Primary Care Providers’ Referral Practices for Concussion Management: A Health Services Study

Research Objectives: To examine primary care providers’ (PCPs) referral practices for concussion specialty care for patients who have a new concussion and potential pre-injury risk factors (i.e., anxiety, depression, ADHD, migraine), across the first year after diagnosis.

Design: Retrospective data analysis of an electronic health record system.

Setting: University medical center.

Participants: 1761 adults who received a new diagnosis of concussion between January 1 and December 31, 2018 and remained alive during the study period.

Interventions: Not applicable.

Main Outcome Measures: Concussion specialty referrals early (0 to 3 months) vs. later (4-12 months) after diagnosis.

Results: 448 (25.4%) patients received at least one specialty care referral by a PCP within one-year of their injury. Of those patients, most were female (64.3%), White (73.2%), non-Hispanic (85.0%), and had at least one pre-injury risk factor (53.6%). Most of these patients received between 1 and 2 (60.5%) specialty referrals. Of all referrals placed by PCPs, the most common specialty referral was to physical therapy both early (12.6%) and later (11.2%), followed by referrals to specialty medical disciplines (neurology 6.1% & 4.0%, sports medicine 3.5% & 4.1%, rehabilitation medicine 4.7% & 1.4%).

Conclusions: To our knowledge, this is the first health services study to examine PCPs’ referral practices for concussion management. In this sample PCPs did not commonly refer to concussion specialists despite the high prevalence of pre-injury risk factors associated with protracted recovery. When they did, PCPs most often referred to physical therapy. Referrals are inconsistent with known symptom profiles following concussion with few referrals for cognitive and behavioral management of symptoms.

Author(s) Disclosures: The authors do not have any disclosures.