Beidler Erica, Welch Bacon Cailee E, Hattrup Nicholas, Powers Cassidy, Saitz Lilly, McLeod Tamara Valovich
A.T. Still University, Athletic Training Programs, School of Osteopathic Medicine in Arizona, 5850 E Still Circle, Mesa, AZ 85206, United States,
Boston University, Athletic Training Services, 285 Babcock Street, Boston, Massachusetts 02215, United States,
J Athl Train. 2020 Jun 18;57(1):32-43. doi: 10.4085/1062-6050-0505.20.
CONTEXT: State laws provide general guidelines for sport-related concussion (SRC) management, but do not comprehensively address the multiple layers of management for this complex injury. While high schools are encouraged to develop a SRC protocol that includes both state law tenets and additional management practices, the execution of this warrants examination. OBJECTIVE: To investigate state law compliance and practice components included in high school SRC protocols, and determine whether the degree of sports medicine coverage influenced protocol quality. DESIGN: Qualitative document analysis. SETTING: High school athletics. PARTICIPANTS: In total, 184 Pennsylvania high schools [24.3% of schools statewide; full-time athletic trainer=149, part-time athletic trainer=13, missing=21] voluntarily provided copies of their protocol from the 2018-2019 academic year. MAIN OUTCOME MEASURES: Four athletic trainers conducted document analyses using a 67-item component analysis guide. Frequencies were computed for included protocol components related to the state law, preparticipation and prevention, recognition and assessment, and management. The difference in the total number of included components (max 60) by sports medicine coverage was assessed using a Mann-Whitney U test. RESULTS: There was heterogeneity in components included in the submitted protocols. Only 23.4% included all mandatory state law tenets. Immediate removal from play was noted in 67.4% of protocols, while only 1.6% contained prevention strategies. Return-to-play was addressed more frequently than return-to-learn (74.5% versus 32.6%). The sample had a mean of 15.5±9.7 total components per protocol. Schools with full-time sports medicine coverage had significantly more protocol components than those with part-time athletic trainers (15 [8.5-22.5] versus 6 [3-10.5] median components; U = 377.5, p < .001) Conclusions: School-level written SRC protocols were often missing components of the state law and additional best practice recommendations. Full-time sports medicine coverage in high schools is recommended to increase SRC protocol and healthcare quality.
背景：州法律为与运动相关的脑震荡（SRC）管理提供了一般指导方针，但并未全面涵盖这种复杂损伤的多层管理。虽然鼓励高中制定包含州法律原则和其他管理措施的SRC协议，但对其执行情况仍需进行审查。 目的：调查高中SRC协议中包含的州法律合规情况和实践内容，并确定运动医学覆盖程度是否会影响协议质量。 设计：定性文献分析。 背景：高中体育活动。 参与者：共有184所宾夕法尼亚州的高中[占全州学校的24.3%；全职运动训练师=149所，兼职运动训练师=13所，缺失数据=21所]自愿提供了2018 - 2019学年其协议的副本。 主要观察指标：四名运动训练师使用一份包含67项内容的分析指南进行文献分析。计算了协议中与州法律、参与前和预防、识别和评估以及管理相关的内容的频率。使用曼 - 惠特尼U检验评估运动医学覆盖情况下所包含内容总数（最多60项）的差异。 结果：提交的协议中包含的内容存在异质性。只有23.4%的协议包含所有强制性州法律原则。67.4%的协议提到了立即停止比赛，而只有1.6%包含预防策略。关于重返比赛的内容比重返学习的内容提及得更频繁（74.5%对32.6%）。每个协议的样本平均包含15.5±9.7项内容。有全职运动医学覆盖的学校的协议内容明显多于有兼职运动训练师的学校（中位数内容分别为15[8.5 - 22.5]项和6[3 - 10.5]项；U = 377.5，p <.001）结论：学校层面的书面SRC协议往往缺少州法律的部分内容和其他最佳实践建议。建议高中配备全职运动医学人员以提高SRC协议和医疗保健质量。
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