Going Beyond the State Law: Investigating High School Sport-Related Concussion Protocols

Abstract

Context: State laws provide general guidelines for sport-related concussion (SRC) management, but do not comprehensively address the multiple layers of management for this complex injury. While high schools are encouraged to develop a SRC protocol that includes both state law tenets and additional management practices, the execution of this warrants examination. Objective: To investigate state law compliance and practice components included in high school SRC protocols, and determine whether the degree of sports medicine coverage influenced protocol quality. Design: Qualitative document analysis. Setting: High school athletics. Participants: In total, 184 Pennsylvania high schools [24.3% of schools statewide; full-time athletic trainer=149, part-time athletic trainer=13, missing=21] voluntarily provided copies of their protocol from the 2018–2019 academic year. Main Outcome Measures: Four athletic trainers conducted document analyses using a 67-item component analysis guide. Frequencies were computed for included protocol components related to the state law, preparticipation and prevention, recognition and assessment, and management. The difference in the total number of included components (max 60) by sports medicine coverage was assessed using a Mann-Whitney U test. Results: There was heterogeneity in components included in the submitted protocols. Only 23.4% included all mandatory state law tenets. Immediate removal from play was noted in 67.4% of protocols, while only 1.6% contained prevention strategies. Return-to-play was addressed more frequently than return-to-learn (74.5% versus 32.6%). The sample had a mean of 15.5±9.7 total components per protocol. Schools with full-time sports medicine coverage had significantly more protocol components than those with part-time athletic trainers (15 [8.5–22.5] versus 6 [3–10.5] median components; U = 377.5, p < .001) Conclusions: School-level written SRC protocols were often missing components of the state law and additional best practice recommendations. Full-time sports medicine coverage in high schools is recommended to increase SRC protocol and healthcare quality.

Acute Sport-Related Concussion Management and Return to Sport Time in High School Athletes

“…This is supported by a study of concussion management protocols across Pennsylvania, reporting that schools with full-time AT coverage had significantly more SRC protocol components than those with part-time ATs. 3 Contextually, disparities in protocol development, implementation, and review may extend beyond AT access. For example, 72% of ATs reported that they had a team physician assigned to their school, however, only 51% had a policy and procedures manual that was developed and reviewed by their team physician, which varied by residential area (urban, suburban, rural) and school distinction (public, private).…”

Heading Towards Accountability: An Analysis of the Efficacy of Concussion Protocol

“…However, researchers noted that even in the most thorough protocols, there was no follow up for long term symptoms that would be indicative of post-concussion syndrome. This would include documentation of headaches, vestibular dysfunction, sensory sensitivity, and cognitive impairments following a concussion (Beidler et al, 2022). As anticipated, it was concluded that high school concussion protocols are inadequate.…”

“…Through the study, they discovered that the most effective high school guidelines addressed Pennsylvania state law, included advice for injury prevention and post injury procedure, and included penalties for coaches who did not follow procedure. It also uncovered that schools with access to at least one Volume 12 Issue 2 (2023) ISSN: 2167ISSN: -1907 www.JSR.org athletic trainer were more likely to identify concussions early on, as well as follow procedure (Beidler et al, 2022). This led to better and more timely treatment, and thus a quicker recovery.…”

“…Simply put, teachers must know about any symptoms a student experiences and accommodate a gradual return based on physician recommendation. It is crucial that these symptoms are addressed as rushing recovery worsens physical symptoms, which damages a patient's psyche (Beidler et al, 2022).…”

Neuroethics across the Disorders of Consciousness Care Continuum

“…At local, national, and international levels, policies and laws to promote brain injury prevention should be strengthened; such steps might include harmonized road safety regulations, 46 modifications to rules of contact sports and education around risks of brain injury, 47 48 49 50 51 52 53 54 increased research and monitoring of brain-injury risk factors and incidence, and multilevel educational programs to raise awareness of causes, consequences, and optimal responses to brain injury. 55 56 57 58 59 Integrated case management and preventative strategies for individuals at risk of being undomiciled or socially excluded are also needed, as these populations might be at higher risk of brain injury when housing remains unstable.…”