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Clinical Practices in Collegiate Concussion Management
#MMPMID27037282
Baugh CM
; Kroshus E
; Stamm JM
; Daneshvar DH
; Pepin MJ
; Meehan WP 3rd
Am J Sports Med
2016[Jun]; 44
(6
): 1391-9
PMID27037282
show 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: The purposes of this study were to (1) examine
current practices in concussion diagnosis and management at National Collegiate
Athletic Association (NCAA) member colleges, (2) explore the extent to which
current practices reflect current recommendations for concussion diagnosis and
management, and (3) determine whether there are differences in management
patterns across divisions of competition. DESIGN: Descriptive epidemiology study.
METHODS: An electronic questionnaire was sent to sports medicine clinicians at
all NCAA member colleges during September and October 2013. Clinicians were asked
about baseline assessments, diagnosis and management practices, return-to-play
protocols, the perceived prevalence of underdiagnosis, 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. Preparticipation 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 preseason baseline and postinjury
assessments. Multimodal examination in line with NCAA and other guidance was used
only at a minority of institutions. Athletic trainers most commonly administered
and interpreted the preseason baseline examination. Most clinicians reported that
their institutions' 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 (9.13 vs
10.31 days, respectively) and more frequently referring concussed athletes to a
physician within 24 hours of diagnosis at Division I schools. CONCLUSION:
Concussion management at many colleges in the United States incorporates elements
recommended by current guidelines; however, there is room to improve. Increasing
the use of a multimodal baseline and postinjury examination will elevate the
concussion care provided to college athletes and better align with best practice
guidance.
|Adolescent
[MESH]
|Athletic Injuries/*diagnosis/*therapy
[MESH]
|Brain Concussion/*diagnosis/*therapy
[MESH]
|Guidelines as Topic
[MESH]
|Humans
[MESH]
|Male
[MESH]
|Socioeconomic Factors
[MESH]
|Sports Medicine/statistics & numerical data
[MESH]
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