Personal subjectivity in clinician discussion about retirement from sport post-concussion

There is increasing focus on the number of concussions after which an athlete should discontinue participating in contact or collision sports. This is a clinically subjective and, in some cases, a preference-sensitive decision.

Our goal was to assess whether there is personal subjectivity in when athletic trainers (ATs) discuss the possibility of sport retirement post-concussion with athletes.

A national sample of ATs who provide clinical care to college athletes completed a questionnaire (n = 677, 34% response rate). Structural equation modeling was used to assess the association between risk perceptions, risk tolerance, social influences (beliefs about athlete, coach and parent preferences), expectancies about athlete success (on and off field), and the number of concussions after which retirement would be discussed.

There was a significant direct effect of AT risk tolerance on the number of concussions after which sport retirement would be discussed, among both male and female ATs (male B = 0.54, p < 0.001; female B = 0.31, p < 0.001). ATs who more strongly prioritized athletes' on-field achievements indicated that they would discuss sport retirement after a larger number of concussions compared to their peers who less strongly valued athletic achievement.

The results suggest the potential utility of standardized approaches to communicating concussion risk consistently to athletes. This can help ensure that all athletes are uniformly able to make informed decisions about continued exposure to concussion risk that are based on their values and preferences.