Concussion-assessment and -management techniques used by athletic trainers

Lynall LM, Stanek R, Kevin G, Jason P, Justin M. Journal of Athletic Training. 2013:131021123020006.

Take-Home Message: Athletic trainers in different settings may adopt different strategies to assess and
manage concussions. Athletic trainers must continue to increase their use of both objective concussion assessment tools and the standard clinical examination to ensure the proper diagnosis and management of concussion.

It is no surprise that athletic trainers have changed how they assess and manage concussions over the years. With the introduction of numerous concussion assessment tools, it is unknown how athletic trainers manage concussions and learn about new concussion research.  It is important to learn this because it may help us develop strategies to improve quality of care. The purpose of this study was to assess current clinical concussion diagnostic and return-to-participation practices among athletic trainers. A web-based survey was completed by 1053 certified athletic trainers (average years of experience = ~ 11 years) working in a variety of settings. The survey consisted of four different categories of questions. First, the authors inquired about demographic information and number of concussions observed per year. Second, the authors asked about tools or methods to diagnose, manage, and safely return athletes to participation. Third, athletic trainers answered questions regarding various widely used concussion-assessment tools and the value of these tools. Finally, the last set of questions asked about the athletic
trainer’s understanding of current concussion literature and the effect of the new information on their clinical practices. The data revealed that athletic trainers saw an average of 10.7 concussions per year. Athletic trainers most commonly reported using clinical evaluations to diagnose concussions. However, it appears that most athletic trainers use a combination of various tools, such as clinical evaluation, objective tools, and symptoms check-list. The authors noticed several interesting trends between work settings when comparing survey results. Collegiate athletic trainers used balance assessments and computerized
neurological testing more than athletic trainers in the high school settings. Furthermore, athletic trainers in the clinical or high school setting relied on physician return-to-play protocols and decisions, while athletic trainers in the collegiate setting made these decisions themselves based on their assessments. The majority of respondents was familiar with concussion publications and directives and used these documents to make adjustments to their concussion management.

The results of this survey suggest that athletic trainers are continuing to make progress when assessing concussions and formulating safe return-to-participation decisions.  However, this study shows that there is still a large discrepancy in the methods clinicians use to evaluate and manage concussions between settings. These differences could be caused by the amount of funding or resources available to athletic trainers in various settings. However, money should not dictate whether or not clinicians have all the necessary concussion assessment and management tools. Safety is a top priority of all athletic trainers and the most effective tools should be provided in each setting to ensure the safety of every athlete.  Clinicians should know that the most effective concussion diagnostic and management tools are still unknown and that the use of multiple tools may be the best current practice, including objective measures and standard clinical examination. Finally, researchers should continue to focus on concussion assessment tools and methods that allow the clinician to make the best decision regarding the safety of the athlete. We can assure proper and safe concussion assessment and management by staying updated on the most recent literature and by conveying this evidence based medicine in the educational setting.

Questions for Discussion: As a clinician, what concussion assessment and management tools do you use and why? What tools do you feel are the most effective in diagnosing and return to play decisions?

Written by: Sara Dorsten
Reviewed by: Lisa Chinn and Jeffrey Driban

Lynall R, Laudner KG, Mihalik JP, & Stanek JM (2013). Concussion-Assessment and -Management Techniques Used by Athletic Trainers. Journal of athletic training PMID: 24143906