Medical Retirement From Sport After Concussion: A Survey of Perspectives and Experiences of Collegiate Physicians and Athletic Trainers.

Abstract

Objective: To identify status of and barriers to sports health care providers engaging in discussions to guide athletes considering retirement (also known as disqualification) in the context of sports-related concussion (SRC).

Design: An observational, 1-time questionnaire.

Setting: In advance of the in-person 2018 Big10-Ivy League Traumatic Brain Injury Consortium meeting, a clinical-research summit on SRC, all invitees were asked to complete an anonymous survey.

Participants: Health professionals and staff supporting multiple Division I organized collegiate sports medicine programs.

Assessment: Survey instrument.

Main outcome measures: Measuring of attitudes, awareness, and gaps in SRC retirement care.

Results: Eighty-one participants included 40 from the Ivy League (53%) and 30 from Big10 (39%). Most were athletic trainers (n = 31, 38%) or physicians (n = 23, 28%). On average clinicians were 16.0 years (SD = 13.0) from their terminal degree; most were aware of medical retirement post-SRC and engage in discussions (n = 62, 86%). Physicians were more aware of a published tool for decision making (39% for MDs, 7% for trainers, P = 0.03); trainers were more likely to discuss retirement only in special cases (56% vs 23%, overall P = 0.03). Knowledge, preparedness, and confidence with discussions did not differ by role; years of provider experience was not associated with any outcomes.

Conclusions: Safe return to athletics and academics after SRC follows protocols, but processes by which medical retirement takes place remain in development and without consensus. Guidance for medical retirement after SRC exists but this survey suggests gaps remain between skills and self-perceived abilities to discuss medical retirement after SRC. Retirement is considered important in SRC care but remains underdeveloped in sports medicine education.

Summary statement: These findings identify gaps in knowledge and skills training around retirement discussions and provide opportunities for closing these gaps with targeted training.