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Athletic Trainers' Knowledge and Clinical Expertise of Concussions

Traumatic brain injury (TBI) is a significant health concern among athletes who play contact sports. Even a mild TBI (more commonly called a concussion) can cause symptoms such as headache, dizziness, nausea, blurry vision for days or weeks following the injury, impairing the athlete’s ability to safely resume their typical activities. Furthermore, individuals who experience repeat concussions over time are at high risk for neurological disorders (such as dementia) and for general cognitive impairment (such as memory loss or trouble concentrating).

Despite the potentially serious implications of sustaining a concussion, many athletes do not or cannot adequately report these injuries. Most are not trained to recognize symptoms of concussion, and many are disincentivized to report a concussion for fear of removal from play during the recovery period.

As a result, certified athletic trainers are a valuable asset in concussion management because they often are closely involved in the diagnosis and return-to-play decision-making process. Athletic trainers who have extensive concussion knowledge and clinical experience are best equipped to diagnose a player’s concussion, recommend a management plan, and decide when the player is ready to resume normal athletic activities. However, few studies have investigated concussion knowledge among athletic trainers, nor have they identified knowledge gaps to address with educational initiatives.

A research team in Georgia administered an online knowledge survey to assess concussion knowledge and clinical experience among 773 athletic trainers certified by the National Athletic Trainers’ Association (NATA). The survey collected demographic data, information about use of concussion assessment and management tools, and general concussion knowledge. They found that:

  • Athletic trainers correctly identified 78% of common concussion signs and symptoms. Most of them successfully identified amnesia, dizziness, blurred vision, confusion, and headache as real symptoms of concussion.
  • Most (95%) of the athletic trainers were familiar with the 2014 NATA guidance statement on concussion, although fewer (56.4%) were familiar with the 2017 National Collegiate Athletic Association (NCAA) consensus on best practices for concussion diagnosis and management.
  • Athletic trainers with clinical experience were less likely to use concussion assessment tools, such as symptom checklists or standardized sideline tools. Additionally, their use of standardized return-to-play assessment guides decreased as their years of past clinical experience increased.
  • Nearly half of athletic trainers reported letting an athlete return to play if the athlete used idiomatic language to underplay their injury (for example, “I’m fine, I just got my bell rung”).

These results indicate that while athletic trainers knowledgeable about the common signs and symptoms of concussion, many of them—especially those who had prior clinical experience—still allowed their athletes to return to play without completing a standardized sideline symptom assessment. As a result, the researchers recommend that athletic trainers should strive to keep up to date with new guidance on concussion best practices, implementing these guidelines every time an athlete is suspected to have a head injury.

Lempke LB, Schmidt JD, & Lynhall RC. Concussion knowledge and clinical expertise among athletic trainers: implications for concussion health care practices. Journal of Athletic Training. (July 2020).


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