Implementing An interdisciplinary Concussion Clinic : Application of Best Practice
Bibliographic record
Abstract
Background: Concussion/Mild traumatic brain injury (mTBI) is a significant cause of morbidity and mortality, with many survivors dealing with persisting difficulties for years post-injury. One Canadian study examining both hospital-treated cases as well as those presenting to a family physician calculated the incidence of mTBI in Ontario to lie between 493 and 653/100,000 (Rhy, 2009). Approximately 66% of patients with mild concussion will recover in approximately 2-4 weeks with follow up from their GP or primary care giver. About 33% will experience more persistent symptoms requiring further assessment and support. Of that group, another 50% of may experience persisting symptoms beyond 3 months. The consequences for these individuals may include physical, cognitive, emotional and behavioural symptoms resulting in reduced functional ability, heightened emotional distress, and delayed return to work or school. These patients require more specialized management to assist in the returning to their pre injury activities. Intervention: Due to an identified gap in service in the South Central Ontario region, a comprehensive, interdisciplinary outpatient clinic was established for the assessment, diagnosis and treatment (including disposition to the appropriate follow-up resource), of patients with mild head injury/concussion. The features of the clinic and the model of care are consistent with the Ontario Neurotrauma Foundation (ONF) Standards of Post-Concussion Care (2017). The interdisciplinary care model is unique in that assessments are done collaboratively, leveraging the specific expertise of each discipline (neurology, physiatry, neuropsychology, nursing and others) in making an accurate diagnosis and determining a plan of care. Further, because this clinic is located at a regional center, consultations/referrals to neurosurgeons and trauma specialists are more easily facilitated when needed. Outcomes: Currently, the clinic operates 1 day/week. In the first 4 months of operation, 288 referrals have been received with approximately 16-20 patients seen daily. Wait time to be seen post injury has been reduced from several weeks to 3-5 days. Expected patient outcomes include: shorter/more effective recovery, hospital avoidance, less long term symptoms/sequelae, quicker reintegration into the community, less lost time at work; increased productivity. Health system outcomes include: decreased demand on ED and other acute care resources, increased skill capacity in the community as follow-up teaching and referral is completed, improved utilization of existing community resources to support patients in their recovery journey.
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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 | 0.026 | 0.067 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.006 | 0.003 |
| Scholarly communication | 0.007 | 0.005 |
| Open science | 0.006 | 0.012 |
| Research integrity | 0.005 | 0.009 |
| Insufficient payload (model declined to judge) | 0.007 | 0.002 |
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".