Assessment and Management of Sport-Related Concussions in United States High Schools

Meehan WP, d’Hemecourt P, Collins CL, Comstock RD. Am J Sports Med. 2011 Oct; ahead of print

There are several different concussion assessment tools (e.g., SCAT2, BESS, Headminder) to evaluate an athlete, however, little research is done on what medical professionals use to assess concussions. The purpose of this study was to describe the medical providers and medical studies used when assessing sport-related concussions, as well as, to determine the effects of medical provider type on timing of return to play, frequency of imaging, and frequency of neuropsychological testing. This study followed 192 U.S. high schools with at least one full time athletic trainer during the 2009 to 2010 academic year. The results showed that nearly 15% (1,056) of the athletic injuries were concussions. Boys’ contact sports had the highest number of concussions per 100,000 athletic exposures (i.e., football, ice hockey, and lacrosse). Most of the concussion (53%) took place during a varsity contest, and grade level was about the same (freshman 25.8%, sophomore 25.1%, juniors 22.7%, seniors 23%). The most commonly reported sign and symptoms were headache (94%), dizziness (76%), difficulty concentrating (54%), and confusion (44%). Most athletes had resolution of symptoms within 7 days (78%), but 2.8% had symptoms lasting within a month. Nearly, 93% of the time there was a medical professional on the scene at the time of the concussion, where athletic trainers were there 70% of the time. However, there was no significant difference found between having a medical professional at the scene of the injury and duration of symptoms or return to play time. Out of all the recorded concussions an athletic trainer assessed 94%, 59% were evaluated by a physician, and 5% were evaluated by an orthopedic physician. Most were assessed by more than one medical professional (87% assessed by athletic trainer and physician). Computed tomography (CT) was used in 21% of the concussed athletes, where only 3% received magnetic resonance imaging (MRI). Return to play decisions were commonly made by an athletic trainer (46%) or a physician (50%), but there was still almost 3% getting cleared by nonmedical professionals like coaches. Athletes whose symptoms took longer to resolve (over 7 days) were seen more often by a physician.

It is imperative the medical professionals know how to handle and manage sports-related concussions. Though, few studies have been done to evaluate who and what tests are evaluating concussive injuries. This epidemiologic report did find that most of the concussions were first evaluated by an athletic trainer; however, this study only included schools that had at least one full time athletic trainer on staff. Many schools in the U.S. still do not have a full time athletic trainer, and it would be advantageous to investigate these schools. Also, 60% of the athletes were evaluated by a physician that does not specialize in treating athletic injuries. Although, return to play time was not significantly different between athletic trainers or physicians, this suggests that both use similar evaluation tools. However, the actual tools that the medical professionals used were not reported. Finally, this study revealed that 1 and 5 concussed athletes receive a CT as part of the evaluation process, but these concussions do not usually involve structural damage that can be seen in a CT. MRIs are radiation free and are more sensitive in detecting concussions. This study demonstrates the need for general physicians to continue their education in concussion injuries due to the common occurrence of these injuries. Also, future research should consider specifying what type of concussion tests are being used for diagnosis and treatment. Specifically, what tests are being used at the site of the injury; what tests are being used in the athletic trainer room, and what tests are general physicians using? Current concussion literature states that a battery of tests [i.e., concussion sign and symptom survey, SCAT2, BESS, and a computerized exam (e.g., ImPACT, Headminer)] are sensitive enough to evaluate a concussion, however there have been no studies done on what is actually being practiced especially within a general physician’s office.

Written by: Jane McDevitt MS, ATC, CSCS
Reviewed by: Stephen Thomas

Meehan Iii WP, d’Hemecourt P, Collins CL, & Comstock RD (2011). Assessment and Management of Sport-Related Concussions in United States High Schools. The American Journal of Sports Medicine PMID: 21969181