title: Knowledge and management of sports concussions among coaches and certified athletic trainers in Alabama.
abstract: OBJECTIVE
  To identify modifiable barriers in resources, knowledge, and management that may improve the care of young athletes with concussions in the state of Alabama.
  
  
  METHODS
  An electronic survey was distributed to 2668 middle and high school coaches of contact sports in Alabama, and a paper survey was completed by 79 certified athletic trainers (ATCs) in 2010. Questions focused on their resource availability, knowledge of concussions based on the 2008 Consensus Statement on Concussion in Sport: the 3rd International Conference on Concussion in Sport (commonly known as the Zurich consensus statement), and management of concussions.
  
  
  RESULTS
  A total of 402 (16% response rate) coaches and 55 ATCs (70% response rate) responded to the survey. This study highlights that ATC coverage often is limited to the high school level, football, and competitions. Both coaches and ATCs primarily use physicians to make return-to-play decisions, although coaches (43.7%) usually refer to primary care physicians, whereas ATCs (43.6%) refer to orthopedic or sports medicine physicians. The study also revealed that coaches and ATCs desire education and could expand concussion awareness by providing education to parents and athletes. No overall difference was seen in the knowledge and management of concussions between coaches and ATCs; however, ATCs were more likely to identify symptoms that are positive for concussions (P = 0.04). Both groups had difficulty recognizing subtle symptoms such as trouble sleeping, personality changes, and dizziness; they also were unaware that strenuous mental activities could delay concussion recovery, although ATCs scored significantly better than coaches (P < 0.001). Neither coaches nor ATCs consistently use standardized measures such as the Sports Concussion Assessment Tool 2 (7.5% vs 56.4%) or neuropsychological testing (5.3% vs 14.5%).
  
  
  CONCLUSIONS
  This study describes coaches' and ATCs' varying knowledge and management techniques and highlights areas in which targeted interventions and outreach could be useful. These areas include increased ATC availability, coach/ATC concussion education, improved parent/athlete education, increased "return to think" awareness, and more consistent use of Sports Concussion Assessment Tool 2.
authors.affiliation: From the Division of Pediatric Emergency Medicine, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee, the Division of Pediatric Emergency Medicine, Texas Children's Hospital, Houston, the Division of Pediatric Emergency Medicine, University of Alabama at Birmingham, the Southeast Child Safety Institute, Children's of Alabama, University of Alabama at Birmingham, and the Division of Pediatric Rehabilitation Medicine, University of Alabama at Birmingham.
authors.forename: Kimberly G
authors.initials: KG
authors.lastname: Naftel
authors.affiliation: From the Division of Pediatric Emergency Medicine, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee, the Division of Pediatric Emergency Medicine, Texas Children's Hospital, Houston, the Division of Pediatric Emergency Medicine, University of Alabama at Birmingham, the Southeast Child Safety Institute, Children's of Alabama, University of Alabama at Birmingham, and the Division of Pediatric Rehabilitation Medicine, University of Alabama at Birmingham.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Yust
authors.affiliation: From the Division of Pediatric Emergency Medicine, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee, the Division of Pediatric Emergency Medicine, Texas Children's Hospital, Houston, the Division of Pediatric Emergency Medicine, University of Alabama at Birmingham, the Southeast Child Safety Institute, Children's of Alabama, University of Alabama at Birmingham, and the Division of Pediatric Rehabilitation Medicine, University of Alabama at Birmingham.
authors.forename: Michele H
authors.initials: MH
authors.lastname: Nichols
authors.affiliation: From the Division of Pediatric Emergency Medicine, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee, the Division of Pediatric Emergency Medicine, Texas Children's Hospital, Houston, the Division of Pediatric Emergency Medicine, University of Alabama at Birmingham, the Southeast Child Safety Institute, Children's of Alabama, University of Alabama at Birmingham, and the Division of Pediatric Rehabilitation Medicine, University of Alabama at Birmingham.
authors.forename: William D
authors.initials: WD
authors.lastname: King
authors.affiliation: From the Division of Pediatric Emergency Medicine, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee, the Division of Pediatric Emergency Medicine, Texas Children's Hospital, Houston, the Division of Pediatric Emergency Medicine, University of Alabama at Birmingham, the Southeast Child Safety Institute, Children's of Alabama, University of Alabama at Birmingham, and the Division of Pediatric Rehabilitation Medicine, University of Alabama at Birmingham.
authors.forename: Drew
authors.initials: D
authors.lastname: Davis
mesh_terms: D000293:Adolescent; D000407:Alabama; D001265:Athletic Injuries / Q000175:diagnosis / Q000628:therapy*; D001924:Brain Concussion / Q000175:diagnosis / Q000628:therapy*; D002648:Child; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012574:Schools