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.