191 How do we do better? Managing community rugby concussions in a primary care setting. (3rd March 2020) - Salmon, Danielle
Abstract : Background: Concussions in rugby are of a global player welfare concern. To address this challenge New Zealand Rugby has employed a social ecological model to develop a concussion management pathway (CMP). Following a suspected concussion, the pathway encourages compliance and supports the relevant stakeholders (e.g. players, coaches, physiotherapists, doctors) throughout the recovery process. Objective: To examine (i) user uptake of technology that operationalises the CMP and (ii) stakeholder experiences. Design: Prospective mixed-methods multi-centre study. Setting: Community rugby in three New Zealand provincial unions. Patients (or Participants): Community rugby male and female players (n=1893) were invited to participate of which 1540 provided pre-season baseline data. Interventions (or assessment of risk factors): Pre-season, players were baseline tested using a modified SCAT5. In season, suspected concussions were logged on an App, notifying relevant stakeholders and entering the player into the CMP. Players were referred to a doctor who assessed them for a concussion while comparing to the player's baseline assessment via a customized online portal. This information was also used by the doctor at the time of medical clearance. To gain a deeper understanding of the participants' experience with the CMP, 130 stakeholders were interviewed post-season. Results: Two-hundred suspected concussions were logged, of these 154 saw a doctor for a diagnosis, 171 obtained medical clearance following completion of GRTP, and 17 were referred on for further investigation/treatment by a doctor involved in the pilot. Stakeholders agreed that having a clearly defined pathway facilitated an efficient and informed management process for concussions and encouraged compliance with seeking medical advice/clearance. Conclusions: The CMP provides an electronic platform for monitoring compliance with medical visits and the safe RTP while ensuring all stakeholders are aware of the player's status. The system provides controlled access to centrally stored baseline information to help inform medical decisions. Stakeholders supported the use of the CMP.