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What Influences Time to Medical Clearance from Sport-Related Concussions?

Access to an athletic trainer in the initial examination seemed to positively influence the subsequent care received.

Sport-related concussions are common in high school sports. Medical clearance prior to return to play is taken very seriously following sport-related concussions. In the US, most states have requirements that written medical clearance must be obtained by a qualified healthcare professional (ex., MD, PA, NP) prior to athletes returning to play. 

But which healthcare professionals are making those decisions? And do their credentials or place of work influence time to medical clearance? 

Recent Research using Michigan’s Concussion Reporting System

A research team in Michigan sought to answer these questions through their recently published study in the Journal of Athletic Training. The Michigan High School Athletic Association requires use of a concussion reporting system to track sport-related concussions that occur in sanctioned events. Researchers used this data to study which healthcare providers were involved in concussion care and medical clearance. There were a total of 16,001 concussion cases in the system over 4 academic years (2015-2019), in which 12,856 cases obtained authorized medical clearance.

In Michigan, only healthcare providers with credentials MD, DO, NP, or PA are qualified to provide medical clearance. (Note that this requirement varies by state.)

Although athletic trainers cannot provide medical clearance of concussions in Michigan, they played a crucial role in initial examination. 

The researchers found that athletic trainers were the initial examiner in 71% of the cases, further supporting the importance of athletic trainers in concussion management. Athletic trainers often know the athletes best and are, therefore, well-suited to being the first to evaluate concussions. 

Athletic trainers were more often initial examiners for boys (74%) than for girls (66%). This indicates a potential bias toward more athletic training coverage for male sports, which further stresses the need for more athletic trainers in high schools, particularly for female sports. 

Medical Doctors at primary care clinics most often provided medical clearance.  

Researchers found that medical clearance was most often obtained from medical doctors (64%) and at primary care clinics (71%). Researchers also found that athletes were more likely to obtain medical clearance from the team doctor (versus primary care or other doctors) when an athletic trainer was the initial examiner. This line of care is important, because concussed athletes are more compliant with concussion protocols when being treated by the most appropriate medical team (athletic trainer and team doctor versus primary care or emergency room doctors).

Type of healthcare facility influenced time to medical clearance. 

Athletes obtained medical clearance from the team physician’s office 5 days later than athletes who obtained medical clearance from urgent care facilities. Assuming that the team physician’s office is better suited for post-concussion care than an urgent care clinic, these results are concerning and may indicate that urgent care facilities are not as conservative for medical clearance. 

Takeaways for Sport-Related Concussion Care 

Obtaining medical clearance is only one aspect of post-concussion care. Athletes must also progress through a gradual return to play criteria before full return to unrestricted activity. A limitation of the present study was that the authors were not able to determine if full medical clearance was obtained before, during, or after the gradual return to play protocol. 

Regardless, athletes and parents should consider which healthcare provider is making the decision for medical clearance. The information in this study is extremely useful for educating athletes about seeking appropriate medical care. Access to an athletic trainer in the initial examination seemed to positively influence the subsequent care received for sport-related concussions. 

References

Bretzin AC, Zynda AJ, Wiebe DJ, Covassin T. Time to Authorized Clearance from Sport-Related Concussion: The Influence of Healthcare Provider and Medical Facility. J Athl Train. 2020 Dec 22. doi: 10.4085/JAT0159-20. Epub ahead of print. PMID: 33351918.

About the Author 
Dr. Jennifer Hunnicutt is a licensed athletic trainer with a PhD in Health and Rehabilitation Science, who has worked with all types of athletes, including professionals and Olympians. She has held prominent research positions at Emory Sports Medicine and the NBA Hawks Center in Atlanta, GA, as well as serving on the national network of healthcare providers for U.S. Figure Skating. Now the owner of Hunnicutt Writing and Consulting, LLC, Dr. Hunnicutt collaborates with global institutions, spearheading innovation and research among professionals and businesses in Sports Medicine and Orthopedics. Learn more at https://drhunnicutt.com.

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