Sports Medicine Research: In the Lab & In the Field: NCAA Schools Are Not 100% Compliant with Concussion-Related Protocols (Sports Med Res)


Tuesday, December 22, 2015

NCAA Schools Are Not 100% Compliant with Concussion-Related Protocols

Concussion-related protocols and preparticipation assessments used for incoming student-athletes in National Collegiate Athletic Association member institutions

Kerr ZY., Snook EM., Lynall RC., Dompier TP., Sales L., Parsons JT., Hainline B. Journal of Athletic Training. 2015;50(11):1174-1181.

Take Home Message: 43% of NCAA institutions fully complied with concussion legislation for preparticipation assessments and roughly 1 in 3 institutions lacked a return-to-learn policy. Many schools need to implement a balance assessment into the preparticipation exam as well as a return-to-learn policy during concussion management.

National Collegiate Athletic Association (NCAA) requires member institutions to have policies regarding concussion diagnosis, management, and education; however, the legislation is broad, and there is flexibility on how these policies are carried out. The research concerning conformity with recommendations is minimal. It is imperative that the use of concussion-related protocols and preparticipation assessment be explored within the NCAA to identify areas of needed improvement. Therefore, the authors examined the characteristics and prevalence of concussion-related protocols at member intuitions of the NCAA as of the 2013-2014 academic year. The authors contacted head athletic trainers from 1113 institutions and received completed surveys from 327 head athletic trainers (29% response rate). The athletic trainers answered questions about university information, concussion-related protocols, and preparticipation assessments. Most universities had protocols for concussion management and return to play (97%). Return-to-learn policies were less prevalent (63%), and only 3% reported that they involve academic support in the management of concussed athletes. Many of the universities also provided concussion education to student athletes (95%) and coaches (90%). Common preparticipation assessments were the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT; 77%) and Balance Error Scoring System (BESS; 47%). Many universities also incorporated concussion history (99.7%), neurocognitive exam (83%), and symptom checklist (92%) into their preparticipation exam.  In total, 44% of the universities complied with the recommendations for preparticipation assessments that included concussion history, balance testing, neurocognitive testing, and symptom checklist. Many of the universities that were not in full compliance did not have a balance assessment (57%). Division I institutions (55%) complied with baseline assessment recommendation more often than Divisions II or III (38% and 36% respectively).

Overall, the authors found that the many of the institutions implemented some form of concussion preparticipation assessment. However, there was not 100% compliance. One of the more distressing findings was that there was not 100% compliance regarding concussion education. If the athletic trainer is not there to witness the concussive event, than it is up to the players and coaches to recognize a potential concussion. Concussion education is vital to distribute during the preparticipation exam prior to athletic participation. Additionally, the authors found that almost 1 in 3 institutions lack a return-to-learn policy and only 3% involve academic support in the management of these athletes. Return to learn should be part of the management protocol. Concussion recovery involves both physical and cognitive rest; therefore, it is essential for a return-to-learn policy be implemented. With the aid and involvement of academic advisors this could be carried out efficiently. The results also indicate that Divisions II and III may need more resources to carry out the more time consuming concussion-related policies such as the concussion history and balance testing. Athletic trainers should be aware of the concussion legislation and should continue to improve upon the concussion-related policies and preparticipation exam to advance patient care and improve long-term patient outcomes.

Questions for Discussion: What is your institution’s policy on preparticipation concussion evaluation? Do you use a balance assessment during baseline testing? How can we best implement return to learn?

Written by: Jane McDevitt, PhD
Reviewed by: Jeff Driban

Related Posts:

Kerr ZY, Snook EM, Lynall RC, Dompier TP, Sales L, Parsons JT, & Hainline B (2015). Concussion-Related Protocols and Preparticipation Assessments Used for Incoming Student-Athletes in National Collegiate Athletic Association Member Institutions. Journal of Athletic Training, 50 (11), 1174-81 PMID: 26540099


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