title: Concussion management in United States college sports: compliance with National Collegiate Athletic Association concussion policy and areas for improvement.
abstract: BACKGROUND
  In 2010, the National Collegiate Athletic Association (NCAA) adopted its Concussion Policy and Legislation, which applies to more than 450,000 collegiate athletes annually. To date, there has been no examination of school-level compliance with the NCAA Concussion Policy.
  
  
  OBJECTIVE
  To examine whether stakeholders at NCAA schools report that their school has a concussion management plan and whether existing plans are consistent with the NCAA policy. Also examined were stakeholders' perceptions regarding concussion management at their institution and possible areas for improvement.
  
  
  METHODS
  Cross-sectional study; Level of evidence, 3.
  
  
  METHODS
  Surveys were sent by e-mail to coaches, sports medicine clinicians, and compliance administrators at all 1066 NCAA member institutions. Surveys asked population-specific questions about institutional concussion management. Individuals (N=2880) from 907 unique schools participated in this survey.
  
  
  RESULTS
  Most respondents (n=2607; 92.7%) indicated their school had a concussion management plan. Most schools had all (82.1%) or some (15.2%) respondents indicate a concussion management plan was present. When asked to indicate all individuals who could have final responsibility for returning athletes to play after a concussion, 83.4% selected team doctor, 72.8% athletic trainer, 31.0% specialist physician, 6.8% coach, and 6.6% athlete. Most respondents (76.1%) indicated that their institution had a process for annual athlete concussion education; 91.2% required athletes to acknowledge their responsibility to report concussion symptoms. Nearly all respondents (98.8%) thought their school's concussion management plan protected athletes "well" or "very well." Top categories suggested for improvement included better coach education (39.7%), increasing sports medicine staffing (37.2%), and better athlete education (35.2%).
  
  
  CONCLUSIONS
  Although a large majority of respondents indicated that their school has a concussion management plan, improvement is needed. Compliance with specified components (eg, annual athlete education) lags behind the presence of the plan itself, and stakeholders had suggestions for areas in which improvements are needed. Increasing scientific evidence supporting the seriousness of concussion underscores the need for the NCAA to use its regulatory capabilities to ensure that athletes' brains are safe.
authors.affiliation: Interfaculty Initiative in Health Policy, Harvard University, Cambridge, Massachusetts, USA Division of Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA Edmond J. Safra Center for Ethics, Harvard University, Cambridge, Massachusetts, USA cbaugh@g.harvard.edu.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Baugh
authors.affiliation: Edmond J. Safra Center for Ethics, Harvard University, Cambridge, Massachusetts, USA Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, USA NCAA Sport Science Institute, Indianapolis, Indiana, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Kroshus
authors.affiliation: Center for the Study of Traumatic Encephalopathy, Boston University School of Medicine, Boston, Massachusetts, USA Sports Legacy Institute, Boston, Massachusetts, USA.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Daneshvar
authors.affiliation: Harvard College, Cambridge, Massachusetts, USA.
authors.forename: Naji A
authors.initials: NA
authors.lastname: Filali
authors.affiliation: Department of Government, Harvard University, Cambridge, Massachusetts, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Hiscox
authors.affiliation: Department of Health Law, Bioethics, and Human Rights, Boston University School of Public Health, Boston, Massachusetts, USA.
authors.forename: Leonard H
authors.initials: LH
authors.lastname: Glantz
mesh_terms: D056352:Athletes / Q000193:education; D001265:Athletic Injuries / Q000175:diagnosis / Q000628:therapy*; D001924:Brain Concussion / Q000175:diagnosis / Q000628:therapy*; D003430:Cross-Sectional Studies; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D016134:Organizational Policy; D009938:Organizations / Q000331:legislation & jurisprudence; D010465:Perception; D013178:Sports Medicine / Q000592:standards*; D014481:United States; D014495:Universities / Q000458:organization & administration* / Q000706:statistics & numerical data
keywords: NCAA; college; concussion; health policy