Return to sports after pediatric traumatic brain injury: An expert panel survey
Colby Hansen1, Allison N Capizzi2, Nick Gavern1
1Department of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, Utah, USA.
Insights
Pediatric traumatic brain injury (TBI) experts show significant variability in return to play (RTP) recommendations. Standardized guidelines are needed to help clinicians guide RTP decisions for children with TBI.
Area of Science:
- Pediatric neurology and rehabilitation
- Sports medicine
- Neuropsychology
Background:
- Current clinical practice lacks evidence-based guidelines for advising pediatric patients with traumatic brain injury (TBI) on return to play (RTP).
- This gap necessitates understanding expert consensus and practice patterns.
Purpose of the Study:
- To investigate how pediatric TBI experts assess injury severity and guide RTP decisions for children with complicated mild, moderate, or severe TBI.
- To identify factors influencing expert RTP decision-making.
Main Methods:
- A cross-sectional, web-based survey was conducted among 30 TBI experts from diverse specialties.
- Participants rated the importance of factors for assessing injury severity and recovery.
- RTP timelines were assessed based on activity risk and injury severity.
Main Results:
- Significant variability exists in RTP recommendations, influenced by activity risk across all TBI severity levels.
- No significant differences in RTP recommendations were found based on medical specialty.
- Experts identified various factors influencing RTP decisions, with notable agreement on several points.
Conclusions:
- Expert consensus on RTP timing and severity assessment for pediatric TBI is variable.
- Further research is crucial to develop standardized RTP guidelines for pediatric TBI patients.
- These findings inform clinicians but underscore the need for evidence-based protocols.
Background:
There are no evidence based guidelines for clinicians to follow in advising pediatric patients with traumatic brain injury (TBI) on return to play (RTP).
Objective:
To understand practice patterns of experts in pediatric traumatic brain injury (TBI) in relation to how they assess severity of TBI and guide return to play (RTP) decisions with their patients who sustain complicated mild, moderate, or severe TBI.
Design:
Cross-sectional web-based survey.
Setting:
Not applicable.
Participants:
Thirty experts (defined by attesting to their clinical management of children with TBI and demonstrating a history of publication in the area of pediatric TBI including mild TBI) represented by physical medicine and rehabilitation, neurology, neurosurgery, sports medicine, and neuropsychology. Fifty-five candidates were invited, 37 responded (67% response rate), and 30 were eligible to participate.
Interventions:
Not applicable.
Main Outcome Measure(S):
Ratings of agreement as to the relative importance of a variety of factors used to assess initial severity of injury as well as to measure recovery. RTP timelines were measured for different scenarios (adjusted by level of risk of activity returned to and the severity of initial injury sustained). Finally, ratings of agreement with various factors that could influence their RTP decision making as well as a free text option.
Results:
Recommendations on RTP timing varied significantly based on risk of activity returned to for all levels of TBI severity (p < .05). There was large variability of RTP timeline for any given level of injury severity. There was no significant association between medical specialty and RTP recommendations. Experts also noted a variety of factors which may inform their RTP decision making, many with high agreement.
Conclusions:
These results can inform clinicians who care for these patients in their own RTP decision making. The description of these RTP trends, in combination with the variability seen in both severity determination and recovery assessment, highlight the importance of further study of outcomes related to RTP and the eventual development of standardized guidelines for this patient population.
