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Are sports-related concussions mismanaged? Research by Timothy A. McGuine, PhD featured by UW Health and Local News Outlets

Madison, Wisconsin
by Gian Galassi

Student athletes attending high schools with limited access to athletic trainers (ATs) are far less likely to have a sport-related concussion (SRC) identified, assessed and managed properly, compared to schools with ATs available consistently during both practice and competition. That’s according to a study published recently in the Journal of Athletic Training and led by researchers at the University of Wisconsin School of Medicine and Public Health (UW SMPH).

Researchers worked with 31 high schools across Wisconsin to gather injury data on approximately 2,400 student athletes ages 14-18. The schools were divided into three categories: nine schools with high AT availability (35-45 hours per week throughout the year, including all home varsity and sub-varsity competitions); eight with mid AT availability (20-40 hours per week, including school sessions and some home varsity events. n=8); and 14 with low AT availability (one hour a week during the school day with availability during home varsity football games).

The primary goal of the study was to determine whether the availability of athletic trainers at Wisconsin high schools affected both the reporting and management of SRCs. The study’s most important findings include the following:

  • On average, athletes at low AT availability schools waited 24 hours between the onset of an SRC and their first meeting with an AT, while athletes at both mid- and high AT availability schools were evaluated within an hour of the injury.
  • Only 53 percent of athletes who sustained an SRC at a low AT availability school underwent a “return to sport” protocol, compared to 94 percent at mid AT availability schools and 100 percent at high AT availability schools.
  • Athletes with an SRC were kept out of their sport for 2.5 days longer at high- and mid AT availability schools than at low AT availability schools.
  • Athletes at Wisconsin high schools with high AT availability were more likely to be diagnosed with an SRC than athletes at schools with low AT availability.

“Our findings clearly show that limited access to athletic trainers in high schools is resulting in unreported and mismanaged sport-related concussions in our student athletes,” said Tim McGuine, the study’s principal investigator and sports medicine researcher at UW SMPH. “There is no question that misdiagnosing or delaying appropriate medical intervention for these types of injuries could have short- or long-term consequences. It is crucial that we find responsible solutions so that all schools can provide the highest standard of safety for these kids.”

Of the estimated 7.1 to 7.5 million athletes participating in high school sports nationwide, approximately 340,000 SRCs are reported each year. It has long been suspected, however, that a substantial number of SRCs in the United States are still going unreported, resulting in an untold number of athletes returning to competition prematurely and increasing their risk for additional concussions and other injuries.

The American Medical Association (AMA) and the National Athletic Trainer Association (NATA) have both recognized the value of having athletic trainers on staff, but the extent to which ATs are available to high school athletes is inconsistent at best. Only one third of the 400 high schools in Wisconsin that sponsor interscholastic teams have an athletic trainer available daily during sport practice and competition hours; another third of these schools only have an AT available to them 10-15 hours per week with limited coverage for events; and the remaining third have extremely limited AT coverage (only 1 to 1.5 hours per week) or no coverage at all during the school year. There are also additional implications, McGuine says, for high school athletes who compete on club teams, because those teams rarely, if ever, have an athletic trainer present during practices or games. And unlike at high schools in Wisconsin, there does not seem to be an effort to encourage clubs to hire ATs to work with their players.

McGuine also cautions that schools with low availability of athletic trainers should not be unduly criticized because funding is typically the main reason schools can’t provide more consistent AT coverage. Currently, each school in Wisconsin has the costs of their AT services subsidized to some degree (50 to 100 percent) by local medical providers such as UW Health, Aurora, Bellin, Marshfield, and others. All of the schools in the low AT and mid AT groups were publicly funded, while the high AT group had the most schools with private funding (78 percent).

The study was funded by a grant from the National Athletic Trainers Association Research and Education Foundation. Other researchers involved in the study include Adam Pfaller and Dr. Alison Brooks, both from UW Department of Orthopedics and Rehabilitation; Eric Post, School of Exercise and Nutritional Sciences at San Diego State University; Scott Hetzel, Department of Biostatistics and Medical Informatics at UW-Madison; and Steven Broglio, Neuro Trauma Research Laboratory at the University of Michigan, Ann Arbor.

Related Study: School and Community Socioeconomic Status and Access to Athletic Trainer Services in Wisconsin Secondary Schools

Dr. McGuine’s work was also featured by WISC-TV: