Case Characterization and Perceptions of Athletic Trainers Regarding Medical Disqualification Following Concussion.

Context: Medical disqualification (MDQ) following concussion is a challenging decision clinicians may encounter with little evidence-based guidance.

Objective: To (1) describe the MDQ following concussion cases athletic trainers (ATs) have been involved in, (2) describe beliefs about MDQ following concussion, and (3) explore factors that ATs believed should be involved in the MDQ following concussion process.

Design: Mixed methods.

Setting: Online cross-sectional survey with follow-up semistructured interviews.

Patients Or Other Participants: Athletic trainers (n = 502) employed at the collegiate setting completed a survey (completion rate = 82.3%, n = 413/502; men = 175, 34.9%; women = 235, 46.8%, prefer not to answer = 4, 0.8%; no response = 88, 17.5%; age = 35.3 ± 10.8 years). Twenty participants were also interviewed (men = 13, 65.0%; women = 7, 35.0%; average age = 40.7 ± 11.0 years).

Data Collection And Analysis: Participants completed a cross-sectional survey comprised of 3 sections of MDQ experience and specific case information, MDQ beliefs, and demographic items. We also interviewed participants who completed the survey and indicated involvement in at least 1 MDQ following a concussion case. We addressed aims 1 and 2 using descriptive statistics and aim 3 with a 5-cycle content analysis.

Results: Nearly half of respondents had been involved in an MDQ case following concussion (49.0%, n = 246; not involved = 51.0%, n = 256). Athletic trainers who had been involved in at least 1 MDQ case were involved in an average of 2.3 ± 1.9 cases (n = 241). Participants often described many factors that they believed should influence the MDQ decision, including sport type, concussion history and recovery, health-related quality of life, and academic performance.

Conclusions: Our findings highlight that nearly half of participants were involved in an MDQ case following concussion and navigated this process without guidelines. Given this, multiple factors were considered to evaluate the patient's well-being holistically. The number of ATs involved in MDQ cases following concussion and factors that guided this process warrant further research to develop evidence-based recommendations that assist clinicians in these difficult decisions.