Comparison Of Concussion Management Programs On Return To Participation Outcomes Of Concussed High School Student-Athletes During 2011-12

Journal of Athletic Training. -


Kanaoka , T., L. M. Goeckeritz, R. K. Uyeno, R. S. Oshiro, T. M. Furutani, T. P. Wahl, M. H. Kocher and N. M. Murata.



Context: A multifaceted approach for the management of sport-related concussion that includes a clinical examination, graded symptom check list, postural stability testing, neurocognitive testing, and a Gradual Return to Play Protocol (GRPP) has been recommended by several concussion consensus statements and position papers. Healthcare professionals caring for concussed student-athletes across the United States may not be following these guidelines and therefore allowing student-athletes to return to participation (RTP) prematurely. Objective: To investigate how the duration of RTP and GRPP for concussed high school student athletes was influenced by the type of Concussion Management Program (CMP), which incorporated two different neuropsychological testing batteries for RTP decision-making. Design: Retrospective cross-sectional investigation. Setting: Two different neurocognitive tests were utilized within the CMP of 37 public high schools and 3 private high schools in the State of Hawaii. Patients or Other Participants: Concussed student-athletes (n=390, between the ages of 13 to 18) received baseline and post-concussion neurocognitive testing during school year (SY) 2011-12. Interventions: Two different neurocognitive tests used in a CMP were compared: 19 schools utilized the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and 21 schools utilized Standard Assessment of Concussion (SAC). Main Outcome Measures: The difference in means between two different neurocognitive tests used in the CMP (ImPACT n=225, SAC n=165) were compared using an independent samples t-test. Days of restricted participation postconcussion and duration of the GRPP until return to unrestricted participation, mean, standard deviation (SD), and 95% confidence intervals (CI) were reported. The duration of the GRPP was defined as the number of days of the rehabilitation period, starting from light aerobic exercise to full-contact practice. The GRPP consisted of five steps, each separated by a minimum of 24 hours. Results: A significant (F1=2.865, p=.033) difference was found between restricted participation postconcussion for ImPACT=26.25±18.99 (CI= 23.76 – 28.75) days compared to SAC=22.50±14.17 (CI= 20.32 – 24.67) days. No significant (F1=.728, p=.870) difference was found for the average duration of the GRPP incorporating ImPACT=10.30±7.06 (CI=9.38 – 11.25) days compared to SAC=10.18±7.37 (CI=9.05 – 11.31) days. Conclusions: The duration of GRPP for concussed student-athletes was not significantly different; however, the days of restricted participation post-concussion was significantly different when using the two different neurocognitive testing batteries (SAC or ImPACT) within the CMPs. The schools that utilized ImPACT in the CMP had a significantly longer number of days restricted than the schools that utilized SAC in the CMP. This result indicates a more conservative approach to RTP decision-making by Athletic Trainers who utilized the CMP incorporating ImPACT. The two testing batteries used in this study are just one part of the multifaceted nature of RTP decision-making within a comprehensive CMP. Thus, utilizing additional clinical examinations is vital to prevent the premature release of concussed student-athletes.

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