Concussion management by paediatricians: a national survey of Canadian paediatricians
Bibliographic record
Abstract
Objective To determine: (a) concussion/mTBI guideline use, (b) criteria used in initiating return to play (RTP), and (c) the management of RTP by Canadian paediatricians. Design Cross-sectional survey. Subjects Sample of 2599 Canadian paediatric specialists and subspecialists. Methods The Canadian Paediatric Surveillance Program provided the sampling frame and survey management. Potential participants were sent a seven-item survey inquiring whether they managed children with concussion, and if so, which guidelines they used, and their initiating RTP criteria and duration. Results 809 paediatricians responded (31%), with 503 eligible for the study by indicating that they managed children/youth with newly diagnosed with concussion/mTBI. They reported collectively managing approximately 6700 children/youth within the last 12 months (2010–2011). They reported using many concussion/mTBI guidelines: Canadian Paediatric Society (n=244), American Academy of Paediatrics (n=101), Concussion in Sport Group (n=68), Canadian Academy of Sport and Exercise Medicine (n=58), and the American Academy of Neurology (n=25). Similarly, different criteria were used to determine asymptomatic status. Most common were: free from all concussion symptoms, by patient report (n=323), by proxy report (parent/other) (n=269), and free from continuous daily (unremitting) headache (n=162). Of those reporting, most (∼85%) indicated that theydid notinitiate RTP immediately after their patients became asymptomatic. The median recommend time before initiating RTP was 7 days. Conclusions Concussions/mTBI are frequently encountered by Canadian paediatricians. There is heterogeneity in the guidelines used and the criteria used to determine when patients become asymptomatic with most recommending asymptomatic time before starting RTP. Competing interests None.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.006 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".