Diagnosing and managing paediatric concussion: Key recommendations for general paediatricians and family doctors.

Concussion in children and adolescents is an important health concern. Most paediatric patients fully recover in 1 month or less following an acute concussion. However, some experience prolonged or persistent concussion symptoms for months. Those with prolonged post-concussion-related symptoms may have impaired quality of life, and limited involvement in social, academic, and physical activities with associated mental health implications. In this review, we share key updated clinical recommendations from the Living Guideline for Diagnosing and Managing Pediatric Concussion that will improve the way general paediatricians and family doctors diagnose and manage paediatric patients with suspected concussion.

Primary care management of concussion in Canada.

Concussion has emerged as an important public health issue affecting thousands of Canadians annually. Health care providers including paediatricians, family and emergency medicine physicians, nurses, and nurse practitioners are commonly tasked with the responsibility of providing primary care to patients with acute concussion and those with persistent post-concussion symptoms. In July 2017, Parachute, in collaboration with the Public Health Agency of Canada and Sport Canada released the Canadian Guideline on Concussion in Sport that outlines a standardized and evidence-based approach to the recognition, diagnosis, and management of youth and adults with suspected concussion. In this report, we provide a brief overview of the important roles of primary care providers in the medical assessment, management, and prevention of concussion as outlined in this national best practice guideline.

Legislation for Youth Sport Concussion in Canada: Review, Conceptual Framework, and Recommendations.

In this article, we conduct a review of introduced and enacted youth concussion legislation in Canada and present a conceptual framework and recommendations for future youth sport concussion laws. We conducted online searches of federal, provincial, and territorial legislatures to identify youth concussion bills that were introduced or successfully enacted into law. Internet searches were carried out from July 26 and 27, 2016. Online searches identified six youth concussion bills that were introduced in provincial legislatures, including two in Ontario and Nova Scotia and one each in British Columbia and Quebec. One of these bills (Ontario Bill 149, Rowan's Law Advisory Committee Act, 2016) was enacted into provincial law; it is not actual concussion legislation, but rather a framework for possible enactment of legislation. Two bills have been introduced in federal parliament but neither bill has been enacted into law. At present, there is no provincial or federal concussion legislation that directly legislates concussion education, prevention, management, or policy in youth sports in Canada. The conceptual framework and recommendations presented here should be used to guide the design and implementation of future youth sport concussion laws in Canada.

Physical activity after total joint replacement: a cross-sectional survey.

OBJECTIVE: To determine the level of physical activity participants are able to perform at a minimum of 1 year after primary total hip or knee replacement. DESIGN: Cross-sectional survey. SETTING: A tertiary care arthroplasty center. PARTICIPANTS: A total of 170 primary total hip and 184 primary total knee arthroplasty patients. INTERVENTIONS: The University of California Los Angeles (UCLA) activity score was mailed to 242 primary hip and 225 primary knee arthroplasty patients. Patients were abstracted from a prospectively tabulated arthroplasty database and pre-selected for good/excellent clinical outcomes as determined by 1 year postoperative Knee Society (KSS) and Harris Hip (HHS) scores. Clinical outcomes including the Oxford Hip/Knee score were collected preoperatively, and at 6 and 12 months postoperatively. Correlations between UCLA scores, demographics, and clinical outcomes were calculated using Pearson's correlation. MAIN OUTCOME MEASUREMENTS: Harris Hip Score, Oxford Hip Score, Knee Society Score, Oxford Knee Score, and UCLA Activity Scale. RESULTS: : Postal survey response rates for hips were 70.2% (170 of 242) and 81.8% for knees (184 of 225). Mean results at postoperative year 1 include: HHS (94.8), Oxford Hip Score (16.6), KSS clinical score (95.9), KSS function score (95.0), and Oxford Knee score (18.2). For both primary total hip arthroplasty and total knee arthroplasty patients, median UCLA score was 6, indicating moderate activity levels at a mean follow-up of 40.7 months for hips and 36.6 months for knees. CONCLUSIONS: UCLA scores indicate the average total joint replacement patient maintains a moderate activity level, and many perform active/very active levels of activity.