The impact of patient characteristics on nurse practitioners’ assessment and management of adolescent concussion

Background and purpose To evaluate the effect of patient sex and type of activity on concussion assessment and management recommendations. Methods We administered a web-based survey to all nurse practitioners (NPs) actively licensed in Washington and Oregon. Participants were randomized to view one of four standardized patient scenario videos of an adolescent seeking care for a concussion, portraying the same symptomology but differing by sex and activity (soccer/hiking). Respondents provided assessment and management recommendations. Conclusions In total, 1021 NPs provided sufficient data for analysis. Most NPs correctly identified the injury as a concussion (92.8%); fewer identified it as a mild traumatic brain injury (55.3%). NPs who viewed hiking videos were 40% more likely to indicate that the patient was definitely or likely safe to return to activity in 1 week, compared to a soccer player, after adjusting for covariates (RR = 1.40, 95% CI [1.16, 1.68]). Implications for practice While most assessment and management recommendations did not vary according to patient sex, providers may manage concussions differently based on etiology. Appropriate and consistent concussion assessment and management is important, as NPs are authorized to assess adolescents with concussions and make determinations regarding return to activity or school.