Preventing catastrophic injury and death in collegiate athletes: interassociation recommendations endorsed by 13 medical and sports medicine organisations.

The following organisations endorsed this document: American Association of Neurological Surgeons, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, American Osteopathic Academy of Sports Medicine, College Athletic Trainers' Society, Collegiate Strength and Conditioning Coaches Association, Congress of Neurological Surgeons, Korey Stringer Institute, National Athletic Trainers' Association, National Strength and Conditioning Association, National Operating Committee for Standards on Athletic Equipment, Sports Neuropsychology Society. The following organisation has affirmed the value of this document: American Academy of Neurology. The Second Safety in College Football Summit resulted in interassociation consensus recommendations for three paramount safety issues in collegiate athletics: (1) independent medical care for collegiate athletes; (2) diagnosis and management of sport-related concussion; and (3) year-round football practice contact for collegiate athletes. This document, the fourth arising from the 2016 event, addresses the prevention of catastrophic injury, including traumatic and non-traumatic death, in collegiate athletes. The final recommendations in this document are the result of presentations and discussions on key items that occurred at the summit. After those presentations and discussions, endorsing organisation representatives agreed on 18 foundational statements that became the basis for this consensus paper that has been subsequently reviewed by relevant stakeholders and endorsing organisations. This is the final endorsed document for preventing catastrophic injury and death in collegiate athletes. This document is divided into the following components. (1) Background-this section provides an overview of catastrophic injury and death in collegiate athletes. (2) Interassociation recommendations: preventing catastrophic injury and death in collegiate athletes-this section provides the final recommendations of the medical organisations for preventing catastrophic injuries in collegiate athletes. (3) Interassociation recommendations: checklist-this section provides a checklist for each member school. The checklist statements stem from foundational statements voted on by representatives of medical organisations during the summit, and they serve as the primary vehicle for each member school to implement the prevention recommendations. (4) References-this section provides the relevant references for this document. (5) Appendices-this section lists the foundational statements, agenda, summit attendees and medical organisations that endorsed this document.

Implementation of the 2017 Berlin Concussion in Sport Group Consensus Statement in contact and collision sports: a joint position statement from 11 national and international sports organisations.

The 2017 Berlin Concussion in Sport Group Consensus Statement provides a global summary of best practice in concussion prevention, diagnosis and management, underpinned by systematic reviews and expert consensus. Due to their different settings and rules, individual sports need to adapt concussion guidelines according to their specific regulatory environment. At the same time, consistent application of the Berlin Consensus Statement's themes across sporting codes is likely to facilitate superior and uniform diagnosis and management, improve concussion education and highlight collaborative research opportunities. This document summarises the approaches discussed by medical representatives from the governing bodies of 10 different contact and collision sports in Dublin, Ireland in July 2017. Those sports are: American football, Australian football, basketball, cricket, equestrian sports, football/soccer, ice hockey, rugby league, rugby union and skiing. This document had been endorsed by 11 sport governing bodies/national federations at the time of being published.

Concussion Knowledge and Communication Behaviors of Collegiate Wrestling Coaches.

Sport coaches can play an important role in shaping a team's approach to concussion safety through their communication with team members. However, across all sports, there is limited knowledge about factors that make coaches more or less likely to engage in safety-supportive communication. The objectives of this study were to assess the concussion-related knowledge and attitudes of wrestling coaches, as well as the extent to which they engage in autonomy-supportive coaching practices, and to determine how these factors are related to communication with athletes in support of concussion safety. Data were collected through an online survey of head coaches of National Collegiate Athletic Association (NCAA) wrestling teams (n = 89, 40.5% response rate). On average, coaches answered five out of a possible nine knowledge questions correctly and were significantly more likely to think it was acceptable for an athlete to continue playing after sustaining a concussion during a national qualifying competition as compared to during an early-season competition. Engaging in autonomy-supportive coaching behaviors was the coach factor explaining the largest percentage of variability in communication. Findings suggest that while knowledge deficits and attitudes about the acceptability of continued play while symptomatic during more consequential competitive matches should be addressed in educational programming for collegiate wrestling coaches, these changes alone may not be a sufficient for adequately increasing concussion safety communication. Targeting more distal factors such as autonomy-supportive approaches to coaching may hold promise for intervention design and should be explored in future prospective research.

Interassociation consensus statement on cardiovascular care of college student-athletes.

Cardiovascular evaluation and care of college student-athletes is gaining increasing attention from both the public and medical communities. Emerging strategies include screening of the general athlete population, recommendations of permissible levels of participation by athletes with identified cardiovascular conditions and preparation for responding to unanticipated cardiac events in athletic venues. The primary focus has been sudden cardiac death and the usefulness of screening with or without advanced cardiac screening. The National Collegiate Athletic Association convened a multidisciplinary task force to address cardiovascular concerns in collegiate student-athletes, and to develop consensus for an interassociation statement. This document summarises the task force deliberations and follow-up discussions, and includes available evidence on cardiovascular risk, preparticipation evaluation and the recognition of and response to cardiac arrest. Future recommendations for cardiac research initiatives, education and collaboration are also provided.

School nurses' familiarity and perceptions of academic accommodations for student-athletes following sport-related concussion.

The purpose of this study was to evaluate school nurses' familiarity and perceptions regarding academic accommodations for student-athletes following sport-related concussion. School nurses (N = 1,246) accessed the survey School Nurses' Beliefs, Attitudes and Knowledge of Pediatric Athletes with Concussions (BAKPAC-SN). The BAKPAC-SN contained several questions pertaining to concussion management and academic accommodations. There were significant differences regarding personal experience as well as familiarity of academic accommodations (p < .001) between school nurses who work at a school that employs an athletic trainer and school nurses who work at a school that does not employ an athletic trainer. There were significant weak positive relationships between years of experience and familiarity with academic accommodations (r = .210, p < .001), 504 plans (r = .243, p < .001), and individualized education plans (r = .205, p < .001). School nurses employed at a single school were significantly more familiar with academic accommodations (p = .027) and 504 plans (p = .001) than school nurses employed at multiple schools. Health care professionals should collaborate to effectively manage a concussed patient and should consider academic accommodations to ensure whole-person health care.

Randomized Evaluation of the National Collegiate Athletic Association's Concussion Education Fact Sheet for Coaches.

Background. Concussion education for coaches is being increasingly recommended by leading sports organizations, yet the effectiveness of available materials has not often been assessed. This study evaluated the impact of the National Collegiate Athletic Association's (2017) publication: "Concussion safety: What coaches need to know" (the "NCAA Fact Sheet for Coaches") on participants' concussion knowledge and safety supportive intentions. Method. NCAA head coaches (n = 779) were randomized to view the NCAA Fact Sheet for Coaches either before (intervention condition) or after (control condition) responding to questions assessing concussion knowledge and intentions to engage in three behaviors (talk to team about concussion safety; allow symptomatic athlete to continue play; encourage medical staff to return athlete as quickly as possible). Results. Knowledge scores were significantly higher among coaches in the intervention condition as compared to the control condition, largely driven by differences in knowledge about the consequences of continued play postconcussion (injury, reaction time, possible death). Fewer coaches in the intervention condition expected that they would allow an athlete with a suspected concussion continue to participate in a game or practice or that they would encourage medical staff to return athletes to play as quickly as possible. Discussion. The present study provides evidence that educational content, like that contained in the NCAA Fact Sheet for Coaches, may have a positive short-term impact on concussion knowledge and behavioral intentions of coaches. In light of these findings, sports organizations should consider providing similar educational materials to coaches, evaluating whether the information is impactful in their population.

Preventing Catastrophic Injury and Death in Collegiate Athletes: Interassociation Recommendations Endorsed by 13 Medical and Sports Medicine Organisations.

The Second Safety in College Football Summit resulted in interassociation consensus recommendations for three paramount safety issues in collegiate athletics: (1) independent medical care for collegiate athletes; (2) diagnosis and management of sport-related concussion; and (3) year-round football practice contact for collegiate athletes. This document, the fourth arising from the 2016 event, addresses the prevention of catastrophic injury, including traumatic and non-traumatic death, in collegiate athletes. The final recommendations in this document are the result of presentations and discussions on key items that occurred at the summit. After those presentations and discussions, endorsing organisation representatives agreed on 18 foundational statements that became the basis for this consensus paper that has been subsequently reviewed by relevant stakeholders and endorsing organisations. This is the final endorsed document for preventing catastrophic injury and death in collegiate athletes. This document is divided into the following components. (1) Background-this section provides an overview of catastrophic injury and death in collegiate athletes. (2) Interassociation recommendations: preventing catastrophic injury and death in collegiate athletes-this section provides the final recommendations of the medical organisations for preventing catastrophic injuries in collegiate athletes. (3) Interassociation recommendations: checklist-this section provides a checklist for each member school. The checklist statements stem from foundational statements voted on by representatives of medical organisations during the summit, and they serve as the primary vehicle for each member school to implement the prevention recommendations. (4) References-this section provides the relevant references for this document. (5) Appendices-this section lists the foundational statements, agenda, summit attendees and medical organisations that endorsed this document.

The evolving landscape of policies, rules, and law in sport-related concussion.

Beginning in 2009 with the passage of the Zackery Lystedt law in the state of Washington, all 50 states have passed concussion laws that implement a mandatory framework of care for high school and youth athletes. The structure of these laws generally shares the three primary components of the Lystedt law: (1) preseason concussion education; (2) mandatory removal from play with suspected concussion; and (3) clearance from a healthcare professional prior to return to play. These same three policy components are also found at the collegiate and professional levels of sport, either through established policy or labor contracts. This chapter explores concussion-specific legal and policy developments that currently inform concussion management practices across multiple levels of the US athletic system.

Epidemiology of National Collegiate Athletic Association Men's and Women's Cross-Country Injuries, 2009-2010 Through 2013-2014.

CONTEXT: Recent injury-surveillance data for collegiate-level cross-country athletes are limited. OBJECTIVE: To describe the epidemiology of National Collegiate Athletic Association (NCAA) men's and women's cross-country injuries during the 2009-2010 through 2013-2014 academic years. DESIGN: Descriptive epidemiology study. SETTING: Aggregate injury and exposure data collected from 25 men's and 22 women's cross-country programs, providing 47 and 43 seasons of data, respectively. PATIENTS OR OTHER PARTICIPANTS: Collegiate student-athletes participating in men's and women's cross-country during the 2009-2010 through 2013-2014 academic years. MAIN OUTCOME MEASURE(S): Injury rates; injury rate ratios (RRs); injury proportions by body site, diagnosis, and apparatus; and injury proportion ratios were reported with 95% confidence intervals (CIs). RESULTS: The Injury Surveillance Program captured 216 injuries from men's cross-country and 260 injuries from women's cross-country, leading to injury rates of 4.66/1000 athlete-exposures (AEs) for men (95% CI = 4.04, 5.28) and 5.85/1000 AEs for women (95% CI = 5.14, 6.56). The injury rate in women's cross-country was 1.25 times that of men's cross-country (95% CI = 1.05, 1.50). Most injuries affected the lower extremity (men = 90.3%, women = 81.9%). The hip/groin-injury rate in women (0.65/1000 AEs) was higher than that in men (0.15/1000 AEs; RR = 4.32; 95% CI = 1.89, 9.85). The ankle-injury rate in men (0.60/1000 AEs) was higher than that in women (0.29/1000 AEs; RR = 2.07; 95% CI = 1.07, 3.99). Common diagnoses were strains (men = 19.9%, women = 20.4%) and inflammation (men = 18.1%, women = 23.8%). The majority of injuries were classified as overuse (men = 57.6%, women = 53.3%). CONCLUSIONS: Consistent with prior research, injury distributions varied between male and female athletes, and the injury rate among females was higher. Understanding the epidemiology of these cross-country injuries may be important for developing appropriate preventive interventions.

Epidemiology of Exertional Heat Illnesses in Youth, High School, and College Football.

INTRODUCTION: Data on exertional heat illness (EHI) in youth football are limited and have not been compared across competition levels. PURPOSE: This study describes the epidemiology of EHI events in youth, high school (HS), and college football in the 2012-2014 seasons. METHODS: One hundred and eighteen youth teams (players age 5-14 yr), 96 HS programs (~14-18 yr), and 34 college programs (~18-23 yr) participated. During games and practices, athletic trainers recorded EHI events and athlete exposures (AE), defined as one athlete participating in one game/practice. We calculated the number of reported EHI by time in season, game/practice, and need for emergency transportation. EHI rates, risk, included rate ratios (IRR), and risk ratios (RR) with 95% confidence intervals (CI) were calculated in 2015. RESULTS: EHI rates for youth, HS, and college football were 1.82, 0.57, and 1.67/10,000 AE, respectively. Rates were highest during the preseason (youth: 2.76; HS: 1.47; college: 3.66/10,000 AE). Game rates were higher than practice rates in youth (4.04 vs 1.22/10,000 AE; IRR = 3.31; 95% CI, 1.75-6.26) and college (4.42 vs 1.38/10,000 AE; IRR = 3.21; 95% CI, 2.00-5.16); the practice rate was higher than the game rate in HS (0.63 vs 0.27/10,000 AE; IRR = 2.33; 95% CI, 1.01-5.38). The EHI risk was higher in college (0.9%) than in youth (0.6%; RR = 1.59; 95% CI, 1.06-2.37) and HS (0.5%; RR = 2.01; 95% CI, 1.43-2.81). Common EHI events included heat cramps (youth: 15.8%; HS: 28.6%; college: 45.6%), heat exhaustion (youth: 42.1%; HS: 32.9%; college: 20.0%), and dehydration (youth: 31.6%; HS: 28.6%; college: 28.9%). CONCLUSIONS: EHI risk was low. Higher preseason football EHI rates across levels emphasize developing and continually modifying preseason heat acclimatization policies. Lower EHI rates in HS games and youth practices may be attributable to night events, suggesting the importance of modifying/canceling events based on environmental conditions.

Interassociation Consensus Statement on Cardiovascular Care of College Student-Athletes.

Cardiovascular evaluation and care of college student-athletes is gaining increasing attention from both the public and medical communities. Emerging strategies include screening of the general athlete population, recommendations of permissible levels of participation by athletes with identified cardiovascular conditions, and preparation for responding to unanticipated cardiac events in athletic venues. The primary focus has been sudden cardiac death and the utility of screening with or without advanced cardiac screening. The National Collegiate Athletic Association convened a multidisciplinary task force to address cardiovascular concerns in collegiate student-athletes and to develop consensus for an interassociation statement. This document summarizes the task force deliberations and follow-up discussions, and includes available evidence on cardiovascular risk, pre-participation evaluation, and the recognition of and response to cardiac arrest. Future recommendations for cardiac research initiatives, education, and collaboration are also provided. (J Am Coll Cardiol 2016;doi: 10.1016/j.jacc.2016.03.527.)

Interassociation Consensus Statement on Cardiovascular Care of College Student-Athletes.

Cardiovascular evaluation and care of college student-athletes is gaining increasing attention from both the public and medical communities. Emerging strategies include screening of the general athlete population, recommendations of permissible levels of participation by athletes with identified cardiovascular conditions, and preparation for responding to unanticipated cardiac events in athletic venues. The primary focus has been sudden cardiac death and the utility of screening with or without advanced cardiac screening. The National Collegiate Athletic Association convened a multidisciplinary task force to address cardiovascular concerns in collegiate student-athletes and to develop consensus for an interassociation statement. This document summarizes the task force deliberations and follow-up discussions, and includes available evidence on cardiovascular risk, pre-participation evaluation, and the recognition of and response to cardiac arrest. Future recommendations for cardiac research initiatives, education, and collaboration are also provided.

Athletic trainers' familiarity with and perceptions of academic accommodations in secondary school athletes after sport-related concussion.

CONTEXT: Sport-related concussion can affect athletes' sport participation and academic success. With the recent emphasis on cognitive rest, student-athletes may benefit from academic accommodations (AA) in the classroom; however, athletic trainers' (ATs') perceived familiarity with, and use of, AA is unknown. OBJECTIVE: To assess secondary school ATs' perceived familiarity with, attitudes and beliefs about, and incorporation of AA for student-athletes after sport-related concussion. A secondary purpose was to determine whether employment status altered familiarity and use of AA. DESIGN: Cross-sectional study. SETTING: Online survey. PATIENTS OR OTHER PARTICIPANTS: Of 3286 possible respondents, 851 secondary school ATs accessed the survey (response rate = 25.9%; 308 men [36.2%], 376 women [44.2%], 167 respondents [19.6%] with sex information missing; age = 37.3 ± 10.1 years). MAIN OUTCOME MEASURE(S): Participants were solicited via e-mail to complete the Beliefs, Attitudes and Knowledge Following Pediatric Athlete Concussion among Athletic Trainers employed in the secondary school setting (BAKPAC-AT) survey. The BAKPAC-AT assessed ATs' perceived familiarity, perceptions, and roles regarding 504 plans, Individualized Education Programs (IEPs), and returning student-athletes to the classroom. Independent variables were employment status (full time versus part time), employment model (direct versus outreach), years certified, and years of experience in the secondary school setting. The dependent variables were participants' responses to the AA questions. Spearman rank-correlation coefficients were used to assess relationships and Mann-Whitney U and χ(2) tests (P < .05) were used to identify differences. RESULTS: Respondents reported that approximately 41% of the student-athletes whose sport-related concussions they managed received AA. Respondents employed directly by the school were more familiar with 504 plans (P < .001) and IEPs (P < .001) and had a greater belief that ATs should have a role in AA. Both the number of years certified and the years of experience at the secondary school were significantly correlated with perceived familiarity regarding 504 plans and IEPs. CONCLUSIONS: The ATs employed directly by secondary schools and those with more experience as secondary school ATs were more familiar with AA. Understanding AA is important for all ATs because cognitive rest and "return to learn" are becoming more widely recommended in concussion management.

Staffing Levels at National Collegiate Athletic Association Football Bowl Subdivision-Level Institutions.

CONTEXT: The "Appropriate Medical Coverage for Intercollegiate Athletics" (AMCIA) document was created to support assessment and calculation of athletic training personnel requirements. However, little is known regarding disparities between current and recommended staffing practices. OBJECTIVE: To identify the staffing and employment characteristics of athletic health care services at Football Bowl Subdivision-level institutions. DESIGN: Cross-sectional study. SETTING: Web-based survey. PATIENTS OR OTHER PARTICIPANTS: Head athletic trainers and athletic training staff members who were knowledgeable about budget and staff. MAIN OUTCOME MEASURE(S): The survey, Assessment of Staffing Levels at National Collegiate Athletic Association Football Bowl Subdivision-Level Institutions, was used to evaluate personal, university, and staff demographics; staffing and employment topics; and AMCIA variables and use. RESULTS: The survey was accessed and partially completed by 104 individuals (response rate = 84.6%). A total of 79 athletic trainers (response rate = 76%) completed the entire survey. One-third of the respondents (34.2%, n = 26) met the recommended number of full-time equivalents (FTEs) for football, two-thirds of the respondents (65.7%, n = 50) failed to meet the recommendation, and 26.2% (n = 27) were missing data needed for FTE calculation. Among those who did not meet the recommended FTEs (n = 50), 38.0% (n = 19) were within 1 FTE of being compliant, 26.0% (n = 13) were within 2 FTEs, and 24.0% (n = 12) were within 3 FTEs. About one-third of respondents (35.9%, n = 37) reported not using the AMCIA, citing lack of funding (29.7%, n = 11), lack of administrative support (21.6%, n = 8), and other reasons (37.8%, n = 14). CONCLUSIONS: The majority of institutions that used the AMCIA were able to provide justification for staffing. For most of the institutions that failed to meet their recommendation, adding 1-3 FTE athletic trainers for football would change their compliance status. A uniform definition of the term FTE within collegiate athletics is needed to allow for structured assessment and allocation of staffing and workloads.

Concussion-Related Protocols and Preparticipation Assessments Used for Incoming Student-Athletes in National Collegiate Athletic Association Member Institutions.

CONTEXT: National Collegiate Athletic Association (NCAA) legislation requires that member institutions have policies to guide the recognition and management of sport-related concussions. Identifying the nature of these policies and the mechanisms of their implementation can help identify areas of needed improvement. OBJECTIVE: To estimate the characteristics and prevalence of concussion-related protocols and preparticipation assessments used for incoming NCAA student-athletes. DESIGN: Cross-sectional study. SETTING: Web-based survey. PATIENTS OR OTHER PARTICIPANTS: Head athletic trainers from all 1113 NCAA member institutions were contacted; 327 (29.4%) completed the survey. INTERVENTION(S): Participants received an e-mail link to the Web-based survey. Weekly reminders were sent during the 4-week window. MAIN OUTCOME MEASURE(S): Respondents described concussion-related protocols and preparticipation assessments (eg, concussion history, neurocognitive testing, balance testing, symptom checklists). Descriptive statistics were compared by division and football program status. RESULTS: Most universities provided concussion education to student-athletes (95.4%), had return-to-play policies (96.6%), and obtained the number of previous concussions sustained by incoming student-athletes (97.9%). Fewer had return-to-learn policies (63.3%). Other concussion-history-related information (e.g., symptoms, hospitalization) was more often collected by Division I universities. Common preparticipation neurocognitive and balance tests were the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT; 77.1%) and Balance Error Scoring System (46.5%). In total, 43.7% complied with recommendations for preparticipation assessments that included concussion history, neurocognitive testing, balance testing, and symptom checklists. This was due to moderate use of balance testing (56.6%); larger proportions used concussion history (99.7%), neurocognitive testing (83.2%), and symptom checklists (91.7%). More Division I universities (55.2%) complied with baseline assessment recommendations than Division II (38.2%, χ2 = 5.49, P = .02) and Division III (36.1%, χ2 = 9.11, P = .002) universities. CONCLUSIONS: National Collegiate Athletic Association member institutions implement numerous strategies to monitor student-athletes. Division II and III universities may need additional assistance to collect in-depth concussion histories and conduct balance testing. Universities should continue developing or adapting (or both) return-to-learn policies.

Injury Rates in Age-Only Versus Age-and-Weight Playing Standard Conditions in American Youth Football.

BACKGROUND: American youth football leagues are typically structured using either age-only (AO) or age-and-weight (AW) playing standard conditions. These playing standard conditions group players by age in the former condition and by a combination of age and weight in the latter condition. However, no study has systematically compared injury risk between these 2 playing standards. PURPOSE: To compare injury rates between youth tackle football players in the AO and AW playing standard conditions. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Athletic trainers evaluated and recorded injuries at each practice and game during the 2012 and 2013 football seasons. Players (age, 5-14 years) were drawn from 13 recreational leagues across 6 states. The sample included 4092 athlete-seasons (AW, 2065; AO, 2027) from 210 teams (AW, 106; O, 104). Injury rate ratios (RRs) with 95% CIs were used to compare the playing standard conditions. Multivariate Poisson regression was used to estimate RRs adjusted for residual effects of age and clustering by team and league. There were 4 endpoints of interest: (1) any injury, (2) non-time loss (NTL) injuries only, (3) time loss (TL) injuries only, and (4) concussions only. RESULTS: Over 2 seasons, the cohort accumulated 1475 injuries and 142,536 athlete-exposures (AEs). The most common injuries were contusions (34.4%), ligament sprains (16.3%), concussions (9.6%), and muscle strains (7.8%). The overall injury rate for both playing standard conditions combined was 10.3 per 1000 AEs (95% CI, 9.8-10.9). The TL injury, NTL injury, and concussion rates in both playing standard conditions combined were 3.1, 7.2, and 1.0 per 1000 AEs, respectively. In multivariate Poisson regression models controlling for age, team, and league, no differences were found between playing standard conditions in the overall injury rate (RRoverall, 1.1; 95% CI, 0.4-2.6). Rates for the other 3 endpoints were also similar (RRNTL, 1.1 [95% CI, 0.4-3.0]; RRTL, 0.9 [95% CI, 0.4-1.9]; RRconcussion, 0.6 [95% CI, 0.3-1.4]). CONCLUSION: For the injury endpoints examined in this study, the injury rates were similar in the AO and AW playing standards. Future research should examine other policies, rules, and behavioral factors that may affect injury risk within youth football.

Benefits of and barriers to using patient-rated outcome measures in athletic training.

CONTEXT: Patient-rated outcome measures (PROMs) are important for driving treatment decisions and determining treatment effectiveness. However, athletic trainers (ATs) rarely use them; understanding why may facilitate strategies for collection of these outcomes. OBJECTIVE: To identify the benefits of and barriers to using PROMs in athletic training. DESIGN: Cross-sectional study. SETTING: Web-based survey. PATIENTS OR OTHER PARTICIPANTS: A total of 1469 randomly sampled ATs (age = 36.8 ± 9.8 years; 48% female) working in the college/university, 2-year institution, secondary school, clinic, hospital, or industrial/occupational setting. INTERVENTION(S): An e-mail was sent to ATs inviting them to complete a survey regarding the use, benefits, and barriers of PROMs. Athletic trainers who indicated they used PROMs (AT-PRs) completed 65 questions about the benefits of and barriers to their use. Athletic trainers who indicated no use of PROMs (AT-NONs) completed 21 questions about barriers of use. MAIN OUTCOME MEASURE(S): Dependent variables were the endorsements for the benefits of and barriers to the use of PROMs. RESULTS: A total of 458 ATs initiated the survey and 421 (AT-PR = 26%, AT-NON = 74%) completed it (response rate = 28.7%). The most frequently endorsed benefits by AT-PRs were enhancing communication with patients (90%) and other health care professionals (80%), directing patient care (87%), and increasing examination efficiency (80%). The most frequently endorsed barriers by AT-PRs were that PROMs are time consuming (44%), difficult (36%), and confusing (31%) for patients and time consuming for clinicians to score and interpret (29%). The most frequently endorsed problems by AT-NONs were that PROMs are time consuming for clinicians to score and interpret (31%), time consuming (46%) and irrelevant to patients (28%), and lacking a support structure for clinicians (29%). CONCLUSIONS: These results suggest that, although benefits to using PROMs exist, there are also barriers. Barriers are similar for AT-PRs and AT-NONs. Strategies to decrease barriers and facilitate the use of PROMs warrant investigation.

Athletic trainers' management practices and referral patterns for adolescent athletes after sport-related concussion.

BACKGROUND: Athletic trainers (ATs) play an important role in the evaluation, management, and referral of student-athletes after sport-related concussion. Understanding factors that influence ATs' patient care decisions is important to ensure best practices are followed. PURPOSE: To identify ATs' current concussion management practices and referral patterns for adolescent student-athletes after sport-related concussion as well as the factors associated with those practices. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 3. METHODS: A total of 851 participants from a convenience sample of 3286 ATs employed in the secondary school setting (25.9% response rate) completed the Athletic Trainers' Beliefs, Attitudes, and Knowledge of Pediatric Athletes with Concussions (BAKPAC-AT) survey. The BAKPAC-AT consists of several questions to assess ATs' concussion management, referral practices, and established relationships with other health care professionals. RESULTS: The majority of ATs had a written concussion policy (82.4%, n = 701) and standing orders approved by their directing physician (67.3%, n = 573); 75.1% (n = 639) of ATs conduct baseline testing, with the majority using computerized neurocognitive tests (71.2%, n = 606). Follow-up concussion testing was employed by 81.8% (n = 696). Years of certification (P = 0.049) and type of secondary school (P = 0.033) predicted ATs' use of baseline testing. Nearly half of the respondents (48.8%, n = 415) refer 100% of concussion cases to a physician. The most influential factors that lead to a referral were state law (40.3%, n = 343), personal preference (34.7%, n = 295), and school district policy (24.8%, n = 211). CONCLUSION: Of the ATs surveyed, most were engaged in baseline and follow-up testing, primarily with neurocognitive tests. Most ATs refer patients to physicians after concussion. While state regulation and personal preference were primary factors influencing referral decisions, it is unclear at what point of care the referral occurs.

The national sports safety in secondary schools benchmark (N4SB) study: defining athletic training practice characteristics.

CONTEXT: Increased rates of sport participation and sport-related injury have led to greater emphasis on and attention to medical care of student-athletes in the secondary school setting. Access to athletic training services is seen as a critical factor for delivering adequate injury prevention and medical care to student-athletes. However, few data are available regarding practice characteristics of athletic trainers (ATs) in this setting. OBJECTIVE: To characterize the practices of secondary school athletic trainers (ATs). DESIGN: Descriptive study. SETTING: Web-based survey. PATIENTS OR OTHER PARTICIPANTS: A total of 17 558 ATs with current National Athletic Trainers' Association membership were identified for survey distribution. Of these, 4232 ATs indicated that they practiced in the secondary school setting, and 4045 completed some part of the survey. MAIN OUTCOME MEASURE(S): A Web-based survey was used to obtain demographic information about ATs and their secondary schools and characteristics of athletic training practice. Descriptive data regarding the athletic trainer's personal characteristics, secondary school characteristics, and practice patterns are reported as percentages and frequencies. RESULTS: Most respondents were in the early stages of their careers and relatively new to the secondary school practice setting. Nearly two-thirds (62.4%; n = 2522) of respondents had 10 or fewer years of experience as secondary school ATs, 52% (n = 2132) had been certified for 10 or fewer years, and 53.4% (n = 2164) had 10 or fewer years of experience in any practice setting. The majority of respondents (85%) worked in public schools with enrollment of 1000 to 1999 (35.5%) and with football (95.5%). More than half of respondents were employed directly by their school. Most respondents (50.6%) reported an athletic training budget of less than $4000. The majority of ATs performed evaluations (87.5%) on-site all of the time, with a smaller percentage providing treatments (73.3%) or rehabilitation (47.4%) services all of the time. CONCLUSIONS: This is the first study to describe secondary school athletic training that reflects national practice trends. To improve the quality of athletic training care and to support and improve current working conditions, the profession must examine how its members practice on a day-to-day basis.