Department of Orthopaedics and Rehabilitation, University of Wisconsin, Madison.
School of Exercise and Nutritional Sciences, San Diego State University, CA.
J Athl Train. 2018 Nov;53(11):1017-1024. doi: 10.4085/1062-6050-209-18. Epub 2018 Nov 7.
In many US high schools, the athletic trainer (AT) has the responsibility to identify and manage athletes with concussions. Although the availability of ATs varies a great deal among schools, how the level of AT availability in high schools affects the reported incidence and management of sport-related concussions (SRCs) is unknown.
To determine how the presence of an AT affects the reporting and management of SRCs.
Prospective cohort study.
A total of 2459 (female = 37.5%, age = 16.1 ± 1.2 years) athletes from 31 Wisconsin high schools were categorized as having low availability (LoAT), mid availability (MidAT), or high availability (HiAT) of ATs. Athletic trainers recorded the incidence, days lost from sport, and postconcussion management through return to sport. The incidence of SRC reporting among categories was examined using a multivariate Cox proportional hazards model. Fisher exact tests were used to determine if postconcussion management differed based on AT availability.
The incidence of reported SRCs was lower for the LoAT schools (2.4%) compared with the MidAT (5.6%, hazard ratio = 2.59, P = .043) and HiAT (7.0%, hazard ratio = 3.33, P = .002) schools. The median time before the first AT interaction was longer for LoAT schools (24.0 hours) than for MidAT (0.5 hours, post hoc P = .012) and HiAT (0.2 hours, post hoc P = .023) schools. The number of post-SRC interactions was different in all groups (LoAT = 2 interactions, MidAT = 3, and HiAT = 4; all post hoc P values < .05). Days lost were greater for MidAT and HiAT (both 14 days lost) schools compared with LoAT schools (11.5 days lost, post hoc P = .231 and P = .029, respectively). Athletes at LoAT schools were less likely to undergo a return-to-play protocol (9/18 SRCs, 50.0%) than athletes at MidAT (44/47 SRCs, 93.6%; post hoc P = .001) or HiAT (64/64 SRCs, 100%; post hoc P < .001) schools.
The level of AT availability positively influenced the reported incidence of SRCs as well as postconcussion management activities in this sample of high schools.
在美国许多高中，运动训练师（AT）有责任识别和管理患有脑震荡的运动员。尽管学校之间 AT 的可用性差异很大，但高中 AT 可用性水平如何影响报告的运动相关脑震荡（SRC）的发生率和管理尚不清楚。
确定 AT 的存在如何影响 SRC 的报告和管理。
前瞻性队列研究。
来自威斯康星州 31 所高中的 2459 名运动员（女性=37.5%，年龄=16.1±1.2 岁）被分为 AT 可用性低（LoAT）、中等（MidAT）或高（HiAT）的类别。运动训练师通过重返运动记录 SRC 的发生率、运动损失天数和脑震荡后管理。使用多变量 Cox 比例风险模型检查各分类中 SRC 报告的发生率。Fisher 确切检验用于确定基于 AT 可用性，脑震荡后管理是否存在差异。
LoAT 学校（2.4%）报告 SRC 的发生率低于 MidAT（5.6%，风险比=2.59，P=.043）和 HiAT（7.0%，风险比=3.33，P=.002）学校。LoAT 学校的首次 AT 互动前中位数时间较长（24.0 小时），而 MidAT（0.5 小时，事后 P=.012）和 HiAT（0.2 小时，事后 P=.023）学校较短。所有组的 SRC 后交互次数均不同（LoAT=2 次，MidAT=3 次，HiAT=4 次；所有事后 P 值均<.05）。与 LoAT 学校（11.5 天）相比，MidAT 和 HiAT 学校（均为 14 天）的 SRC 损失天数更大，事后 P 值分别为.231 和.029（均为 P=.231 和 P=.029）。LoAT 学校的运动员（9/18 SRCs，50.0%）比 MidAT（44/47 SRCs，93.6%；事后 P=.001）或 HiAT（64/64 SRCs，100%；事后 P<.001）学校的运动员更不可能进行复出比赛协议。
在这个高中样本中，AT 的可用性水平对报告的 SRC 发生率以及脑震荡后的管理活动有积极影响。
