Going Beyond the State Law: Investigating High School Sport-Related Concussion Protocols

State laws provide general guidelines for sport-related concussion (SRC) management but do not comprehensively address the multiple layers of management for this complex injury. Although high schools are encouraged to develop SRC protocols that include both state law tenets and additional management practices, the execution of these protocols warrants examination.

To investigate state law compliance and practice components included in high school SRC protocols and determine whether the degree of sports medicine coverage influenced protocol quality.

Qualitative document analysis.

High school athletics.

In total, 184 Pennsylvania high schools (24.3% of schools statewide; full-time athletic trainers [ATs] = 149, part-time ATs = 13, missing = 22) voluntarily provided copies of their protocols from the 2018-2019 academic year.

Four ATs conducted document analyses using a 67-item component analysis guide. Frequencies were computed for included protocol components related to the state law, preparticipation and prevention, recognition and assessment, and management. The difference in the total number of included components (maximum = 60) by sports medicine coverage was assessed using a Mann-Whitney U test.

Heterogeneity existed in the components included in the submitted protocols. Only 23.4% included all mandatory state law tenets. Immediate removal from play was noted in 67.4% of protocols, whereas only 1.6% contained prevention strategies. Return to play was addressed more frequently than return to learn (74.5% versus 32.6%). The sample had a mean of 15.5 ± 9.7 total components per protocol. Schools with full-time sports medicine coverage had more protocol components than those with part-time ATs (15 [interquartile range = 8.5-22.5] versus 6 [3-10.5] median components; U = 377.5, P < .001).

School-level written SRC protocols were often missing components of the state law and additional best-practice recommendations. Full-time sports medicine coverage in high schools is recommended to increase SRC protocol and health care quality.