CCGI Best Practice Collaborators
CCGI Best Practice Collaborators
CCGI Best Practice Collaborators
In April 2016, CCGI Opinion Leaders were joined by a new team of CCGI Best Practice Collaborators. These are influential evidence-informed clinicians recently nominated by their colleagues in a nationwide survey. They are assisting Opinion Leaders in their area with reaching out to other chiropractors and teaching them about critical thinking, proper interpretation of evidence-informed clinical practice guidelines, and evidence-informed practice in general.
CCGI is delighted to have them on board and looks forward to collaborating with them to take the best practices forward in Canada.
Roles and Activities of CCGI Best Practice Collaborators
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understanding how clinical practice guidelines are developed;
-
discussing best practices and guidelines with colleagues;
-
having a presence on social media to raise awareness of resources on evidence-informed practice;
-
encouraging clinicians and patients to use the CCGI website and resources;
-
making presentations on evidence-informed practice at continuing education events and conferences in collaboration with their local opinion leaders team.
In April 2016, CCGI Opinion Leaders were joined by a new team of CCGI Best Practice Collaborators. These are influential evidence-informed clinicians recently nominated by their colleagues in a nationwide survey. They are assisting Opinion Leaders in their area with reaching out to other chiropractors and teaching them about critical thinking, proper interpretation of evidence-informed clinical practice guidelines, and evidence-informed practice in general.
CCGI is delighted to have them on board and looks forward to collaborating with them to take the best practices forward in Canada.
Roles and Activities of CCGI Best Practice Collaborators
-
understanding how clinical practice guidelines are developed;
-
discussing best practices and guidelines with colleagues;
-
having a presence on social media to raise awareness of resources on evidence-informed practice;
-
encouraging clinicians and patients to use the CCGI website and resources;
-
making presentations on evidence-informed practice at continuing education events and conferences in collaboration with their local opinion leaders team.
In April 2016, CCGI Opinion Leaders were joined by a new team of CCGI Best Practice Collaborators. These are influential evidence-informed clinicians recently nominated by their colleagues in a nationwide survey. They are assisting Opinion Leaders in their area with reaching out to other chiropractors and teaching them about critical thinking, proper interpretation of evidence-informed clinical practice guidelines, and evidence-informed practice in general.
CCGI is delighted to have them on board and looks forward to collaborating with them to take the best practices forward in Canada.
Roles and Activities of CCGI Best Practice Collaborators
-
understanding how clinical practice guidelines are developed;
-
discussing best practices and guidelines with colleagues;
-
having a presence on social media to raise awareness of resources on evidence-informed practice;
-
encouraging clinicians and patients to use the CCGI website and resources;
-
making presentations on evidence-informed practice at continuing education events and conferences in collaboration with their local opinion leaders team.
Are you interested in getting involved with CCGI?
We are always looking to get people involved in our projects. No experience necessary - we provide training!
Contact us today!
Are you interested in getting involved with CCGI?
We are always looking to get people involved in our projects. No experience necessary - we provide training!
Contact us today!
Mild Traumatic Brain Injury Among Children & Adolescents
This tool provides information to facilitate the management of mild traumatic brain injury (mTBI) among children and adolescents ≤18 years of age.
Focused examination
1. Patient History
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Assess level of concern for major structural or other pathologies. If required, refer to an appropriate healthcare provider.
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Identify and assess other conditions, co-morbidities. Manage using appropriate care pathways.
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Address any prognostic factors that may delay recovery.
Major structural or other pathologies may be suspected with certain signs and symptoms (red flags):
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Age younger than 2 years, vomiting, loss of consciousness, severe mechanism of injury, severe or worsening headache, amnesia, non-frontal scalp hematoma, GCS score less than 15, clinical suspicion of skull fracture, seizures, focal neurologic signs, looks very drowsy/can’t be awakened, slurred speech, can’t recognize people or places, increasing confusion or irritability, weakness or numbness in arms or legs, neck pain, unusual behavioural change, change in state of consciousness
Examples of risk factors for persistent symptoms:
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Older children/adolescents, lower socioeconomic status, severe presentation of mTBI including those associated with intracranial injury
Examples of prognostic factors that may delay recovery:
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Premorbid histories of mTBI, intracranial lesion, neurological or psychiatric disorders, learning difficulties, increased preinjury symptoms, family and social stressors
2. Physical Examination
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Use validated clinical decision rules (e.g., Pediatric Emergency Care Applied Research Network (PECARN) Decision Rules).
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Assess levels of concern regarding major structural or other pathologies.
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Use the Canadian C-spine Rule to rule out cervical spine fractures and dislocations associated with acute trauma.
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Assess mental status and cognition, physical status, cranial nerves, extremity tone, strength, and reflexes, gait and balance, deterioration/ improvement since injury.
3. Management
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Offer information on nature, management, and the course of mTBI.
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Discuss the range of effective interventions with the patient and, together, select a therapeutic intervention.
Patient Handouts
Patient/Family Education and Reassurance
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Include the following information:
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Warning signs of more serious injuries
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Description of injury and expected course of symptoms and recovery
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How to monitor post-concussive symptoms
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Prevention of further injury
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Return to play/school as tolerated; avoid prolonged physical and cognitive rest
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Specific Management of Symptoms
Provide structured patient education (reassurance, promote and facilitate return to work and normal activities, self-care advice) and any one of the following therapeutic interventions*:
Cognitive/Physical Rest and Aerobic Exercise
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Consider restricting physical and cognitive activity during the first several days after injury
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Consider counselling to resume a gradual schedule of activity that does not exacerbate symptoms significantly
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Consider progressive reintroduction of non-contact aerobic activity that does not exacerbate symptoms
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Consider counselling to return to full activity when they return to pre-injury performance
Psychological and Emotional Support
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Assess the extent and types of social support available to the patient and emphasize its importance in their recovery
Return to School
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Consider counselling patient and family regarding the process of gradually increasing the duration and intensity of academic activities as tolerated
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Consider customizing return-to-school protocols based on severity of symptoms
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Consider assessing the educational needs of the patient and determine the need for additional educational supports for those with prolonged symptoms that interfere with academic performance
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Consider monitoring post-concussive symptoms and academic progress in school
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Consider monitoring and adjusting educational supports on an ongoing basis
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Consider referring patient to a specialist in paediatric mTBI for those who demonstrate prolonged symptoms and academic difficulties
Post-traumatic Headache
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Consider obtaining a head CT for severe headache, especially when associated with other risk factors and worsening headaches after injury
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Consider emergent neuroimaging when undergoing observational periods for headache with acutely worsening symptoms
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Consider non-opioid analgesia (ie. ibuprofen or acetamenophen) for painful headache combined with counselling regarding the risks of analgesic overuse, including rebound headache
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Consider referring for multidisciplinary evaluation and treatment
Vestibulo-Oculomotor Dysfunction
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Consider referring for vestibular rehabilitation
Sleep
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Consider sleep hygiene
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Consider referring to sleep disorder specialist
Cognitive Impairment
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Determine the etiology of cognitive dysfunction within the context of mTBI symptoms
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Recommend treatment that reflects presumed etiology
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Consider referring for a formal neuropsychological evaluation
*Interventions are recommended if guidelines used terms such as ‘recommended for consideration’ (e.g., ‘offer’, ‘consider’), ‘strongly recommended’, ‘recommended without any conditions required’, or ‘should be used’. Recommendations from low-quality evidence are not listed.
Care Pathway for the management of mTBI in children and adolescents
4. Reevaluation and Discharge
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Reassess the patient at every visit to determine if: (1) additional care is necessary; (2) the condition is worsening; or (3) the patient has recovered.
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Monitor for any emerging factors that may delay recovery.
5. Referrals and Collaboration
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Refer the patient to an appropriate healthcare provider for further evaluation at any time during their care if they develop worsening symptoms and new physical or psychological symptoms.