1. ©2014 MFMER | slide-1 Concussion Task Force Update 2014 Jennifer Roth Maynard, MD Assistant Professor Family Medicine Associate Director Primary Care Sports Medicine Fellowship Chair Northeast Florida Sports Concussion Task Force FHSAA Sports Medicine Advisory Committee April 11, 2014

2. ©2014 MFMER | slide-2 Provider Concussion Survey Survey is closed! 141 responses Email solicitation sent to ~8000 providers ~1.7% response rate…ouch! Analysis in progress with Mayo biostatistician Family Med vs Peds Fellowship trained vs Non-fellowship Endpoints: concussion knowledge of symptoms, practices, return to play (RTP) Florida State Law & AT-18

3. ©2014 MFMER | slide-3 Florida Provider Concussion Survey 2013 Are you aware of the Florida “concussion law?” 52% AWARE … 48% UNAWARE

4. ©2014 MFMER | slide-4 Florida Provider Concussion Survey 2013 Are you aware of the FHSAA RTP AT-18 form? 59% physicians UNAWARE of AT18 form!!!

5. ©2014 MFMER | slide-5 Order of Evaluation of Concussion 1.Concussion suspected 2.Remove from play immediately 3.Eval by MD or DO 4.*Meet “checklist” criteria on NEW AT-18* 5.MD or DO initiates supervised RTP progression by signing page 1 of AT-18 6.ATC or coach supervises RTP, signs and dates progression 7.**Final clearance by MD or DO** by signing page 2 AT-18 form

6. ©2014 MFMER | slide-6 RTP protocol MUST be supervised by ATC or coach!! Athlete must meet all criteria in “checkbox” area to begin RTP! Signed by MD/DO.

7. ©2014 MFMER | slide-7 Form MUST be signed by MD/DO for FINAL clearance prior to allowing athlete to play.

8. ©2014 MFMER | slide-8 A little controversy… CJSM March 2014 Too many definitions Symptoms are wide and nonspecific May be “better accounted for by another condition” Too all encompassing- may lead to missed school, work or sport “unnecessarily”

9. ©2014 MFMER | slide-9 Zurich Controversy “The problem” Lack of diagnostic specificity Management strategies that are not evidence based Rehabilitation goals that are not attainable “Given these problems, the Zurich Guidelines cannot be endorsed.” What is asymptomatic? Average symptom score of Uninjured athlete is not zero, but 3-10…

10. ©2014 MFMER | slide-10 Our response Differential diagnosis is a part of all evaluations “Asymptomatic” is in relation to baseline knowledge of the athlete “The ‘guidelines’ are a safety initiative based upon delaying a return to high risk activity; they are nothing more than a system of checks and balances to increase a more informed return to sport versus an arbitrary decision.” Bob Sefcik, ATC

11. ©2014 MFMER | slide-11 Task Force Educational Videos Provider Concussion Education Kevin Kaplan, MD & Micky Collins PhD Definition, sx recognition Office evaluation, Primary management Neurocognitive testing General RTP guidelines RTP Video- Florida specific Bob Sefcik, ATC “Formology” AT-18 Link to NFHS concussion education

12. ©2014 MFMER | slide-12 Questions & Discussion