The Influence of Athletic Trainers on the Incidence and Management of Concussions in High School Athletes

Abstract

Context In many US high schools, the athletic trainer (AT) has the responsibility to identify and manage athletes with concussions. Although the availability of ATs varies a great deal among schools, how the level of AT availability in high schools affects the reported incidence and management of sport-related concussions (SRCs) is unknown. Objective To determine how the presence of an AT affects the reporting and management of SRCs. Design Prospective cohort study. Patients or Other Participants A total of 2459 (female = 37.5%, age = 16.1 ± 1.2 years) athletes from 31 Wisconsin high schools were categorized as having low availability (LoAT), mid availability (MidAT), or high availability (HiAT) of ATs. Athletic trainers recorded the incidence, days lost from sport, and postconcussion management through return to sport. The incidence of SRC reporting among categories was examined using a multivariate Cox proportional hazards model. Fisher exact tests were used to determine if postconcussion management differed based on AT availability. Results The incidence of reported SRCs was lower for the LoAT schools (2.4%) compared with the MidAT (5.6%, hazard ratio = 2.59, P = .043) and HiAT (7.0%, hazard ratio = 3.33, P = .002) schools. The median time before the first AT interaction was longer for LoAT schools (24.0 hours) than for MidAT (0.5 hours, post hoc P = .012) and HiAT (0.2 hours, post hoc P = .023) schools. The number of post-SRC interactions was different in all groups (LoAT = 2 interactions, MidAT = 3, and HiAT = 4; all post hoc P values < .05). Days lost were greater for MidAT and HiAT (both 14 days lost) schools compared with LoAT schools (11.5 days lost, post hoc P = .231 and P = .029, respectively). Athletes at LoAT schools were less likely to undergo a return-to-play protocol (9/18 SRCs, 50.0%) than athletes at MidAT (44/47 SRCs, 93.6%; post hoc P = .001) or HiAT (64/64 SRCs, 100%; post hoc P < .001) schools. Conclusions The level of AT availability positively influenced the reported incidence of SRCs as well as postconcussion management activities in this sample of high schools.

Challenges Faced by Collegiate Athletic Trainers, Part II: Treating Concussed Student-Athletes

“…9 Although these investigations highlight the challenges of diagnosing patients with concussions, the presence of ATs was associated with increases in the diagnosis rate and the implementation of safe return-to-play protocols. 10 Coaches believed it was more acceptable to allow athletes to continue playing after a concussion, depending on the importance of the event, than to disqualify them from further participation. 11 The disconnect between coaches' beliefs and current best practice for a patient with concussion 12 provides grounds for organizational conflict.…”

Access to Athletic Trainer Services in California Secondary Schools

“…1 Overall, nearly 8 million student-athletes participate in high school athletics, which makes availability and access to athletic trainer (AT) services at the US secondary school level vital to ensuring prompt and appropriate medical care. 2 Researchers [3][4][5][6][7] have indicated that access to ATs at the secondary school level results in a variety of positive health outcomes, including reduced injury rates and improved recognition and management of various sport-related injuries, such as acute musculoskeletal injuries, recurrent injuries, and concussions. In addition to positive health outcomes, secondary schools with ATs are more likely to have emergency action plans, heat-illness policies, and automated external defibrillators, all of which greatly reduce the risk of catastrophic injury and death among student-athletes.…”

Incidence, Awareness, and Reporting of Sport-Related Concussions in Manitoba High Schools

“…Meehan 13 suggests that trained observer data are significantly higher than self-reported data. McGuine 17 determined that the reporting of concussions increases from schools with low-to medium-to high-level access of on-site athletic trainers. Only 50% of those athletes with low access to an athletic trainer followed a return to play protocol.…”

“…Sport-related concussions (SRCs) have been at the forefront of sport medical concerns at all levels of sport. Concerns are especially focused on children aged [10][11][12][13][14][15][16][17][18][19] given their high prevalence of concussions 1 and considering the importance of this time period with respect to brain development. 2 The increasing awareness of chronic traumatic encephalopathy (CTE) has added to the concern about the long-term implications on quality of life in later years.…”

“…Of those, males 15-19 years incurred the most concussions reportedly in rugby (22.7%), ice hockey (20.2%), football (17.4%), and basketball (10.4%). Conversely, concussions in female athletes [15][16][17][18][19] years in this same time period represented 18% of all injuries including ringette (44.37%), ice hockey (36.6%), rugby (27.7%), and basketball (17.7%). 6 Harris et al 2 reported on SR-based head injuries (HI) from five hospitals in the Edmonton region from 1995 to 2007.…”