Knowledge and practice of evidence-based mild traumatic brain injury guidelines among physicians providing emergency and trauma care in Israel.

BACKGROUND

Over the past decade, clinical guidelines for the management of mild traumatic brain injury (mTBI) have evolved worldwide to prevent re-injury and reduce the risk of prolonged recovery. However, to date, no study has examined the knowledge and practice of these clinical guidelines in Israel.

AIMS: To describe knowledge and implementation of up-to-date post-mTBI guidelines among physicians providing emergency and trauma care in Israel.

METHODS

An exploratory cross-sectional survey of 68 hospital-based physicians providing emergency and trauma care (32% residents; 79% male; 87% general surgery/trauma/emergency medicine). Participants completed a 30-item multiple-choice questionnaire covering (1) demographics/professional characteristics and (2) knowledge and implementation of post-mTBI recommendations (e.g., symptom recognition, accepted protocols, and follow-up advice).

RESULTS

Most respondents (90%) recognized common post-mTBI symptoms, such as headaches and dizziness; however, only 40-60% identified neck pain, sleep disturbances, balance problems, and light/noise sensitivity. Although 50% reported familiarity with the internationally accepted guidelines, only 38% instructed for return-to-activity/sport protocol, 32% for return-to-school/work protocols, and 21% provided standardized discharge handouts. While 60% recommended post-injury medical follow-up, only 44% instructed patients to seek further care if they develop persisting symptoms, only 16% referred patients to clinicians specializing in post-mTBI management when clinically indicated, and only two respondents (3%) referred patients to a specialized mTBI clinic. The most frequently reported barrier (38-50%) was a lack of awareness of mTBI specialized services/providers.

CONCLUSIONS

In this exploratory sample, gaps in both knowledge and implementation of internationally accepted post-mTBI guidelines were observed among Israeli physicians providing emergency and trauma care. The findings support revisions to national procedures, targeted training, and the development of a coordinated stepped-care pathway that links emergency and primary care with community-based follow-up for all patients following mTBI. They also support better access to interdisciplinary rehabilitation services for those with persistent or complex symptoms.