A cross-sectional study reporting concussion exposure, assessment and management in Western Australian general practice

Elizabeth Thomas,Huijun Chih,Belinda Gabbe,Melinda Fitzgerald,Gill Cowen

doi:10.1186/s12875-021-01384-1

Abstract

BackgroundGeneral Practitioners (GPs) may be called upon to assess patients who have sustained a concussion despite limited information being available at this assessment. Information relating to how concussion is actually being assessed and managed in General Practice is scarce. This study aimed to identify characteristics of current Western Australian (WA) GP exposure to patients with concussion, factors associated with GPs’ knowledge of concussion, confidence of GPs in diagnosing and managing patients with concussion, typical referral practices and familiarity of GPs with guidelines.MethodsIn this cross-sectional study, GPs in WA were recruited via the RACGP WA newsletter and shareGP and the consented GPs completed an electronic survey. Associations were performed using Chi-squared tests or Fisher’s Exact test.ResultsSixty-six GPs in WA responded to the survey (response rate = 1.7%). Demographics, usual practice, knowledge, confidence, identification of prolonged recovery as well as guideline and resource awareness of GPs who practised in regional and metropolitan areas were comparable (p > 0.05). Characteristics of GPs were similar between those who identified all symptoms of concussion and distractors correctly and those who did not (p > 0.05). However, 84% of the respondents who had never heard of concussion guidelines were less likely to answer all symptoms and distractors correctly (p = 0.039). Whilst 78% of the GPs who were confident in their diagnoses had heard of guidelines (p = 0.029), confidence in managing concussion was not significantly associated with GPs exposure to guidelines. It should be noted that none of the respondents correctly identified signs of concussion and excluded the distractors.ConclusionsKnowledge surrounding concussion guidelines, diagnosis and management varied across GPs in WA. Promotion of available concussion guidelines may assist GPs who lack confidence in making a diagnosis. The lack of association between GPs exposure to guidelines and confidence managing concussion highlights that concussion management may be an area where GPs could benefit from additional education and support.

Highlights

General Practitioners (GPs) may be called upon to assess patients who have sustained a concussion despite limited information being available at this assessment
This study aimed to identify characteristics of current Western Australian (WA) GP exposure to patients with concussion, factors associated with their knowledge, confidence in diagnosing and managing patients with concussion, referral practices and familiarity with guidelines
The survey was disseminated via the Royal Australian College of General Practitioners (RACGP) WA newsletter and the WA ShareGP group

Summary

Introduction

General Practitioners (GPs) may be called upon to assess patients who have sustained a concussion despite limited information being available at this assessment. The GP may, or may not, know the patient, and it may, or may not, be clear to the GP whether the patient’s presenting symptoms originate from the described concussive injury This complicates a GP’s understanding of how a patient is affected by a concussion and limits their ability to optimise early clinical assessment and management with a view to improving long term outcomes. There are currently no blood tests or imaging techniques available to GPs to confirm a diagnosis of concussion [8] Symptoms such as dizziness, fogginess, headache, nausea, sleep and mood disturbance, memory impairment and neck pain are indicators of concussion [9] after either a direct blow to the head, or after sustaining a transmitted force to the head from an impact to the body [10]. Collateral history may assist with diagnosis, with brief loss of consciousness, unsteadiness, posturing, a dazed appearance, disorientation and agitation all suggestive of concussion [11]

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