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Clinical practices in collegiate concussion management #MMPMID27037282
Am J Sports Med 2016[Jun]; 44 (6): 1391-9 PMID27037282show ga
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.
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Am+J+Sports+Med 2016 ; 44 (6): 1391-9
