Concussion evaluation methods among Washington State high school football coaches and athletic trainers

Abstract

Objective: To evaluate awareness of concussion assessment methods and to determine whether there are differences among Washington State high school football coaches and athletic trainers in urban versus rural school districts.

Design: A Catalyst WebQ survey link was randomly sent by e-mail to varsity head football coaches, athletic trainers, and athletic directors in Washington State school districts.

Participants: Survey participants were high school varsity head football coaches and athletic trainers from a total of 106 Washington State high schools.

Methods: A 12-item questionnaire on Catalyst WebQ was distributed via e-mail. The survey inquired about use of the methods of concussion assessment, both on the field and for follow-up; participants' concussion education training; and familiarity with Washington State's Zackery Lystedt Law.

Main outcome measurements: The survey examined differences in concussion management practices between rural and urban school districts and also between coaches and athletic trainers in Washington State, specifically regarding the use of the Standardized Concussion Assessment Tool 2 (SCAT2) and neurocognitive testing (NCT).

Results: Twenty-seven of 48 respondents (56%) used the SCAT2 for on-the-field assessment; urban respondents were significantly more likely to use SCAT2 (P < .05). The difference between coaches and athletic trainers with respect to SCAT2 use was not significant (P = .08). NCT was used by 18 of 58 respondents (31%). This was more commonly used by those in urban districts (P < .01) and by athletic trainers (P < .01). Eleven of these 18 individuals (61%) reported that a neuropsychologist interpreted the results; the rest used other providers not specifically trained in neuropsychology. There was no statistically significant correlation between years of experience and use of the SCAT2, but those with more than 10 years of experience were less likely to use NCT (P < .01). All respondents reported being familiar with Washington State's Zackery Lystedt Law, but only 44.1% reported that the law changed their concussion management.

Conclusions: There were statistically significant differences between SCAT2 and NCT use for respondents from urban and rural districts, and also between coaches and athletic trainers, as well as NCT use among respondents with varying years of experience. Further understanding and identification of barriers that limit identification and management of concussions in high school athletes are crucial to prevent serious permanent injury. Additional education is necessary to ensure that athletic trainers and coaches are aware of current recommendations within the medical literature for the evaluation and management of concussions.