Concussion Management in United States College Sports Compliance With National Collegiate Athletic Association Concussion Policy and Areas for Improvement

Christine M. Baugh; Emily Kroshus; Daniel H. Daneshvar; Naji A. Filali; Michael J. Hiscox; Leonard H. Glantz

doi:10.1177/0363546514553090

Concussion Management in United States College Sports

Compliance With National Collegiate Athletic Association Concussion Policy and Areas for Improvement

^†Interfaculty Initiative in Health Policy, Harvard University, Cambridge, Massachusetts, USA
^‡Division of Sports Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
^§Edmond J. Safra Center for Ethics, Harvard University, Cambridge, Massachusetts, USA
^||Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, USA
^¶NCAA Sport Science Institute, Indianapolis, Indiana, USA
^#Center for the Study of Traumatic Encephalopathy, Boston University School of Medicine, Boston, Massachusetts, USA
^**Sports Legacy Institute, Boston, Massachusetts, USA
^††Harvard College, Cambridge, Massachusetts, USA
^‡‡Department of Government, Harvard University, Cambridge, Massachusetts, USA
^§§Department of Health Law, Bioethics, and Human Rights, Boston University School of Public Health, Boston, Massachusetts, USA
C.M.B. and E.K. are co–first authors.
Investigation performed at Boston University School of Medicine, Boston, Massachusetts, USA, and Harvard School of Public Health, Boston, Massachusetts, USA

↵*Christine M. Baugh, MPH, Interfaculty Initiative in Health Policy, Harvard University, 14 Story Street, 4th Floor, Cambridge, MA 02138, USA (e-mail: cbaugh{at}g.harvard.edu).

Abstract

Background: In 2010, the National Collegiate Athletic Association (NCAA) adopted its Concussion Policy and Legislation, which applies to more than 450,000 collegiate athletes annually. To date, there has been no examination of school-level compliance with the NCAA Concussion Policy.

Purpose: To examine whether stakeholders at NCAA schools report that their school has a concussion management plan and whether existing plans are consistent with the NCAA policy. Also examined were stakeholders’ perceptions regarding concussion management at their institution and possible areas for improvement.

Study Design: Cross-sectional study; Level of evidence, 3.

Methods: Surveys were sent by e-mail to coaches, sports medicine clinicians, and compliance administrators at all 1066 NCAA member institutions. Surveys asked population-specific questions about institutional concussion management. Individuals (N = 2880) from 907 unique schools participated in this survey.

Results: Most respondents (n = 2607; 92.7%) indicated their school had a concussion management plan. Most schools had all (82.1%) or some (15.2%) respondents indicate a concussion management plan was present. When asked to indicate all individuals who could have final responsibility for returning athletes to play after a concussion, 83.4% selected team doctor, 72.8% athletic trainer, 31.0% specialist physician, 6.8% coach, and 6.6% athlete. Most respondents (76.1%) indicated that their institution had a process for annual athlete concussion education; 91.2% required athletes to acknowledge their responsibility to report concussion symptoms. Nearly all respondents (98.8%) thought their school’s concussion management plan protected athletes “well” or “very well.” Top categories suggested for improvement included better coach education (39.7%), increasing sports medicine staffing (37.2%), and better athlete education (35.2%).

Conclusion: Although a large majority of respondents indicated that their school has a concussion management plan, improvement is needed. Compliance with specified components (eg, annual athlete education) lags behind the presence of the plan itself, and stakeholders had suggestions for areas in which improvements are needed. Increasing scientific evidence supporting the seriousness of concussion underscores the need for the NCAA to use its regulatory capabilities to ensure that athletes’ brains are safe.

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Footnotes

One or more of the authors has declared the following potential conflict of interest or source of funding: C.M.B. received funding from the Edmond J. Safra Center for Ethics for the conduct of this study. Material support in the form of an e-mail distribution list and service was provided by the NCAA Sport Science Institute (SSI). The SSI contributed to the design and conduct of the study. E.K. received the NCAA Graduate Student Research Grant for 2012-2013 and was funded as a postdoctoral research fellow by the NCAA Sports Science Institute as of June 2014.