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Updated: May 10, 2026

Autonomic Function Following Concussion in Youth Athletes: An Exploration of Heart Rate Variability Using 24-hour Recording Methodology

Autonomic Function Following Concussion in Youth Athletes: An Exploration of Heart Rate Variability Using 24-hour Recording Methodology

Published on: September 21, 2018

Team clinician variability in return-to-play decisions.

Rebecca Shultz¹, Jennifer Bido, Ian Shrier

¹*Department of Orthopaedic Surgery, Human Performance Laboratory, Stanford University School of Medicine, Palo Alto, California; †Division of Sports Medicine, Department of Orthopaedic Surgery, Stanford University School of Medicine, Palo Alto, California; ‡Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; and §Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.

Clinical Journal of Sport Medicine : Official Journal of the Canadian Academy of Sport Medicine

|June 26, 2013

Summary

Experienced clinicians show significant variability in return-to-play (RTP) decisions for athletes. Even with clearer guidelines, discrepancies persist in assessing injury risk and athlete well-being during RTP evaluations.

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Autonomic Function Following Concussion in Youth Athletes: An Exploration of Heart Rate Variability Using 24-hour Recording Methodology

Autonomic Function Following Concussion in Youth Athletes: An Exploration of Heart Rate Variability Using 24-hour Recording Methodology

Published on: September 21, 2018

Development and Implementation of a Multi-Disciplinary Technology Enhanced Care Pathway for Youth and Adults with Concussion

Development and Implementation of a Multi-Disciplinary Technology Enhanced Care Pathway for Youth and Adults with Concussion

Published on: January 20, 2019

Area of Science:

Sports Medicine
Clinical Decision-Making
Athlete Health

Background:

Return-to-play (RTP) decisions are critical for athlete safety and career longevity.
Variability in clinical judgment can impact athlete outcomes.
Standardized RTP models aim to reduce subjectivity.

Purpose of the Study:

To quantify the variability in RTP decisions among experienced sports medicine clinicians.
To evaluate the perceived importance of 19 factors within a proposed RTP decision-making model.

Main Methods:

A survey questionnaire was administered to advanced team physicians.
Sixty-seven clinicians completed the survey, with data analyzed using descriptive statistics.
Respondents provided binary and graded choices for RTP scenarios.

Main Results:

Clinicians reported an average of 13.6 years of experience.
35% of clinicians would clear an athlete even with increased reinjury risk.
Graded RTP options reduced but did not eliminate decision discrepancies.

Conclusions:

Significant variability exists in how clinicians weigh factors for RTP decisions.
More precise definitions for RTP criteria can decrease, but not fully resolve, decision variability.