Delays in Immediate Athletic Training Evaluation Following Concussion Among High School Football Players: A Report From the Athletic Training Practice-Based Research Network

Context: Football is the most popular sport among high school boys in the United States. Concussion risk is elevated in the sport due to the high degree of physical contact. Healthcare providers are more likely to be present at the time of concussion during games and for varsity-level athletes, but how time to an immediate athletic trainer (AT) evaluation varies between sport levels and injury settings has yet to be investigated.Objective: Investigate associations between athlete sport level, injury setting, and same day AT evaluation among high school football players following a concussion. Design: Cross-sectional study.Setting: Retrospective analysis of de-identified patient records created within the Athletic Training Practice-Based Research Network.Patients: Patients evaluated and diagnosed with a concussion during in-season high school football participation from 2010-2023. Main outcome measure: Sport level (freshman, junior varsity [JV], varsity), injury setting (game, practice), and same-day evaluation following concussion (yes, no). Results: 1,260 patient cases were included in analysis. A significant association was found between sport level and same-day evaluation (p=0.02), and between injury setting and same-day evaluation (p<.001). A higher percentage of patients playing at the varsity level were evaluated the same day as their injury compared to those playing at the JV and freshman levels. Additionally, a higher percentage of football athletes were evaluated the same day if they sustained an injury during an in-season practice compared to a game. These associations remained significant after stratifying by sport level for freshman (p=0.01) and JV (p<.001) athletes, but not for varsity athletes (p=0.61).Conclusions: Freshman and JV football athletes, as well as those injured during games, are less likely to receive a same-day evaluation by an AT after concussion. Timely care improves recovery following concussion, emphasizing the need for equitable access to immediate care across sport levels and settings.