The influence of athletic trainers on the incidence and management of concussion in high school athletes.

McGuine TA, Pfaller AY, Post EG, Hetzel SJ, Brooks A, and Broglio SP. J Athl Training. 2018. 52 (11): 1017-1024.

Take Home Message: High school athletes with a sports-related concussion are more likely to report and receive post-concussion care in schools with higher availability of an athletic trainer.

Proper reporting and care of sports-related concussion are critical for athletes returning to activity safely. However, these critical steps in concussion management often rely on having access to healthcare professionals. The availability of athletic trainers varies among high schools in the United States and it remains unknown how athletic trainer availability relates to sports-related concussion reporting and management. McGuine and colleagues completed a prospective cohort study to better understand the relationship between the availability of an athletic trainer and the reporting and treatment of sports-related concussion in secondary schools. The authors enrolled 31 high schools in Wisconsin. All high schools received athletic training services from a local or regional medical center. The authors categorized the availability of an athletic trainer based on the number of athletes an athletic trainer expected to serve per hour. Lower numbers typically meant an athletic trainer spent more hours at the school or had fewer student-athletes: high availability (<20.0 athletes/AT hour), medium availability (20.0-40.0 athletes/AT hour), and low availability (>40.0 athletes/AT hour). Researchers recruited all potential participants and collected demographic data, baseline symptoms. Athletic trainers then recorded the numbers of athlete exposures (practices, competitions, or conditioning session), any suspected sports-related concussion, sport, injury mechanism, position, duration of symptoms, loss of consciousness, immediate actions taken, and post-concussion management activities. Overall, high schools in the low availability category were primarily publicly funded and located in more rural settings. A total of 225 (9.2%) participant reported a sports-related concussion. Compared with student-athletes in high-availability schools, student-athletes in the low-availability schools were…

  • less likely to report a sports-related concussion (2.4% vs 7.0%)
  • taking longer to see an athletic trainer (24 vs 0.2 hrs)
  • likely to have fewer post-concussion evaluations (2 vs 4)
  • less likely to take part in a supervised return-to-play protocol (50% vs 100%)
Overall, the data from this study suggest that the availability of an athletic trainer may impact the reporting and treatment of sports-related concussion. This data, while not surprising, is further evidence that the availability of athletic trainers is an important factor in providing an appropriate level of care for injuries such as sports-related concussion. It should be noted though that while not the purpose of this study, the data may suggest that funding and geography are potential barriers for appropriate access to athletic trainers and management of sports-related concussions. This is a much larger question that future research should seek to better understand. Until analyses such as this can be completed, athletic trainers and parents should continue to advocate for athletic trainers to be as available as much as possible. Furthermore, advocates need to be more proactive in finding strategies to fund athletic trainers in schools that may be less likely to afford these services.

Questions for Discussion: What experiences do you have in various level of athletic training availability? What barriers inhibit the expansion of athletic trainer availability?

Written by: Kyle Harris
Reviewed by: Jeffrey Driban

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