Sports Medicine Research: In the Lab & In the Field: Concussion Evaluation Methods among High School Football Coaches and Athletic Trainers (Sports Med Res)
Monday, July 30, 2012

Concussion Evaluation Methods among High School Football Coaches and Athletic Trainers

Concussion evaluation methods among Washington state high school football coaches and athletic trainers

Murphy A, Kaufman MS, Molton I, Coppel DB, Benson J, & Herring SA. (2012). PM&R, 4:419-426.

Sports medicine personnel are more likely to identify a concussion if clinicians use a multifaceted assessment approach that incorporates the evaluation of signs and symptoms, cognition (memory, processing, decision-making), coordination, balance, and vestibular ocular function. This is because ‘concussions are like faces, they’re all different’ (Joseph Torg, MD). The standardized concussion evaluation form 2 (SCAT2) provides most of these evaluations in a convenient package and its use for sideline evaluation is recommended. Furthermore, the continued use of these assessments as well as neurocognitive testing (NCT; e.g., ImPACT) during managed return to play protocol is also recommended. The authors in the present study examined the awareness of these concussion evaluation methods among athletic trainers and football coaches in urban and rural Washington state high schools. In June 2010 participants completed a 12 question online survey that asked about demographics, SCAT2 and NCT use, and Zachery Lystedt Law knowledge and influence, and concussion education training. A total of 59 surveys (36 athletic trainers, 21 coaches, 2 duel role) were collected for a survey response of 30% (which is good). Athletic trainers and urban district participants (coaches and athletic trainers) were more likely to report using SCAT2 and NCT versus coaches and rural participants. All knew of the Lystedt Law and athletic trainers seemed to have much more concussion education training versus coaches.  Most coaches received training from the school district while most athletic trainers had training at local or national conferences. Within the athletic trainers’ data 30 of 36 used the SCAT2 or other sideline assessment (e.g., SAC), while 6 provided no answer.  Age may have played a role in these results but it is difficult to determine because age data were not broken out by position (athletic trainers vs. coach).  The study highlights that athletic trainers (particularly in rural areas) need to remain vigilant in using the ‘state of the art’ in concussion injury management.  It is likely that the percentages of individuals using appropriate tools would be higher today.  Although these data are only from 2010, concussion awareness seems to have increased dramatically since that time. 

A cursory read of this article could result in many individuals believing that coaches and athletic trainers have equal roles in player concussion management.  Particularly in the abstract and results sections the authors refer to coaches ‘management practices’ and their ‘use of…’ concussion assessment or management tools. The authors noted in the introduction and methods that they were not equating coaches and athletic trainers in their concussion management roles, only that coaches may know which assessments are being used to manage their players, and in some circumstances, may themselves use a tool if an athletic trainer is not present.  It is important to realize that all situations are different and one athletic trainer could be responsible for multiple players, teams, or schools.  Therefore coaches, as well as officials, parents, school nurses and administrators, etc., are part of the team and can play an important role in injury identification and management.  Whenever possible an athletic trainer, however, has the primary role for the injury identification and management and should therefore be knowledgeable and at least collaborate with personnel who utilize recommended concussion management tools. What are some barriers that prevent athletic trainers from using (or teaming up with personnel that use) the most up-to-date management tools?

Written by: Ryan Tierney
Reviewed by: Jeffrey Driban

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Related Posts:

Murphy A, Kaufman MS, Molton I, Coppel DB, Benson J, & Herring SA (2012). Concussion evaluation methods among washington state high school football coaches and athletic trainers. PM & R, 4 (6), 419-26 PMID: 22732154

4 comments:

Jake Marshall ATC CES said...

The one issue I had when I was working part time game and event coverage was not having a baseline to compare to or frequent personal contact with the athletes to help base changes in cognitive status. The computer based systems are generally to expensive and time consuming for high school use, and they require too much training for results analysis. I find them to be rather impractical. As a health care team we need to come up with a better way of doing baseline testing. My thought is including the SCAT 2 or what ever tool is used at each particular school into the pre participation exam.

Ryan Tierney said...

Thanks Jake, part time or event coverage where you have no history of the athletes can be challenging for concussion evaluation. Baselining for many youth sports teams, for example, is rare. Therefore I recommend utilizing coaches and parents to aid in determining some idea of 'normal' for the athlete. Also, as far as sideline assessments, utilizing a SCAT2 is good. I also recommend a vestibular-ocular test battery. Following a 'head acceleration event' my goal is to ID a possible concussion accurately and stress the athlete to elicit signs or symptoms. Without a baseline or knowledge of the athlete it becomes more of an art rather than a quantitative science. If the athlete denies symptoms but is 'struggling' with memory or concentration or balance (e.g., any error on BESS double leg stance) or looks squeamish after a vestibular-ocular assessment, then they are out and being referred for further evaluation. There I would recommend them being referred to a physician trained in concussion management who has access computer based assessments. Hope this helps.

Laura M. McDonald, MS, ATC said...

I echo Jake's comment but I am seeing that more kids are baseline tested because schools are making it a mandatory part of their pre-season routine. We have a physician in the area who is very proactive about getting through to school administrators about the importance. And Ryan, I agree -- use coaches/parents/teammates to get a read on the "normal" behavior for the unfamiliar athlete. I am much more cautious with athletes I don't know about holding them out.

samwalton said...

I have certainly seen some of the constraints on access to reliable resources such as concussion-trained physicians in rural areas. At the youth and high-school levels especially, there seems to be emergent evidence that concussions may cause more detriment compared to these athletes' older counterparts. It is SO important that not only athletic trainers make sure that they are up to date, but that they at least have a point of contact for further evaluation.
I've heard of young athletes being told that they are cleared to participate in physical activity by a pediatrician who is ignorant in care of concussion. Some of these young people are being needlessly exposed to contact before they may be ready.
Perhaps there may be a way to reach some of these rural and or under-resourced areas until a knowledgeable doctor is presented. Maybe web sites and/or video-conferences can be implemented between local providers and physicians who are in the know about concussion management?

I like what some states have done, including the Commonwealth of Virginia, who have made a law essentially stating, "When in doubt, sit them out." This should always be the case, knowing what we know about the potential for more severe latent symptoms and for the risks associated with second impact syndrome. Especially if you don't know the kid, there's no excuse to take unnecessary risks with cognitive functioning and development.

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