Concussion Knowledge and Clinical Experience Among Athletic Trainers: Implications for Concussion Health Care Practices
Lempke LB, Schmidt JD, Lynall RC. Journal of Athletic Training. 2020. https://doi.org/10.4085/1062-6050-340-19
Athletic trainers with more experience were less likely to use 1) standardized concussion sideline tools during a concussion assessment and 2) standardized concussion sideline tools and concussion symptom checklists during a return-to-play evaluation.
An athletic trainer is often the first health care provider to perform a concussion assessment and plays a crucial role in return-to-play decisions. Hence, an athletic trainer needs to keep up to date with the latest concussion knowledge, including evidence-based assessment and management techniques. Unfortunately, it is unclear if years of clinical experience or concussion knowledge relate to an athletic trainer’s clinical approaches. Therefore, the authors performed a survey to examine 1) concussion knowledge among athletic trainers and 2) how concussion knowledge and years of clinical experience related to concussion assessment and management among athletic trainers. The authors created a 15-minute online survey that asked about demographics, concussion assessment and management tools used, and concussion knowledge. They then invited 8777 members of the National Athletic Trainers’ Association to complete the survey.
Overall, 773 (9%) athletic trainers completed the survey, and the average signs/symptoms recognition score was 78%. While the athletic trainers typically identified actual signs/symptoms, many (~50%) incorrectly attributed an abnormal sense of taste/smell to a concussion. Nearly all (95%) athletic trainers knew of the 2014 NATA position statement on concussion. However, less than 60% knew about the NCAA best practice document or the 2016 Berlin consensus statement. Greater years of clinical experience related to being less likely to use 1) standardized sideline tools to assess a concussion and 2) standardized tools and symptom checklists to inform return-to-play decisions. Clinical experience did not relate to the use of clinical examinations, computerized neurocognitive testing, or balance testing. On the other hand, concussion knowledge had no relationship to concussion assessment or return-to-play evaluation.
The authors found that athletic trainers had adequate concussion knowledge and familiarity with concussion position statements, especially NATA’s 2014 statement. However, athletic trainers with more years of clinical experience were less likely to use standardized sideline tools and symptom checklists. Athletic trainers may become more comfortable with concussion diagnosis as they develop during their career, which could give them a belief that standardized tools or symptom checklists are unnecessary to identify a concussion. Despite this belief, updated standardized tools and checklists may still be the best way to implement evidence-based practice and guarantee proper concussion evaluation, management, and documentation. Further research into the barriers for appropriate concussion assessment and management will help further understand these results and improve adherence to concussion best practices. Until then, athletic trainers should review their practices and consider adding standardized sideline tools and symptom checklists to best care for athletes.
Questions for Discussion
How can we promote the use of standardized sideline tools and symptom checklists by experienced athletic trainers? What other continued education should be required for athletic trainers?
Written by: Ryan Paul
Reviewed by: Jeffrey Driban