Athletic Trainers' Concussion-Assessment and Concussion-Management Practices: An Update

Abstract

Context Athletic trainers (ATs) are often the first health care providers to conduct concussion assessments and carry out postinjury management. Best practices for concussion evaluation and management have changed rapidly in recent years, outdating previous reports of ATs' concussion practices. Objective To examine ATs' current concussion-assessment and -management techniques. Design Cross-sectional study. Setting Web-based survey. Patients or Other Participants A random convenience sample of 8777 ATs (response rate = 15.0% [n = 1307]; years certified = 15.0 ± 10.6) from the National Athletic Trainers' Association membership. Main Outcome Measure(s) Survey Web links were e-mailed to prospective participants, with 2 follow-up e-mails sent by the National Athletic Trainers' Association. The survey collected demographic information, the number of concussions assessed, the concussion-recovery patterns, and the assessment and return-to-participation (RTP) decision-making methods used. Results The ATs reported assessing a median of 12.0 (range = 0–218) concussions per year. A total of 95.3% (953/1000) ATs cited clinical examination as the most frequently used concussion-assessment tool, followed by symptom assessment (86.7%; 867/1000). A total of 52.7% (527/1000) ATs described a 3-domain minimum multidimensional concussion-assessment battery. Published RTP guidelines were the most common RTP decision-making tool (91.0%; 864/949), followed by clinical examination (88.2%; 837/949). The ATs with master's degrees were 1.36 times (95% confidence interval [CI] = 1.02, 1.81) more likely to use a 3-domain concussion-assessment battery than ATs with only bachelor's degrees (χ2 = 4.44, P = .05). Collegiate ATs were 2.12 (95% CI = 1.59, 2.84) and 1.63 (95% CI = 1.03, 2.59) times more likely to use a 3-domain concussion-assessment battery than high school and clinic-based ATs, respectively (χ2 = 26.29, P < .001). Conclusions Athletic trainers were using the clinical examination, standardized assessment tools, and a 3-domain concussion-assessment–battery approach more frequently in clinical practice than previously reported. However, despite practice improvements, nearly half of ATs were not using a 3-domain minimum concussion-assessment battery. Clinicians should strive to implement multidimensional concussion assessments in their practices to ensure optimal diagnosis and management.

Time to Authorized Clearance From Sport-Related Concussion: The Influence of Health Care Provider and Medical Facility

“…However, if an athlete is progressing through a return to play progression as expected, it is probable appointments for clearance are made in a timely fashion. A study by Wallace and colleagues found that 84% of athletic trainers report following a gradual stepwise progression during SRC management, and the most commonly used return-to-play guidelines are the National Athletic Trainers' Association 2014 position statement and the International Conference on Concussion in Sport consensus statement 2,33. Wallace and colleagues 32 also reported an interdisciplinary approach (e.g., athletic trainers and team physician, or athletic trainers and PCP) for final return-to-play decisions is utilized 28% of the time, and 22% of the time a PCP making final return-to-play decisions alone.…”

“…Wallace and colleagues 32 also reported an interdisciplinary approach (e.g., athletic trainers and team physician, or athletic trainers and PCP) for final return-to-play decisions is utilized 28% of the time, and 22% of the time a PCP making final return-to-play decisions alone. Whereas, a recent report identified team physicians (41.3%), athletic trainers (37.1%), and PCP (14.5%) as the final decision makers, with athletic trainers collaboratively involved in a majority (93.8%) of the decisions 33. Importantly, these aforementioned studies are reports of athletic trainers practicing in a variety of states and work settings, where XHSAA requires authorized clearance to be made by an MD, DO, NP, or PA.Our results suggest that in cases where student-athletes obtained clearance from an Urgent/Ready care facility, the gradual stepwise progression may have been accelerated, not monitored properly or not incorporated, resulting in the earlier clearance time.…”

Primeiros socorros na Educação Física: uma revisão bibliométrica

“…Os autores outrora citados, concluíram que os treinadores esportivos são membros importantes das equipes de primeiros socorros em campo, fornecendo apoio tanto aos jogadores lesionados quanto a outros profissionais de medicina esportiva. No mais, treinadores atléticos precisam melhorar a sua prática, a partir de competências próprias (exame clínico, ferramentas de avaliação padronizadas e outras) (Lempke, Schmidt & Lynall, 2020).…”

Concussion Knowledge and Clinical Experience Among Athletic Trainers: Implications for Concussion Health Care Practices

“…1,2 Athletic trainers play a vital role in proper concussion management because they are heavily involved in diagnosis, management, and RTP decision making. 3,4 Thus, it is imperative that ATs possess knowledge of concussions and remain up to date on concussion-assessment and -management techniques.…”

“…These findings are valuable, but they provide limited insight into concussion practices because of the specific sample of Division I ATs, the 2011 data collection, and recently published surveys of AT practices. 3,4,18 Therefore, the purpose of our study was to examine (1) the level of concussion knowledge among ATs and (2) the influences of concussion knowledge and years of clinical experience on concussion assessment and management among ATs. We hypothesized that (1) ATs would have a generally high level of concussion knowledge and (2) those with greater knowledge and fewer years of clinical experience would be more likely to assess more concussions annually and perform recommended assessment and management techniques.…”