Nurse Practitioner Assessment and Diagnosis of Adolescent Sports-Related Concussions

Background:  In some states, nurse practitioners (NPs) are independent providers with statutory authority to manage sports-related head injuries and release to play. This study examines NPs knowledge in assessing and diagnosing adolescent sports-related concussions and use of standardized tools.

Methods: A self-administered, web-based survey was sent to licensed family, pediatric, and psychiatric NPs in Washington and Oregon. Respondents assessed and diagnosed adolescent patient actors in a standardized video with concussion symptoms from a sports or recreation injury. Respondents indicated knowledge of standardized concussion assessment tools and familiarity with concussion guidelines (e.g., Centers for Disease Control and Prevention’s [CDC] “Heads Up” toolkit). We examined factors associated with correct diagnosis and lack of use or awareness of resources using modified Poisson regression.

Results: Of 4,612 eligible NPs, 1,156 completed the survey (23% response rate). 1,068 (92%) respondents correctly diagnosed a likely or definite concussion; 54% equated the same symptoms with a mild traumatic brain injury (TBI). Few respondents indicated familiarity with the “Heads Up” toolkit (35%) and 26% reported often using standardized assessments. Multivariable analyses show NPs <34 years were 27% less likely to correctly diagnose a mild TBI, compared to NPs 55-64 years old. The number of concussions treated per year, percent of pediatric patients, and pediatrics training were associated with awareness or use of resources.

Conclusions: This study identified critical gaps in NPs knowledge about concussions and that few NPs utilize existing resources to facilitate assessment and diagnosis of adolescent sports-related concussions.