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Nurse Practitioner Assessment and Management of Adolescent Concussion

American Nurses Foundation
Nursing Research Grants Program
9/1/2014 – 8/31/2015


Each year, nearly 200,000 children and adolescents visit the emergency department for sports- and recreation-related traumatic brain injuries, many of which are concussions. Concussions are significant injuries, resulting in long-term financial, physical, cognitive, and psychological impacts. Up to one third of healthcare providers report not routinely using published guidelines for concussion management. Published research suggests that provider’s recommendations for concussion evaluation and management may vary according to patient attributes.

Nurse practitioners (NPs) are licensed independent practitioners and function as primary providers in Oregon and Washington, where they hold statutory authority to assess and release a concussed adolescent to resume sports activity. The PRACTICE study (Provider Recommendations for Adolescent Concussions: The Impact of patient CharactEristics) will examine variation in adolescent sports-related concussion assessment and management recommendations among NPs. Specifically, we seek to evaluate how, and to what degree, recommendations vary according to patient characteristics, such as sex or sport type. We will administer a web-based survey to all certified family practice, psychiatry or pediatric NPs licensed to practice in Washington and Oregon. The survey is innovative in that it will include a randomly assigned, standardized patient scenario video mapped to CDC criteria for concussion assessment. Four videos will be produced, wherein patient characteristics (sex or sport type) will vary but all other factors (symptoms, physical signs, and history) will remain the same. A questionnaire, administered after the video, will ascertain provider assessment of the patient’s symptoms, management plan, prescription recommendations, concussion knowledge, experience, and demographics. Results will be collected and analyzed using multivariable statistical models to assess the influence of patient characteristics on concussion evaluation and management. Study findings will be used to formulate an action plan for the creation and implementation of an educational module on adolescent concussion assessment and management for NPs.

Primary Investigator

Tracy Klein
Tracy Klein, PhD


Janessa Graves, PhD