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Clinical Practices in Collegiate Concussion Management.

Abstract

BACKGROUND

In recent years, sports leagues and sports medicine experts have developed guidelines for concussion management. The extent to which current clinical practice is consistent with guideline recommendations is unclear. At the collegiate level, there have been few examinations of concussion management practices and the extent to which meaningful differences across divisions of competition exist.

PURPOSE

The purposes of this study were to (1) examine current practices in concussion diagnosis and management at National Collegiate Athletic Association (NCAA) member colleges, (2) explore the extent to which current practices reflect current recommendations for concussion diagnosis and management, and (3) determine whether there are differences in management patterns across divisions of competition.

DESIGN

Descriptive epidemiology study.

METHODS

An electronic questionnaire was sent to sports medicine clinicians at all NCAA member colleges during September and October 2013. Clinicians were asked about baseline assessments, diagnosis and management practices, return-to-play protocols, the perceived prevalence of underdiagnosis, and basic demographic information.

RESULTS

Approximately 30% (n = 866) of contacted clinicians, representing nearly 50% (n = 527) of NCAA member colleges, responded to the questionnaire. Preparticipation baseline examinations were administered at the majority of schools (95%), but most (87.5%) administered baseline assessments only to selected high-risk athletes. Computerized neurocognitive testing and balance assessments were most commonly used as preseason baseline and postinjury assessments. Multimodal examination in line with NCAA and other guidance was used only at a minority of institutions. Athletic trainers most commonly administered and interpreted the preseason baseline examination. Most clinicians reported that their institutions' practices were in line with NCAA guidelines during the first 24 hours of an athlete's concussion diagnosis, with exact percentages varying across measures. Differences across divisions of competition included shorter return-to-play time at Division I schools than Division III schools (9.13 vs 10.31 days, respectively) and more frequently referring concussed athletes to a physician within 24 hours of diagnosis at Division I schools.

CONCLUSION

Concussion management at many colleges in the United States incorporates elements recommended by current guidelines; however, there is room to improve. Increasing the use of a multimodal baseline and postinjury examination will elevate the concussion care provided to college athletes and better align with best practice guidance.

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  • Authors+Show Affiliations

    ,

    Interfaculty Initiative in Health Policy, Harvard University, Cambridge, Massachusetts, USA Micheli Center for Sport Injury Prevention, Division of Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA cbaugh@g.harvard.edu.

    ,

    Department of Pediatrics, University of Washington, Seattle, Washington, USA Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA Harborview Injury Prevention and Research Center, Seattle, Washington, USA.

    ,

    Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA.

    ,

    Chronic Traumatic Encephalopathy Center, Boston University School of Medicine, Boston, Massachusetts, USA.

    ,

    Micheli Center for Sport Injury Prevention, Division of Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.

    Micheli Center for Sport Injury Prevention, Division of Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.

    Source

    MeSH

    Adolescent
    Athletic Injuries
    Brain Concussion
    Guidelines as Topic
    Humans
    Male
    Socioeconomic Factors
    Sports
    Sports Medicine
    Surveys and Questionnaires
    Universities
    Young Adult

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    27037282

    Citation

    TY - JOUR T1 - Clinical Practices in Collegiate Concussion Management. AU - Baugh,Christine M, AU - Kroshus,Emily, AU - Stamm,Julie M, AU - Daneshvar,Daniel H, AU - Pepin,Michael J, AU - Meehan,William P,3rd Y1 - 2016/04/01/ PY - 2016/4/3/entrez PY - 2016/4/3/pubmed PY - 2017/8/23/medline KW - best practices KW - clinical practice KW - college KW - concussion KW - health policy SP - 1391 EP - 9 JF - The American journal of sports medicine JO - Am J Sports Med VL - 44 IS - 6 N2 - BACKGROUND: In recent years, sports leagues and sports medicine experts have developed guidelines for concussion management. The extent to which current clinical practice is consistent with guideline recommendations is unclear. At the collegiate level, there have been few examinations of concussion management practices and the extent to which meaningful differences across divisions of competition exist. PURPOSE: The purposes of this study were to (1) examine current practices in concussion diagnosis and management at National Collegiate Athletic Association (NCAA) member colleges, (2) explore the extent to which current practices reflect current recommendations for concussion diagnosis and management, and (3) determine whether there are differences in management patterns across divisions of competition. DESIGN: Descriptive epidemiology study. METHODS: An electronic questionnaire was sent to sports medicine clinicians at all NCAA member colleges during September and October 2013. Clinicians were asked about baseline assessments, diagnosis and management practices, return-to-play protocols, the perceived prevalence of underdiagnosis, and basic demographic information. RESULTS: Approximately 30% (n = 866) of contacted clinicians, representing nearly 50% (n = 527) of NCAA member colleges, responded to the questionnaire. Preparticipation baseline examinations were administered at the majority of schools (95%), but most (87.5%) administered baseline assessments only to selected high-risk athletes. Computerized neurocognitive testing and balance assessments were most commonly used as preseason baseline and postinjury assessments. Multimodal examination in line with NCAA and other guidance was used only at a minority of institutions. Athletic trainers most commonly administered and interpreted the preseason baseline examination. Most clinicians reported that their institutions' practices were in line with NCAA guidelines during the first 24 hours of an athlete's concussion diagnosis, with exact percentages varying across measures. Differences across divisions of competition included shorter return-to-play time at Division I schools than Division III schools (9.13 vs 10.31 days, respectively) and more frequently referring concussed athletes to a physician within 24 hours of diagnosis at Division I schools. CONCLUSION: Concussion management at many colleges in the United States incorporates elements recommended by current guidelines; however, there is room to improve. Increasing the use of a multimodal baseline and postinjury examination will elevate the concussion care provided to college athletes and better align with best practice guidance. SN - 1552-3365 UR - https://www.unboundmedicine.com/medline/citation/27037282/Clinical_Practices_in_Collegiate_Concussion_Management_ L2 - http://journals.sagepub.com/doi/abs/10.1177/0363546516635639?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed ER -