Many PA high schools’ sports concussion protocols fail to meet state mandates or include current best practices, full-time trainers may help
By Conor Gormally. This article was initially published in our Concussion Update newsletter; please consider subscribing.
A study by Erica Beidler et al. evaluated sport-related concussion (SRC) protocols at 184 high schools in the Pennsylvania Interscholastic Athletic Association (PIAA) during the 2018-19 school year to determine their adherence with state law and current best practices recommendations. They reached out to all 757 schools in the PIAA and heard back from 404 schools but only received SRC protocols from 184. They found significant gaps in a high proportion of schools with regard to both state mandates and current best practices, though protocols were much higher quality in schools with a full-time athletic trainer (AT).
The authors created a 67-factor component analysis guide to assess schools’ protocols. The first 7 factors evaluated compliance with the Pennsylvania Safety in Youth Sports act. The other 60 addressed “education, preparticipation assessment, prevention and reducing exposure to head trauma, on-field recognition, off-field assessment, general follow-up care, RTL [return to learn], and RTP [return to play].”
Only 23.4% of the 184 SRC protocols were fully-compliant with state law. On average, school protocols only included 50% of mandatory state law items and 26% of the other best-practice components from the analysis guide. Further, only 13% of protocols included documentation of concussion history, ~40% included annual education on concussions, 1.6% included prevention education on SRC consequences, less than 50% suggested a multimodal assessment in line with current best practices, <10% mentioned oculomotor or vestibular assessments for general follow-up care, and only 33% noted that students may require academic accommodations.
The authors point to the importance of ATs in high schools, as the “development, implementation, and compliance with SRC protocols may ultimately fall to a single athletic trainer (AT).” Concussion Alliance’s Care Disparities page mentions that lower-funding schools are less likely to have ATs; this research mentions the presence of ATs has been associated with an increase in concussion reporting and diagnoses. Beidler et al. found that schools with full-time ATs had a higher median number of state law-required items than schools with part-time ATs, as well as more concussion-related preparticipation and prevention items, recognition and assessment, and follow-up management.
Overall, schools with full-time ATs had more than two times the number of total components on average. The authors also found that 50% of the schools that responded to the initial call and reported no SRC protocol had no AT or only a part-time AT. This study adds evidence that “having access to a full-time high school AT may be essential to elevating care standards through the development of high-quality SRC protocols.”
However, all high schools did emphasize the importance of immediate removal from play and medical clearance before return to play, and over 75% included graduated return to play protocols. For educators and educational administrators looking to improve concussion protocols, there are return-to-learn protocols available for free for educators in 10 states and protocols being trialed at schools in Washington state.