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Sports medicine personnel are more likely to identify a concussion if clinicians use a multifaceted assessment approach that incorporates the evaluation of signs and symptoms, cognition (memory, processing, decision-making), coordination, balance, and vestibular ocular function. This is because ‘concussions are like faces, they’re all different’ (Joseph Torg, MD). The standardized concussion evaluation form 2 (SCAT2) provides most of these evaluations in a convenient package and its use for sideline evaluation is recommended. Furthermore, the continued use of these assessments as well as neurocognitive testing (NCT; e.g., ImPACT) during managed return to play protocol is also recommended. The authors in the present study examined the awareness of these concussion evaluation methods among athletic trainers and football coaches in urban and rural Washington state high schools. In June 2010 participants completed a 12 question online survey that asked about demographics, SCAT2 and NCT use, and Zachery Lystedt Law knowledge and influence, and concussion education training. A total of 59 surveys (36 athletic trainers, 21 coaches, 2 duel role) were collected for a survey response of 30% (which is good). Athletic trainers and urban district participants (coaches and athletic trainers) were more likely to report using SCAT2 and NCT versus coaches and rural participants. All knew of the Lystedt Law and athletic trainers seemed to have much more concussion education training versus coaches. Most coaches received training from the school district while most athletic trainers had training at local or national conferences. Within the athletic trainers’ data 30 of 36 used the SCAT2 or other sideline assessment (e.g., SAC), while 6 provided no answer. Age may have played a role in these results but it is difficult to determine because age data were not broken out by position (athletic trainers vs. coach). The study highlights that athletic trainers (particularly in rural areas) need to remain vigilant in using the ‘state of the art’ in concussion injury management. It is likely that the percentages of individuals using appropriate tools would be higher today. Although these data are only from 2010, concussion awareness seems to have increased dramatically since that time.
A cursory read of this article could result in many individuals believing that coaches and athletic trainers have equal roles in player concussion management. Particularly in the abstract and results sections the authors refer to coaches ‘management practices’ and their ‘use of…’ concussion assessment or management tools. The authors noted in the introduction and methods that they were not equating coaches and athletic trainers in their concussion management roles, only that coaches may know which assessments are being used to manage their players, and in some circumstances, may themselves use a tool if an athletic trainer is not present. It is important to realize that all situations are different and one athletic trainer could be responsible for multiple players, teams, or schools. Therefore coaches, as well as officials, parents, school nurses and administrators, etc., are part of the team and can play an important role in injury identification and management. Whenever possible an athletic trainer, however, has the primary role for the injury identification and management and should therefore be knowledgeable and at least collaborate with personnel who utilize recommended concussion management tools. What are some barriers that prevent athletic trainers from using (or teaming up with personnel that use) the most up-to-date management tools?
Written by: Ryan Tierney
Reviewed by: Jeffrey Driban