Sports Medicine Physician Confidence in Concussion Assessments for Postconcussion Return-to-Play Decisions.

Abstract

Objective: To identify sport-related concussion (SRC) assessments sports medicine physicians perform and in which they place confidence when making return-to-play (RTP) decisions.

Design: Cross-sectional study.

Setting: Online survey.

Participants: Active members of the American Medical Society for Sports Medicine (AMSSM) at the fellowship level or higher making RTP decisions following concussion within the last year.

Interventions: An electronic REDCap survey gathering demographic and practice information and responses to clinical scenarios was sent to AMSSM members.

Main outcome measures: The primary outcome was the SRC assessment(s) in which physicians expressed the most confidence for RTP decisions.

Results: Four hundred thirty AMSSM members responded to the survey, 392 of which met inclusion criteria. The graded symptom checklist was rated the most useful test for making return-to-play decisions, and respondents felt most confident starting the RTP process if the graded symptom checklist was normal. An assessment was considered most useful if it closely reflected resolution of SRC's pathological processes. Computerized neurocognitive testing was most likely to be ignored if abnormal. An abnormal neurological examination made physicians feel least confident SRC had resolved.

Conclusions: Sports medicine physicians view the graded symptom checklist as a useful tool for making RTP decisions. Physicians expressed less confidence in computerized neurocognitive testing to determine RTP readiness. This study uncovered reliance on symptom reporting by sports medicine physicians and an opportunity for the creation of concussion clinical decision tools.