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School Athletic Trainers Screening Mild Traumatic Brain Injury: Is There Consistency?

Monday, October 22, 2012
Versailles Ballroom (Hilton Riverside)
Jessica K. Mann, AT1, Michael A. Gittelman, MD2, Wendy J. Pomerantz, MD, MS2 and Richard A. Falcone Jr., MD, MPH3, (1)Comprehensive Children's Injury Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, (2)Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, (3)Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Purpose: Mild traumatic brain injuries (mTBIs) in sports require appropriate treatment to prevent problems later in life.  This study was performed to determine who is responsible for the evaluation of high school athletes that have sustained head injuries and what return to play guidelines are followed.

Methods: A 31 question survey was created and emailed to 78 athletic trainers (AT) representing public and private Ohio high schools within 25 miles of a level 1 trauma pediatric hospital.  Follow up emails were sent to those ATs who did not complete the survey 1, 2, and 5 weeks after the initial email.  All results were kept by Survey Monkey.  Participants were excluded if they did not respond to emails or didn’t complete more than 2/3 of the survey.

Results: 48 (61.5%) ATs responded. Mean age was 33 years (range=23-51 years).  Average number of years in the current position was 7 (range=0-29 years).  ATs reported the top sports offered at their schools are football (91.7%), wrestling (91.7%), hockey (20.8%), basketball (93.8%), soccer (89.6 %), baseball (93.8%), softball (91.7%), and volleyball (93.8%).   ATs reported caring for 86.6% all head injuries.   85% of ATs reported feeling comfortable managing head injuries at an 8-10/10 level.  An average of 3.24 head injuries per 100 athletes were reported (range= 0-10.7 head injuries per 100 athletes).  ATs reported the highest number of head injuries occurred in football, soccer, and basketball for boys’ sports, and soccer, basketball, and softball for girls’ sports.  Seven different screening tools were used to assess athletes’ head injuries including Standard Concussion Assessment Tool (SCAT) (10.9%), Standard Concussion Assessment Tool 2 (SCAT2) (58.7%), Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) (71.7%), Post-Concussion Score (PCS) (15.2%), Concussion Grading Scale (CGS) (15.2%), Standard Assessment of Concussion (SAC) (19.6%), and Balance Error Scoring System (BESS) (2.2%).  32/46 ATs (69.6%) used multiple tools. Requiring a physician’s clearance (30.4%), the athlete to be asymptomatic (52.2%), normal ImPACT scores (23.9%), and following a step progression for return to play (52.2%) were some of the guidelines reported being used to determine when an athlete could return to play.  There were inconsistencies of how long an athlete had to be symptom free and how long the step progression took.

Conclusions:  In our community, athletic trainers care for the majority of high school athletes that sustain head injuries.  They report feeling comfortable with the management of these patients.  However, there is no consistent tool used to screen injured athletes and determine when to return them to play.  A standardized screening tool and return to play guidelines should be developed to ensure consistent care for these athletes.