High School Athletic Directors Report Poor Compliance With Concussion Reporting and Medical Clearance in Massachusetts

Abstract

Purpose To assess statewide prevalence of medical access, concussion reporting, and concussion clearance rates of high school athletic departments in Massachusetts after the implementation of state-wide concussion legislation. Methods A random sample of 50 athletic directors (ADs) from Massachusetts high schools with an enrollment of >150 students was selected. A 10-minute electronic survey about access to athletic trainers and physicians, and concussion reporting and clearance practices was administered. Responses were anonymous. Results The response rate was 80% (n = 40). In total, 90% of respondents were male. Median age and experience of respondents was 52 years old and 10 years, respectively. The median school size was 637 students, represented from all Massachusetts geographic athletic districts. ADs disclosed that on average, 12% (95% confidence interval 7%-20%) of concussions go unreported at their schools. In total, 16% of respondents reported that at least 1 in 4 of concussed athletes at their school returned to play without appropriate medical clearance, and 5% of ADs reported that not all of their coaches had undergone any form of concussion training. Overall, 55% of high schools do not have access to a full-time athletic trainer and 50% do not have a team physician; 20% have affiliations with an orthopaedic surgeon and 8% with a neurologist. Conclusions Despite new regulations in Massachusetts, high school ADs report concussion reporting and clearance that are less than 100%. Less than one half of all Massachusetts high schools report access to a full-time athletic trainer or formal relationship with a school physician. Clinical Relevance Investigating compliance with Massachusetts school athletics safety regulations could help identify a need for reform of policies designed to help schools keep student athletes safer in situations where a concussion may have occurred.

Acute Sport-Related Concussion Management and Return to Sport Time in High School Athletes

“…25 In addition, some athletic directors even suggest that not all of their coaches complete any form of SRC training. 26…”

Sport-related Structural Brain Injury in High School and College American Football Athletes, 2002-2020: Effect of Lystedt Law

“…Another possible explanation for the lack of SRSBI reduction with the Lystedt law is poor compliance with concussion reporting and medical clearance. 20 Underreporting by players, mismanagement of injuries, and lack of awareness of concussion symptoms are all obstacles to the effective management of concussions. 1,28 Underreporting of concussions by players can be substantial, with up to 50% of athletes not reporting concussions as many symptoms may be minor or ignored due to the warrior mentality in the sport of football.…”

“…20 Less than 50% of all HSs in the state had a full-time athletic trainer or formal relationship with a school physician. 20 Therefore, renewed efforts are necessary to enforce compliance, such as removing…”

“…18,25 In 1 study assessing compliance with state concussion laws in Massachusetts, an estimated 12% of concussions were not reported and 25% of concussed athletes returned to play without appropriate medical clearance. 20 Less than 50% of all HSs in the state had a full-time athletic trainer or formal relationship with a school physician. 20 Therefore, renewed efforts are necessary to enforce compliance, such as removing athletes with any concussion symptoms from play and not allowing return to play until properly cleared.…”

“…20 Less than 50% of all HSs in the state had a full-time athletic trainer or formal relationship with a school physician. 20 Therefore, renewed efforts are necessary to enforce compliance, such as removing athletes with any concussion symptoms from play and not allowing return to play until properly cleared. Improving access to medical care is also critical.…”