Available financial and personnel resources often dictate the specifics of concussion policies and procedures in the secondary school setting. The purpose of this qualitative study was to explore athletic trainers' perceived challenges toward comprehensive concussion management in the secondary school setting. The findings indicate several challenges exist toward concussion management in the secondary school, including facility, personnel, and community resources, education levels of various stakeholders, and general perceptions of concussion and athletic trainers. It is important to identify challenges athletic trainers may face in order to develop strategies to align current concussion management procedures with current best practices.Keywords: concussion education, traumatic brain injury, return-to-play, multidisciplinary collaborationIn the United States, between 1.1-1.9 million sport-related concussions occur annually among adolescents under the age of 18, and approximately 2,800-5,000 of these concussion cases result in hospitalization. 1 Therefore, proper assessment and management of this public health concern is crucial. Current best practice guidelines suggest concussion assessment should include a multidimensional evaluation (i.e., cognition, symptoms, balance assessment, oculomotor function) both pre-and postinjury. 2,3 While the most current consensus recommendations suggest the use of baseline testing is inconclusive, 2 benefits of baseline testing not only include an opportunity to educate student-athletes about the risks associated with concussion and the importance of reporting concussion symptoms, 4 but also provide clinicians with individualized patient data that can be used for direct comparison during postinjury concussion management. 5 However, although the utility and frequency of baseline testing for student-athletes that are still maturing and developing has been argued, 6-8 researchers have reported that baseline assessment scores improve as an adolescent matures. [8][9][10][11] Therefore, if baseline testing is considered for adolescent studentathletes, it is recommended that the student-athlete complete baseline testing for a second time prior to tenth grade, 9 if not on an annual basis.Following a concussion, a multifaceted approach, similar to baseline testing, is recommended for the diagnosis and management of a concussed student-athlete. 2,3 To effectively monitor the concussed student-athlete and manage all aspects of the studentathlete's health-related quality of life, a multidisciplinary concussion management team is recommended. 12 Outside medical professionals (e.g., primary care physician, concussion specialist) and school-affiliated health care personnel (e.g., athletic trainer, school nurse) should evaluate, monitor, and track symptoms, while school personnel should monitor and track academic and emotional changes of the concussed student-athlete. In the home environment, family members should monitor symptoms, including sleep-related symptoms, as well as impose prescribed...
Clinical Scenario: Eating disorders in female athletes are a commonly underdiagnosed condition. Better screening tools for eating disorders in athletic females could help increase diagnosis and help athletes get the treatment they need. Focused Clinical Question: Should screening tools be used to detect eating disorders in female athletes? Summary of Key Findings: The literature was searched for studies that included information regarding the sensitivity and specificity of screening tools for eating disorders in female athletes. The search returned 5 possible articles related to the clinical question; 3 studies met the inclusion criteria (2 cross-sectional studies, 1 cohort study) and were included. All 3 studies reported sensitivity and specificity for the Athletic Milieu Direct Questionnaire version 2, the Brief Eating Disorder in Athletes Questionnaire version 2, and the Physiologic Screening Test to Detect Eating Disorders Among Female Athletes. All 3 studies found that the respective screening tool was able to accurately identify female athletes with eating disorders; however, the screening tools varied in sensitivity and specificity values. Clinical Bottom Line: There is strong evidence to support the use of screening tools to detect eating disorders in female athletes. Screening tools with higher sensitivity and specificity have demonstrated a successful outcome of determining athletes with eating disorders or at risk for developing an eating disorder. Strength of Recommendation: There is grade A evidence available to demonstrate that screening tools accurately detect female athletes at risk for eating disorders.
School nurses have an integral role in managing student health concerns throughout the school day, yet little is known about their specific role in concussion management. Therefore, the purpose of this study was to explore the challenges encountered by school nurses regarding concussion management in the secondary school setting. Twenty-two school nurses employed in the secondary school setting were interviewed via phone. We analyzed the data via the consensual qualitative research paradigm. Overall, we found school nurses face consistent challenges with their role on the concussion management team, specifically related to education of school personnel, parents, and community health-care providers. Challenging topics included the inconsistency of community health-care provider recommendations and others' perceptions of school nurses' preparation and training to be important members of the concussion management team. Efforts to increase concussion education and improve communication across all stakeholders of the concussion management team should be implemented.
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