Pressure on sports medicine clinicians to prematurely return collegiate athletes to play after concussion
Kroshus E, Baugh CM, Daneshvar DH, Stamm JM, Laursen RM, Austin SB. J Athl Train 2015; 50(6) ahead of print.
Take Home Message: More than half of the sports medicine staff experience pressure from coaches and athletes to release athletes prematurely to play following a concussion.
Concussions are sometimes referred to as the “invisible injury” for many reasons (there is no structural damage on imaging reports and small deficits are not always easily detected with the current assessment tools). This creates an environment, where the athlete or coach may believe that the concussed athlete is ready to return to play and may pressure the medical professional to return the athlete to play prematurely. Therefore, the authors utilized a web-based survey for clinicians who provide care to US collegiate sports teams to quantify the extent they experienced pressure to prematurely clear athletes for participation after a concussion. Seven hundred and eighty-nine athletic trainers and 111 team physicians (from 530 institutions) completed the survey. The survey was composed of 2 main types of questions. First, participants answered demographic type questions (their sex, position in the sports medicine team, number of years working on a sports medicine team, NCAA division, and sex/sport of the team or teams for which they provide care, and whether the heads of their department reported to the athletic department, medical institution, or another entity). The authors also assessed the extent to which a clinician agreed with statements about having experienced pressure from clinicians, coaches, or the athletes themselves to prematurely release an athlete following a concussion. Across all respondents 64% agreed that they experienced pressure from athletes to clear them following a concussion. Fifty-four percent of respondents agreed that they had pressure from coaches and 6.6% agreed they had pressure from other clinicians. Athletic trainers (55%) were more likely than physicians (41%) to experience pressure from coaches. Respondents reported greater pressure from coaches when their departments were under the athletic department’s supervision (54%) rather than a medical institution (40%). Athletic trainers reported less pressure from athletes and coaches in Division III compared with Division I. Female athletic trainers (61%) reported greater pressure from coaches than males (49%), and Female physicians reported greater pressure from other physicians than males.
The authors exemplified that there is pressure on medical professionals to return an athlete to play prematurely. Over half of the clinicians reported experiencing this pressure. Though, the frequency of the pressure and the number of times an athlete was released prematurely is unknown, this is still an alarming response. Another resonating finding was that medical professionals that report to athletic departments experience greater pressure from coaches than those who work under a medical institution, which suggest that a sports medicine team functioning under a medical institution seems to be in the better interest of the patient. Furthermore, it was distressing to see that out of the 530 institutions only 63 institutions were reported to be functioning under the medical supervisory structure. Another school characteristic such as division of school seemed to be strongly predictive, where respondents at a Division I reported the most pressure. This may be due to higher level of competition, stronger athletic identity, and desire to be part of a team. Additionally, female athletic trainers reported greater pressure from coaches compared with males, which suggests coaches feel females are less qualified or more easily intimidated compared to males. This study illustrates the importance for identifying factors associated with variability of pressure on sports medicine professionals to release concussed patients prematurely, and accentuates the need for open communication, and more concussion education among supervisors, coaches, and athletes. Furthermore, in a setting where coaches and athletes are often focused on today it is vital for sports medicine clinicians to be thinking about our patient’s long-term health and safety.
Questions for Discussion: Do you work under a medical supervisory system? Do you feel pressure from other sources not investigated by the authors? How do you handle pressure to return an athlete to play early?
Written by: Jane McDevitt, PhD
Reviewed by: Jeff Driban