Concussion-Management Practice Patterns of National Collegiate Athletic Association Division II and III Athletic Trainers: How the Other Half Lives

Abstract

Context: The National Collegiate Athletic Association (NCAA) has published concussion-management practice guidelines consistent with recent position and consensus statements. Whereas NCAA Division I athletic trainers appear highly compliant, little is known about the concussion-management practice patterns of athletic trainers at smaller institutions where staffing and resources may be limited.

Objective: To descriptively define the concussion-management practice patterns of NCAA Division II and III athletic trainers.

Design: Cross-sectional study.

Setting: Web-based questionnaire.

Patients or other participants: A total of 755 respondents (response rate = 40.2%) from NCAA Division II and Division III institutions.

Main outcome measure(s): The primary outcome measures were the rate of multifaceted concussion-assessment techniques, defined as 3 or more assessments; the specific practice patterns of each assessment battery; and tests used during a clinical examination.

Results: Most respondents indicated using a multifaceted assessment during acute assessment (Division II = 76.9%, n = 473; Division III = 76.0%, n = 467) and determination of recovery (Division II = 65.0%, n = 194; Division III = 63.1%, n = 288) but not at baseline (Division II = 43.1%, n = 122; Division III = 41.0%, n = 176). Typically, when a postconcussion assessment was initiated, testing occurred daily until baseline values were achieved, and most respondents (80.6% [244/278]) reported using a graded exercise protocol before return to participation.

Conclusions: We found limited use of the multifaceted assessment battery at baseline but higher rates at both acute assessment and return-to-participation time points. A primary reason cited for not using test-battery components was a lack of staffing or funding for the assessments. We observed limited use of neuropsychologists to interpret neuropsychological testing. Otherwise, most respondents reported concussion-management protocols consistent with recommendations, including a high level of use of objective measures and incorporation of a progressive return-to-participation protocol.

Keywords: baseline testing; mild traumatic brain injury; return to play.

Figure 1.

Multifaceted concussion-assessment protocols performed by athletic trainers in National Collegiate Athletic Association Divisions II and III combined. Three or more objective assessment tools were used by 41.9% (298/712) of respondents at baseline, 76.4% (550/720) during the acute concussion assessment, and 63.9% (419/656) for the return-to-participation evaluation.

Figure 2.

Respondents' use of each component of the multifaceted concussion protocol at baseline, at acute assessment, and during return-to-participation decisions.

Figure 3.

Components of the clinical concussion assessment that exceeded 50% of respondents' endorsement.