem to use recently developed guidelines for concussion management, regularly use medications and neuropsychological testing in management strategies, and follow established return-to-play guidelines.

Clinical Relevance: Sports medicine physicians seem to have clinical expertise in the management of sport-related concussion.

*The Rothman Institute Orthopaedics, Philadelphia, Pennsylvania;

Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania;

Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts;

§Sports Concussion Clinic, Boston Children's Hospital, Boston, Massachusetts;

The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts;

Division of Emergency Medicine, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts; and

Departments of **Pediatrics; and

††Orthopedics, Harvard Medical School, Boston, Massachusetts.

Corresponding Author: Stephen Stache, MD, 825 Old Lancaster Ave, Ste 200, Bryn Mawr, PA 19096 (Stephen.stache@rothmaninstitute.com).

W.P.M. receives royalties from ABC-Clio publishing for the sale of his book, Kids, Sports, and Concussion: A Guide for Coaches and Parents, and royalties from Wolters Kluwer for working as an author for UpToDate. His research is funded, in part, by a grant from the National Football League Players Association and by philanthropic support from the National Hockey League Alumni Association through the Corey C. Griffin Pro-Am Tournament. The reamining authors report no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.cjsportmed.com).

Received January 28, 2015

Accepted June 16, 2015

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.