A Survey of Sports Concussion Specialists' Clinical Criteria to Determine Concussion Recovery

We sought to identify criteria used by sports concussion specialists in determining recovery from sport-related concussion. We hypothesized differences in decision-making criteria among three specialist groups, neuropsychologists, physicians, and certified athletic trainers (ATCs), for youth athletes and young adult/adult athletes.

We surveyed 156 sports concussion specialists (neuropsychologists = 46, physicians = 42, and ATCs = 68) who rated the importance of specific criteria for determining concussion recovery in youth and young adult/adult athletes. Differences between these specialist groups were examined with Kruskal-Wallis tests. Modal ratings for each age group by specialist were also examined.

There were significant differences (all p < .001) in criteria ratings across specialist groups regarding youth and young adults/adults for "use of neurocognitive test scores," "balance testing," "physical examination," "no symptom provocation with neurocognitive testing," "athlete report of anxiety about return to sport," and "family member's report of recovery." For both age groups, physicians ranked "use of neurocognitive test scores" and "no symptom provocation with neurocognitive testing" as less important than other providers, while "physician examination" was ranked as more important. Neuropsychologists ranked "balance testing" and "athlete report of anxiety about return to sport" as less important than other providers, and ATCs ranked "family member's report of recovery" as less important than other providers. Modal ratings provided more detail.

These results advance understanding of multidisciplinary standards of care in determining recovery from sports concussion and suggest the importance of collaboration in establishing clinical criteria common to all sports concussion health care providers.