title: Athletic trainers' management practices and referral patterns for adolescent athletes after sport-related concussion.
abstract: BACKGROUND
  Athletic trainers (ATs) play an important role in the evaluation, management, and referral of student-athletes after sport-related concussion. Understanding factors that influence ATs' patient care decisions is important to ensure best practices are followed.
  
  
  OBJECTIVE
  To identify ATs' current concussion management practices and referral patterns for adolescent student-athletes after sport-related concussion as well as the factors associated with those practices.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Level 3.
  
  
  METHODS
  A total of 851 participants from a convenience sample of 3286 ATs employed in the secondary school setting (25.9% response rate) completed the Athletic Trainers' Beliefs, Attitudes, and Knowledge of Pediatric Athletes with Concussions (BAKPAC-AT) survey. The BAKPAC-AT consists of several questions to assess ATs' concussion management, referral practices, and established relationships with other health care professionals.
  
  
  RESULTS
  The majority of ATs had a written concussion policy (82.4%, n = 701) and standing orders approved by their directing physician (67.3%, n = 573); 75.1% (n = 639) of ATs conduct baseline testing, with the majority using computerized neurocognitive tests (71.2%, n = 606). Follow-up concussion testing was employed by 81.8% (n = 696). Years of certification (P = 0.049) and type of secondary school (P = 0.033) predicted ATs' use of baseline testing. Nearly half of the respondents (48.8%, n = 415) refer 100% of concussion cases to a physician. The most influential factors that lead to a referral were state law (40.3%, n = 343), personal preference (34.7%, n = 295), and school district policy (24.8%, n = 211).
  
  
  CONCLUSIONS
  Of the ATs surveyed, most were engaged in baseline and follow-up testing, primarily with neurocognitive tests. Most ATs refer patients to physicians after concussion. While state regulation and personal preference were primary factors influencing referral decisions, it is unclear at what point of care the referral occurs.
authors.affiliation: University of Michigan, Ann Arbor, Michigan.
authors.forename: Richelle M
authors.initials: RM
authors.lastname: Williams
authors.affiliation: A.T. Still University, Mesa, Arizona.
authors.forename: Cailee E
authors.initials: CE
authors.lastname: Welch
authors.affiliation: A.T. Still University, Mesa, Arizona.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Weber
authors.affiliation: National Collegiate Athletic Association, Indianapolis, Indiana.
authors.forename: John T
authors.initials: JT
authors.lastname: Parsons
authors.affiliation: A.T. Still University, Mesa, Arizona.
authors.forename: Tamara C
authors.initials: TC
authors.lastname: Valovich McLeod
keywords: adolescent athletes; management practices; referral patterns; sport-related concussion