The National Athletic Trainers' Association has released a new position statement on the management of sport concussion. The release came during the NATA's 5th annual Youth Sports Safety Summit in Washington, DC. in March 2014.
The statement is an update to the NATA's original 2004 concussion guidelines (Guskiewicz KM, et al. 2004) and addresses education, prevention, documentation and legal aspects, evaluation and return-to-play considerations. In particular, the authors amended the return-to-play guidelines and now recommend no return on the day the athlete is concussed. (Note, this brings the NATA in line with the consensus of experts, which has recommended no same-day return-to-play for a number of years).
The statement, created by the NATA Research & Education Foundation, appeared in the March 2014 issue of the Journal of Athletic Training,
"With the continued national spotlight on concussions from professional to youth sports, these recommendations provide a practical roadmap for athletic trainers, physicians and other medical professionals on injury identification and management. We also hope this document will serve as an educational tool for parents and school administrators," said Steven P. Broglio, PhD, ATC, lead author of the position statement and director of the Neurosport Research Lab in the School of Kinesiology at the University of Michigan.
"Athletic trainers (ATs) are commonly the first medical experts available on site to identify and evaluate injuries," added Broglio. "Without exception, ATs should be present at all organized sporting events - from practices to games - and at all levels of play and work closely with their physician or other designated medical expert to implement these guidelines. In light of these general protocols, each athlete should be treated on an individual basis."
Education and Prevention
The statement recommends:
Documentation and legal aspects
The statement recommends that athletic trainers:
"The legislation and policy area is one that is important for ATs, because they need to not only be aware of any state laws, but also their state interscholastic association policy, school district and/or school policy, and their standing orders with their directing physician," says McLeod. "It's a multi-layered system of policies in which one could be more conservative than another. Furthermore, it is important that concussions are documented well as this injury holds a high degree of [potential] liability."
The statement's discussion of the legal liability aspects of concussion management as they relate to athletic trainers, it is worth noting, is believed to be the first such discussion in a position statement regarding concussion management.
Evaluation and return-to-play
The position statement recommends that:
Equipment:
The position statement recommends:
Pediatric concussion:
For younger athletes, the statement recommends:
Home care:
The position statement calls for:
Multiple Concussions:
With respect to the management of patients with a concussion history [21], the statement recommends that:
The clinical practice recommendations set forth in the NATA's statement are "graded" based on the Strength of Recommendation Taxonomy (SOR)(e.g. "A" is based on "consistent and good quality experimental evidence; "B" on inconsistent or limited quality experimental evidcence, and "C" on consensus, usual practice, opinion, or case series or studies of diagnosis, treatment, prevention, or screening, or extraopolations from quasi-experimental research.
As McLeod notes, "the grading of the SOR still finds a lot of recommendations graded with a "C", meaning there is limited evidence and it is based primarily off expert opinion. (In fact, 30 of the 46 recommendations are graded C) I think the number of C recommendations shows there is still a lot of research that needs to be done in many areas."
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To review the NATA's statement in full, please visit: http://dx.doi.org/10.4085/1062-6050-49.1.07.
NATA Press Release, March 10, 2014
Broglio SP, et al. National Athletic Trainers' Association Position Statement: Management of Sport Concussion. J Athl Train. 2014;49(1):000-000. doi: 10.4085/1062-6050-49.1.07 (epub March 10, 2014).
Guskiewicz KM, Bruce SL, Cantu RC, et al. National Athletic Trainers' Association position statement: management of sports-related concussion. J Athl Train. 2004;39(3):280-297.
Kirkwood MW, Peterson RL, Connery AK, Daker DA, Grubenhoff JA. Postconcussion Symptom Exaggeration After Pediatric Mild Traumatic Brain Injury. Pediatrics 2014;133(4). doi: 10.1542/peds.2013-3195 (epublished March 10, 2014).
Most recently revised January 11, 2015
Links:
[1] https://mail.momsteam.com/health-safety/concussion-label-sends-wrong-message-use-MTBI-mild-traumatic-brain-injury-instead
[2] https://mail.momsteam.com/concussion-physical-rest/concussion-recovery-starts-with-both-physical-and-cognitive-rest
[3] https://mail.momsteam.com/health-safety/return-to-play/concussion-return-to-play-step-by-step-approach-recommended
[4] https://mail.momsteam.com/health-safety/concussion-evaluation-management-return-to-play-decision-involves-many-factors
[5] https://mail.momsteam.com/health-safety/every-state-has-youth-sports-concussion-safety-law
[6] https://mail.momsteam.com/health-safety/concussion-signs-and-symptoms-physical-cognitive-emotional-sleep-related
[7] https://mail.momsteam.com/sports/honest-self-reporting-concussions-symptoms-critical-for-athletes
[8] https://mail.momsteam.com/health-safety/concussion-safety/recognition-evaluation/neuropsychological-testing-for-concussions
[9] https://mail.momsteam.com/health-safety/concussion-safety/general/concussion-history-important-in-prevention-and-treatment
[10] https://mail.momsteam.com/health-safety/BESS-balance-error-scoring-system-assessing-balance-in-concussion
[11] https://mail.momsteam.com/baseline/baseline-neuropsychological-tests-getting-valid-results-poses-challenge
[12] https://mail.momsteam.com/health-safety/more-evidence-that-king-devick-test-may-help-identify-concussed-athletes-on-sports-sideline
[13] https://mail.momsteam.com/health-safety/persistent-post-concussion-symptoms-reported-by-children-teens-may-be-exaggerated-feigning
[14] https://mail.momsteam.com/therapies-post-concussion-syndrome
[15] https://mail.momsteam.com/blog/brooke-de-lench/ftc-ban-on-claim-that-mouthguard-reduces-concussion-risk-no-surprise-to-MomsTEAM
[16] https://mail.momsteam.com/health-safety/soccer-headgear-cuts-concussion-risk-in-half-study-says
[17] https://mail.momsteam.com/health-safety/concussion-safety/more-conservative-approach-concussions-in-children-teens-recommended
[18] https://mail.momsteam.com/5-7/concussion-evaluation-management-return-play-different-younger-children
[19] https://mail.momsteam.com/health-safety/parents-critical-participants-in-recognition-treatment-recovery-concussion
[20] https://mail.momsteam.com/academic-accommodations/ensure-successful-return-to-classroom-after-concussion--says-pediatrics-group
[21] https://mail.momsteam.com/health-safety/concussion-safety/multiple-concussion-history-important-factor-in-concussion-management
[22] https://mail.momsteam.com/health-safety/concussion-safety/general/second-impact-syndrome-signs-and-symptoms
[23] https://mail.momsteam.com/health-safety/concussion-rates-high-school-sports
[24] https://mail.momsteam.com/health-safety/new-football-helmets-may-prevent-some-concussions
[25] https://mail.momsteam.com/studies-show-pitfalls-in-baseline-neurocognitive-testing
[26] https://mail.momsteam.com/health-safety/multiple-concussion-history-recent-concussion-increase-risk-longer-recovery
[27] https://mail.momsteam.com/health-safety/effects-concussion-suble-yet-prolonged-those-with-multiple-concussion-history
[28] https://mail.momsteam.com/baseline-neurocognitive-testing/baseline-neurocognitive-testing-younger-athletes-extra-vigilance-required
[29] https://mail.momsteam.com/helmets/helmets-significantly-reduce-head-injuries-among-skiers-snowboarders
[30] https://mail.momsteam.com/cerebral-blood-flow/new-study-supports-more-conservative-management-concussions-in-children-teens
[31] https://mail.momsteam.com/team-of-experts/athletic-trainer-AT-every-school-should-have-one
[32] https://mail.momsteam.com/health-safety/athletic-trainer-plays-key-role-in-concussion-recognition-evaluation-on-sports-sideline