Athletic Trainers' Concussion-Assessment and Concussion-Management Practices: An Update

Abstract

Context: Athletic trainers (ATs) are often the first health care providers to conduct concussion assessments and carry out postinjury management. Best practices for concussion evaluation and management have changed rapidly in recent years, outdating previous reports of ATs' concussion practices.

Objective: To examine ATs' current concussion-assessment and -management techniques.

Design: Cross-sectional study.

Setting: Web-based survey.

Patients or other participants: A random convenience sample of 8777 ATs (response rate = 15.0% [n = 1307]; years certified = 15.0 ± 10.6) from the National Athletic Trainers' Association membership.

Main outcome measure(s): Survey Web links were e-mailed to prospective participants, with 2 follow-up e-mails sent by the National Athletic Trainers' Association. The survey collected demographic information, the number of concussions assessed, the concussion-recovery patterns, and the assessment and return-to-participation (RTP) decision-making methods used.

Results: The ATs reported assessing a median of 12.0 (range = 0-218) concussions per year. A total of 95.3% (953/1000) ATs cited clinical examination as the most frequently used concussion-assessment tool, followed by symptom assessment (86.7%; 867/1000). A total of 52.7% (527/1000) ATs described a 3-domain minimum multidimensional concussion-assessment battery. Published RTP guidelines were the most common RTP decision-making tool (91.0%; 864/949), followed by clinical examination (88.2%; 837/949). The ATs with master's degrees were 1.36 times (95% confidence interval [CI] = 1.02, 1.81) more likely to use a 3-domain concussion-assessment battery than ATs with only bachelor's degrees (χ² = 4.44, P = .05). Collegiate ATs were 2.12 (95% CI = 1.59, 2.84) and 1.63 (95% CI = 1.03, 2.59) times more likely to use a 3-domain concussion-assessment battery than high school and clinic-based ATs, respectively (χ² = 26.29, P < .001).

Conclusions: Athletic trainers were using the clinical examination, standardized assessment tools, and a 3-domain concussion-assessment-battery approach more frequently in clinical practice than previously reported. However, despite practice improvements, nearly half of ATs were not using a 3-domain minimum concussion-assessment battery. Clinicians should strive to implement multidimensional concussion assessments in their practices to ensure optimal diagnosis and management.

Keywords: diagnosis; evaluation; mild traumatic brain injury; sports medicine.

Figure 1

Frequency of assessment methods used for concussion diagnosis (n = 1000). Participants selected all methods they used (“Select all that apply”) for concussion assessments, resulting in cumulative percentages that were >100%.

Figure 2

Frequency of concussion-assessment tools used by type. A, Symptom-assessment tool. ^a Symptom checklist in the Standardized Concussion Assessment Tool. ^b Sway Medical, Aledo, TX. ^c Cleveland, OH. ^d Symptom inventory in the computerized neurocognitive test. B, Balance assessment. ^a Sway Medical, Aledo, TX. ^b Cleveland, OH. Continued on next page.

Figure 2

Continued from previous page. C, Standardized assessment scale. ^a King-Devick Technologies, Inc, Oakbrook Terrace, IL. D, Computerized neurocognitive test. ^a Vista LifeSciences, Parker, CO. ^b Cleveland, OH. ^c CogState, New Haven, CT. ^d Headminder, Inc, New York, NY. ^e CNS Vital Signs, LLC, Morrisville, NC. ^f ImPACT Applications, Inc, Pittsburgh, PA. ^g National Harbor, MD.

Figure 3

Assessment methods used by athletic trainers to determine return to participation. Participants selected all methods they used (“Select all that apply”) to determine when a patient was ready to return to participation, resulting in cumulative percentages that were >100%. ^a Paper and pencil.

Figure 4

Athletic trainers' use of, A, concussion-assessment and, B, return-to-participation tools in our study and previous studies.,