Clinical Practices in Collegiate Concussion Management

Abstract

Background In recent years, sports leagues and sports medicine experts have developed guidelines for concussion management. The extent to which current clinical practice is consistent with guideline recommendations is unclear. At the collegiate level, there have been few examinations of concussion management practices and the extent to which meaningful differences across divisions of competition exist. Purpose To examine current practices in concussion diagnosis and management at NCAA member colleges. To explore the extent to which current practices reflect current recommendations for concussion diagnosis and management. To determine whether there are differences in management patterns across divisions of competition. Design Cross-sectional survey. Methods We sent an electronic questionnaire to sports medicine clinicians at all NCAA member colleges during September and October 2013. We asked clinicians about baseline assessments, diagnosis and management practices, return-to-play protocols, the perceived prevalence of under-diagnosis, and basic demographic information. Results Approximately 30% (n=866) of contacted clinicians, representing nearly 50% (n=527) of NCAA member colleges, responded to the questionnaire. Pre-participation baseline examinations were administered at the majority of schools (95%), but most (87.5%) administered baseline assessments only to selected, high-risk athletes. Computerized neurocognitive testing and balance assessments were most commonly used as pre-season baseline and post-injury assessments. Multi-modal examination in line with NCAA and other guidance was only used at a minority of institutions. Athletic trainers most commonly administered and interpreted the pre-season baseline examination. Most clinicians reported that their institution’s practices were in line with NCAA guidelines during the first 24-hours of an athlete’s concussion diagnosis, with exact percentages varying across measures. Differences across divisions of competition included: shorter return-to-play time at Division I schools than Division III schools (Division I=9.13 days, Division III=10.31 days) and more frequently referring concussed athletes to a physician within 24-hours of diagnosis at Division I schools. Conclusion Concussion management at many U.S. colleges incorporates elements recommended by current guidelines; however, there is room to improve. Increasing the use of a multi-modal baseline and post-injury examination will elevate the concussion care provided to college athletes and better align with best practice guidance.

The Self-Efficacy of Certified Athletic Trainers in Assessing and Managing Sport-Related Concussions

“…17 Both the VOMS and K-D test are newer SRC instruments that may be used by clinicians. Baugh et al 25 reported that fewer than 3% of sports medicine clinicians administered the K-D test during the diagnosis and management of a concussed athlete. The K-D test requires further training, is costly as compared with the VOMS (which is readily available and inexpensive), and has a high false-positive rate.…”

Assessment and Management of Sport-Related Concussion Teaching Trends in Athletic Training Programs

“…[2][3][4][5] However, research has shown that athletic trainers are not following these recommendations and are deviating from the standard of care, beginning at the initial evaluation through return to participation protocols. [6][7][8][9] Athletic trainers should incorporate a clinical examination, symptom checklist, neurocognitive tests, and balance/postural stability measures when evaluating a concussed athlete. 2 However, research has indicated that only 47% to 76% of athletic trainers are administering at least 3 2,3 of these recommended SRC measures.…”

“…2 However, research has indicated that only 47% to 76% of athletic trainers are administering at least 3 2,3 of these recommended SRC measures. 6,7,9,10 Even fewer athletic trainers are using 3 or more of these tools to make returnto-play decisions (34%-64%). [7][8][9] These findings indicate that athletic trainers are not following the National Athletic Trainers' Association (NATA) position statement 2 on SRC.…”

“…22,23 However, Baugh et al 6 reported that fewer than 3% of sports medicine clinicians administer the K-D test during diagnosis and management of a concussed athlete. 6 The VOMS is a newer tool that was designed to assess vestibular and ocular-motor impairment postconcussion in the absence of baseline data. 18,24 Published studies have demonstrated that the VOMS is highly sensitive in identifying an athlete with a concussion, 18 and it also yields a low falsepositive rate of 11%.…”

The auditory comprehension changes over time after sport‐related concussion can indicate multisensory processing dysfunctions

“…Sports-related mTBI usually results in symptoms and cognitive deficits that typically resolve within a few days, 5-10 days (Baugh et al, 2016;Giza et al, 2013) or 7-14 days (Eisenberg, Meehan, & Mannix, 2014;Lau, Lovell, Collins, & Pardini, 2009). However, in a subset of athletes, several symptoms and deficits become chronic and can persist even when individuals report they are asymptomatic.…”