Current trends in athletic training practice for concussion assessment and management

Context: Athletic trainers surveyed in 1999 demonstrated little consensus on the use of concussion grading scales and return-to-play criteria. Most relied on clinical examination or symptom checklists to evaluate athletes with concussion. Objective: To investigate the current trends of certified athletic trainers in concussion assessment and management. Design: Subjects were invited to participate in a 32-question Internet survey. Setting: An Internet link to the survey was e-mailed to the subjects. Patients or Other Participants: A total of 2750 certified athletic trainers and members of the National Athletic Trainers' Association were randomly e-mailed and invited to participate. Main Outcome Measure(s): Survey questions addressed topics including years of certification, number of concussions evaluated each year, methods of assessing concussion, and guidelines used for return to play. Compliance with the recent position statement of the National Athletic Trainers' Association on sport-related concussion was also evaluated. Results: Certified athletic trainers averaged 9.9 +/- 7.3 years of certification and evaluated an average of 8.2 +/- 6.5 concussions per year. To assess concussion, 95% reported using the clinical examination, 85% used symptom checklists, 48% used the Standardized Assessment of Concussion, 18% used neuropsychological testing, and 16% used the Balance Error Scoring System. The most frequently used concussion grading scale and return-to-play guideline belonged to the American Academy of Neurology (30%). When deciding whether to return an athlete to play, certified athletic trainers most often used the clinical examination (95%), return-to-play guidelines (88%), symptom checklists (80%), and player self-report (62%). The most important tools for making a return-to-play decision were the clinical examination (59%), symptom checklists (13%), and return-to-play guidelines (12%). Only 3% of certified athletic trainers surveyed complied with the recent position statement, which advocated using symptom checklists, neuropsychological testing, and balance testing for managing sport-related concussion. Conclusions: Our findings suggest that only a small percentage of certified athletic trainers currently follow the guidelines proposed by the National Athletic Trainers' Association. Various assessment methods and tools are currently being used, but clinicians must continue to implement a combination of methods and tools in order to comply with the position statement.