title: Concussion-assessment and -management techniques used by athletic trainers.
abstract: BACKGROUND
  Understanding concussion-assessmment and -management practices that athletic trainers (ATs) currently use will allow clinicians to identify potential strategies for enhancing the quality of care provided to patients.
  
  
  OBJECTIVE
  To assess current clinical concussion diagnostic and return-to-participation practices among ATs.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Web-based survey.
  
  
  METHODS
  A link to the survey was sent randomly to a convenience sample of 3222 members of the National Athletic Trainers' Association. A total of 1053 (32.7%) certified ATs (experience as an AT = 11.2 ± 9.1 years) responded to the survey.
  
  
  METHODS
  Prospective participants received electronic correspondence informing them of the purpose of the study and providing a link to the Web-based survey instrument. A reminder e-mail was sent approximately 6 weeks later, and the survey remained online for a total of 8 weeks.
  
  
  METHODS
  We collected information on the annual number of concussions assessed and tools employed to diagnose, manage, and safely return an athlete to participation. Descriptive statistics were computed for each variable.
  
  
  RESULTS
  Participants reported observing 10.7 ± 11.0 concussions per year. Clinical examination (n = 743, 70.6%) was the most commonly reported means for evaluating and diagnosing concussion. Less than half of our respondents employed the Standardized Assessment of Concussion (n = 467, 44.3%), any variation of the Romberg test (n = 461, 43.8%), and computerized neuropsychological testing (n = 459, 43.6%). Clinical examination (n = 773, 73.4%), return-to-participation guidelines (n = 713, 67.7%), physician recommendation (n = 660, 62.7%), or player self-report (n = 447, 42.5%) contributed to the return-to-participation decisions of ATs. Only 20.8% (n = 219) of ATs reported using all 3 recommended domains of the concussion battery.
  
  
  CONCLUSIONS
  Our study demonstrated a growth in the number of ATs incorporating objective clinical measures of concussion as a part of their concussion management. Conversely, fewer ATs reported using a standard clinical examination in their concussion assessment. These findings suggest ATs must continue to increase their use of both objective concussion assessment tools and the standard clinical examination.
authors.affiliation: School of Kinesiology and Recreation, Illinois State University, Normal;
authors.forename: Robert C
authors.initials: RC
authors.lastname: Lynall
authors.forename: Kevin G
authors.initials: KG
authors.lastname: Laudner
authors.forename: Jason P
authors.initials: JP
authors.lastname: Mihalik
authors.forename: Justin M
authors.initials: JM
authors.lastname: Stanek
mesh_terms: D000293:Adolescent; D000328:Adult; D056352:Athletes; D001265:Athletic Injuries / Q000453:epidemiology / Q000534:rehabilitation* / Q000628:therapy*; D001924:Brain Concussion / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D062707:Return to Work / Q000706:statistics & numerical data*; D013177:Sports; D013178:Sports Medicine / Q000379:methods; D013223:Statistics as Topic; D011795:Surveys and Questionnaires; D055815:Young Adult