Objective:To provide athletic trainers, physicians, and other health care professionals with best-practice guidelines for the management of sport-related concussions.Background: An estimated 3.8 million concussions occur each year in the United States as a result of sport and physical activity. Athletic trainers are commonly the first medical providers available onsite to identify and evaluate these injuries. Recommendations:The recommendations for concussion management provided here are based on the most current research and divided into sections on education and prevention, documentation and legal aspects, evaluation and return to play, and other considerations.

Context: Many athletes continue to participate in practices and games while experiencing concussion-related symptoms, potentially predisposing them to subsequent and more complicated brain injuries. Limited evidence exists about factors that may influence concussion-reporting behaviors.Objective: To examine the influence of knowledge and attitude on concussion-reporting behaviors in a sample of high school athletes.Design: Cross-sectional study.Setting: Participants completed a validated survey instrument via mail.Patients or Other Participants: A total of 167 high school athletes (97 males, 55 females, 5 sex not indicated; age ¼ 15.7 6 1.4 years) participating in football, soccer, lacrosse, or cheerleading.Intervention(s): Athlete knowledge and attitude scores served as separate predictor variables.Main Outcome Measure(s): We examined the proportion of athletes who reported continuing to participate in games and practices while symptomatic from possible concussion and the self-reported proportion of recalled concussion and bell-ringer events disclosed after possible concussive injury.Results: Only 40% of concussion events and 13% of bellringer recalled events in the sample were disclosed after possible concussive injury. Increased athlete knowledge of concussion topics (increase of 1 standard deviation ¼ 2.8 points) was associated with increased reporting prevalence of concussion and bell-ringer events occurring in practice (prevalence ratio [PR] ¼ 2.27, 95% confidence interval [CI] ¼ 1.60, 3.21) and the reporting prevalence of bell-ringer-only events overall (PR ¼ 1.87, 95% CI ¼ 1.38, 2.54). Athlete attitude scores (increase of 1 standard deviation ¼ 11.5 points) were associated with decreases in the proportion of athletes stating they participated in games (PR ¼ 0.74, 95% CI ¼ 0.66, 0.82) and practices (PR ¼ 0.67, 95% CI ¼ 0.59, 0.77) while symptomatic from concussions.Conclusions: Most recalled concussion events in our study were not reported to a supervising adult. Clinicians should be aware that knowledge and attitude influence concussion reporting. Clinicians and administrators should make concussion education a priority and encourage an optimal reporting environment to better manage and prevent concussive injuries in young athletes.Athlete knowledge and attitude influenced concussion-reporting behaviors in some contexts. A large proportion of recalled concussion events was not reported among the sample of high school athletes. Increasing knowledge of concussion symptoms, improving the culture of sport, and increasing the understanding of the seriousness of concussive injuries should be targets for future interventions. Programs should be implemented to increase awareness, promote reporting, and create a safe reporting environment.

Favourable attitudes toward reporting and social referents' beliefs have the greatest impact on intention to report concussion symptoms. Reporting intention may not always be an indicator of concussion-reporting behaviours. Concussion education initiatives should focus on improving attitudes and beliefs among athletes, coaches and parents to promote better care-seeking behaviours among young athletes.

Athletes reported higher scores on a number of SF-36 and PODCI subscales related to mental, emotional, and physical well-being than nonathletes. Our findings suggest that athletic involvement may be a benefit to the overall health status of adolescents and imply that athletes may be a distinct adolescent group requiring their own normative values when using the SF-36 and PODCI.

The purpose of this study was to evaluate school nurses' familiarity and perceptions regarding academic accommodations for student-athletes following sport-related concussion. School nurses (N = 1,246) accessed the survey School Nurses' Beliefs, Attitudes and Knowledge of Pediatric Athletes with Concussions (BAKPAC-SN). The BAKPAC-SN contained several questions pertaining to concussion management and academic accommodations. There were significant differences regarding personal experience as well as familiarity of academic accommodations (p < .001) between school nurses who work at a school that employs an athletic trainer and school nurses who work at a school that does not employ an athletic trainer. There were significant weak positive relationships between years of experience and familiarity with academic accommodations (r = .210, p < .001), 504 plans (r = .243, p < .001), and individualized education plans (r = .205, p < .001). School nurses employed at a single school were significantly more familiar with academic accommodations (p = .027) and 504 plans (p = .001) than school nurses employed at multiple schools. Health care professionals should collaborate to effectively manage a concussed patient and should consider academic accommodations to ensure whole-person health care.