National Collegiate Athletic Association Division I athletic trainers' concussion-management practice patterns

Abstract

Context: A cornerstone of the recent consensus statements on concussion is a multifaceted concussion-assessment program at baseline and postinjury and when tracking recovery. Earlier studies of athletic trainers' (ATs') practice patterns found limited use of multifaceted protocols; however, these authors typically grouped diverse athletic training settings together.

Objective: To (1) describe the concussion-management practice patterns of National Collegiate Athletic Association (NCAA) Division I ATs, (2) compare these practice patterns to earlier studies, and (3) objectively characterize the clinical examination.

Design: Cross-sectional study.

Setting: Online survey.

Patients or other participants: A total of 610 ATs from NCAA Division I institutions, for a response rate of 34.4%.

Main outcome measure(s): The survey had 3 subsections: demographic questions related to the participant's experiences, concussion-assessment practice patterns, and concussion-recovery and return-to-participation practice patterns. Specific practice-pattern questions addressed balance, cognitive and mental status, neuropsychological testing, and self-reported symptoms. Finally, specific components of the clinical examination were examined.

Results: We identified high rates of multifaceted assessments (i.e., assessments using at least 3 techniques) during testing at baseline (71.2%), acute concussion assessment (79.2%), and return to participation (66.9%). The specific techniques used are provided along with their adherence with evidence-based practice findings. Respondents endorsed a diverse array of clinical examination techniques that often overlapped objective concussion-assessment protocols or were likely used to rule out associated potential conditions. Respondents were cognizant of the Third International Consensus Statement, the National Athletic Trainers' Association position statement, and the revised NCAA Sports Medicine Handbook recommendations.

Conclusions: Athletic trainers in NCAA Division I demonstrated widespread use of multifaceted concussion-assessment techniques and appeared compliant with recent consensus statements and the NCAA Sports Medicine Handbook.

Keywords: baseline testing; head injuries; return to participation.

Figure 1.

Multifaceted concussion-assessment protocols. Three or more objective assessment tools were used by 71.2% of respondents at baseline, by 79.2% during the acute concussion assessment, and by 66.9% for the return-to-participation evaluation.

Figure 2.

Respondents' use of each component of the multifaceted concussion-assessment protocol at baseline, after injury, and in making return-to-participation decisions.

Figure 3.

Components of the clinical examination that exceeded 50% of respondents' endorsement. Abbreviation: PEARL, pupils equal and reactive to light.

Figure 4.

Historical trends of concussion-assessment techniques. Citations: Ferrara et al, 2001; Notebaert and Guskiewicz, 2005; Covassin et al, 2009a; Covassin et al, 2009b.