A study of physicians' knowledge of and attitudes toward concussion management practices points to the need for improved concussion-specific training and infrastructure to support optimal patient care. The findings, recently published online in Pediatrics, led The Children's Hospital of Philadelphia (CHOP) to create a new "medical home" model for managing adolescent and pediatric concussion.

As part of the study, researchers from Children's Hospital's Center for Injury Research and Prevention (CIRP), surveyed 145 emergency medicine and primary care providers. Of those, 91 percent had cared for at least one concussion patient while 92 percent had referred at least one patient to a concussion specialist in the prior three months.

"We have seen concussion visits within our emergency department, primary care, and specialty care network at CHOP quadruple since 2009, to a current total of more than 6,700 each year," said lead author and CIRP researcher Mark Zonfrillo, MD, MSCE.

The best practice for managing a diagnosed concussion in the initial weeks following an injury involves two essential components: using a systematic, clinical assessment to determine if concussion symptoms are resolving; and adhering to a step-by-step program of gradual return-to-learn and return-to-play. However, the study found inconsistent clinical assessment and inconsistent prescribing of the "return" protocols in discharge instructions.

The providers who took part in the study agreed that standardized evaluation and decision-making tools, and training in their use, would increase their comfort with diagnosing and managing concussions. With the providers' input, concussion specialists at CHOP have developed a novel infrastructure, which offers diagnostic and patient education support tools, that is now delivered through CHOP's electronic medical record system.

In addition, earlier this year Children's Hospital concussion experts provided special training to more than 100 providers across the CHOP Care Network, which comprises more than 30 primary care locations across the Philadelphia area. The hope is that Children's Hospital's new Medical Home model for concussion management could eventually be applied to other health systems.

To learn more about youth concussions and CHOP's unique approach to managing pediatric concussion, visit www.chop.edu/concussion.