Original Article
Knowledge and Management of Sports Concussions among Coaches and Certified Athletic Trainers in Alabama
Abstract
Objectives: To identify modifiable barriers in resources, knowledge, and management that may improve the care of young athletes with concussions in the state of Alabama.Methods: An electronic survey was distributed to 2668 middle and high school coaches of contact sports in Alabama, and a paper survey was completed by 79 certified athletic trainers (ATCs) in 2010. Questions focused on their resource availability, knowledge of concussions based on the 2008 Consensus Statement on Concussion in Sport: the 3rd International Conference on Concussion in Sport (commonly known as the Zurich consensus statement), and management of concussions.
Results: A total of 402 (16% response rate) coaches and 55 ATCs (70% response rate) responded to the survey. This study highlights that ATC coverage often is limited to the high school level, football, and competitions. Both coaches and ATCs primarily use physicians to make return-to-play decisions, although coaches (43.7%) usually refer to primary care physicians, whereas ATCs (43.6%) refer to orthopedic or sports medicine physicians. The study also revealed that coaches and ATCs desire education and could expand concussion awareness by providing education to parents and athletes. No overall difference was seen in the knowledge and management of concussions between coaches and ATCs; however, ATCs were more likely to identify symptoms that are positive for concussions ( P = 0.04). Both groups had difficulty recognizing subtle symptoms such as trouble sleeping, personality changes, and dizziness; they also were unaware that strenuous mental activities could delay concussion recovery , although ATCs scored significantly better than coaches ( P < 0.001). Neither coaches nor ATCs consistently use standardized measures such as the Sports Concussion Assessment Tool 2 (7.5% vs 56.4%) or neuropsychological testing (5.3% vs 14.5%).
Conclusions: This study describes coaches’ and ATCs’ varying knowledge and management techniques and highlights areas in which targeted interventions and outreach could be useful. These areas include increased ATC availability, coach/ATC concussion education, improved parent/athlete education, increased “return to think” awareness, and more consistent use of Sports Concussion Assessment Tool 2.
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References
1. Eckner JT, Kutcher JS. Concussion symptom scales and sideline assessment tools: a critical literature update.Curr Sports Med Rep 2010;9:8-15.
2. Sportsconcussions. SportsConcussions.org. 2011; http://www.sportsconcussions.org/laws.html. Accessed May 3, 2011.
3. Aubry M, Cantu R, Dvorak J, et al. Summary and agreement statement of the 1st International Symposium on Concussion in Sport, Vienna 2001. Clin J Sport Med 2002;12:6-11.
4. McCrory P, Johnston K, Meeuwisse W, et al. Summary and agreement statement of the 2nd International Conference on Concussion in Sport, Prague 2004. Clin J Sport Med 2005;15:48-55.
5. McCrory P, Meeuwisse W, Johnston K, et al. Consensus statement on concussion in sport: the 3rd International Conference on Concussion in Sport held in Zurich, November 2008. J Athl Train 2009;44:434-448.
6. Sarmiento K, Mitchko J, Klein C, et al. Evalution of the Centers for Disease Control and Prevention’s concussion initiative for high school coaches: ‘‘Heads Up: Concussion in High School Sports.’’ J Sch Health 2010;80:112-118.
7. Sawyer RJ, Hamdallah M, White D, et al. High school coaches’ assessments, intentions to use, and use of a concussion prevention toolkit: Centers for Disease Control and Prevention’s heads up: concussion in high school sports. Health Promot Pract 2010;11:34-43.
8. Likert R. A Technique for the Measurement of Attitudes. New York: Science Press; 1932.
9. Meehan WP 3rd, d’Hemecourt P, Collins CL, et al. Assessment and management of sport-related concussions in United States high schools. Am J Sports Med 2011;39:2304-2310.
10. Kutcher JS, Eckner JT. At-risk populations in sports-related concussion. Curr Sports Med Rep 2010;9:16-20.
11. Nesmith JD. Sports concussion in the child and adolescent athlete. J Ark Med Soc 2010;107:111-114.
12. Lincoln AE, Caswell SV, Almquist JL, et al. Trends in concussion incidence in high school sports: a prospective 11-year study. Am J Sports Med 2011;39:958-963.
13. Daneshvar DH, Nowinski CJ, McKee AC, et al. The epidemiology of sport-related concussion.Clin Sports Med 2011;30:1-17.
14. Gessel LM, Fields SK, Collins CL, et al. Concussions among United States high school and collegiate athletes. J Athl Train 2007;42:495-503.
15. Meehan WP 3rd, Bachur RG. Sport-related concussion. Pediatrics 2009;123:114-123.
16. Patel DR, Shivdasani V, Baker RJ. Management of sport-related concussion in young athletes. Sports Med 2005;35:671-684.
17. Rechel JA, Yard EE, Comstock RD. An epidemiologic comparison of high school sports injuries sustained in practice and competition. J Athl Train 2008;43:197-204.
18. Schulz MR, Marshall SW, Mueller FO, et al. Incidence and risk factors for concussion in high school athletes, North Carolina, 1996Y1999. Am J Epidemiol 2004;160:937-944.
19. Williams N, Sas A, Madey J, et al. High school coaches perceptions of physicians’ role in the assessment and management of sports-related concussive injury. Front Neurol 2012;3:130.
20. McCrea M, Hammeke T, Olsen G, et al. Unreported concussion in high school football players: implications for prevention. Clin J Sport Med 2004;14:13-17.
21. Stevens PK, Penprase B, Keprose JP, et al. Parental recognition of postconcussive symptoms in children. J Trauma Nurs 2010;17:178-182.
22. Bay E. Mild traumatic brain injury: a midwest survey about the assessment and documentation practices of emergency department nurses. Adv Emerg Nurs J 2011;33:71-83.
23. McCrea M. Standardized mental status testing on the sideline after sport-related concussion. J Athl Train 2001;36:274-279.
24. Cohen JS, Gioia G, Atabaki S, et al. Sports-related concussions in pediatrics. Curr Opin Pediatr 2009;22:288-293.
