Limited access to athletic trainers in high schools leads to unreported, mismanaged sports concussions

That’s according to a study published recently in the Journal of Athletic Training and led by researchers at the University of Wisconsin School of Medicine and Public Health.

Researchers worked with 31 high schools across Wisconsin to gather injury data on approximately 2,400 student athletes ages 14-18. The schools were divided into three categories:

• Nine schools with high athletic trainer availability (35-45 hours per week throughout the year, including all home varsity and sub-varsity competitions)
• Eight with mid athletic trainer availability (20-40 hours per week, including school sessions and some home varsity events)
• 14 with low athletic trainer availability (one hour a week during the school day with availability during home varsity football games)

Key findings

The study’s primary goal was to determine whether the availability of athletic trainers at Wisconsin high schools affected both the reporting and management of sport-related concussions. The study’s most important findings include the following:

• On average, athletes at schools with low athletic trainer availability waited 24 hours between the onset of a sport-related concussion and their first meeting with an athletic trainer, while athletes at schools with both mid and high athletic trainer availability were evaluated within an hour of the injury.
• Only 53 percent of athletes who sustained a sport-related concussion at a school with low athletic trainer availability underwent a “return to sport” protocol, compared to 94 percent at schools with mid athletic trainer availability and 100 percent at schools with high high athletic trainer availability.
• Athletes with a sport-related concussion were kept out of their sport for 2.5 days longer at schools with high and mid athletic trainer availability than at schools with low athletic trainer availability.
• Athletes at Wisconsin high schools with high athletic trainer availability were more likely to be diagnosed with a sport-related concussion than athletes at schools with low athletic trainer availability.

“Our findings clearly show that limited access to athletic trainers in high schools is resulting in unreported and mismanaged sport-related concussions in our student athletes,” said Tim McGuine, PhD, the study’s principal investigator and sports medicine researcher at the UW School of Medicine and Public Health. “There is no question that misdiagnosing or delaying appropriate medical intervention for these types of injuries could have short- or long-term consequences. It is crucial that we find responsible solutions so that all schools can provide the highest standard of safety for these kids.”

Of the estimated 7.1 to 7.5 million athletes participating in high school sports nationwide, approximately 340,000 sport-related concussions are reported each year. It has long been suspected, however, that a substantial number in the United States are still going unreported, resulting in an untold number of athletes returning to competition prematurely and increasing their risk for additional concussions and other injuries.

Availability of athletic trainers often limited

The American Medical Association (AMA) and the National Athletic Trainer Association (NATA) have both recognized the value of having athletic trainers on staff, but the extent to which they are available to high school athletes is inconsistent at best.

• Only one third of the 400 high schools in Wisconsin that sponsor interscholastic teams have an athletic trainer available daily during sport practice and competition hours.
• Another third of these schools only have an athletic trainer available to them 10-15 hours per week with limited coverage for events
• The remaining third have extremely limited AT coverage (only 1 to 1.5 hours per week) or no coverage at all during the school year.

There are also additional implications, McGuine says, for high school athletes who compete on club teams, because those teams rarely, if ever, have an athletic trainer present during practices or games. And unlike at high schools in Wisconsin, there does not seem to be an effort to encourage clubs to hire athletic trainers to work with their players.

McGuine cautions that schools with low availability of athletic trainers should not be unduly criticized because funding is typically the main reason schools can’t provide more consistent athletic trainer coverage. Currently, each school in Wisconsin has the costs of their athletic trainer services subsidized to some degree (50 to 100 percent) by local medical providers such as UW Health, Aurora, Bellin, Marshfield, and others. All of the schools in the low and mid athletic trainer groups were publicly funded, while the high athletic group had the most schools with private funding (78 percent).

The study was funded by a grant from the National Athletic Trainers Association Research and Education Foundation. Other researchers involved in the study include:

• Adam Pfaller and Alison Brooks, MD, MPH, both from the Department of Orthopedics and Rehabilitation at UW-Madison
• Eric Post, PhD, School of Exercise and Nutritional Sciences at San Diego State University
• Scott Hetzel, Department of Biostatistics and Medical Informatics at UW-Madison
• Steven Broglio, PhD, Neuro Trauma Research Laboratory at the University of Michigan, Ann Arbor