Williams RM, Welch CE, Weber ML, Parsons JT, Valovich McLeod TC. Athletic trainers' management practices and referral patterns for adolescent athletes after sport-related concussion.
Sports Health 2014;
6:434-9. [PMID:
25177421 PMCID:
PMC4137683 DOI:
10.1177/1941738114545612]
[Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
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.
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