Zusammenfassung

CONTEXT: Return to play after sport-related concussion (SRC) requires authorized clearance from a health care provider (HCP). The variability in HCPs and facilities where athletes seek care may influence return time. OBJECTIVE: To identify the initial examiner, HCPs who authorize clearance to return to play, and medical facilities that authorize clearance to return to play for high school student-athletes after SRC and compare authorized clearance time by HCPs and medical facilities. DESIGN: Prospective cohort study. SETTING: High school. PATIENTS OR OTHER PARTICIPANTS: Student-athletes (n = 16 001) with SRC participating in athletics sponsored by the Michigan High School Athletic Association. MAIN OUTCOME MEASURE(S): Frequencies of initial examiner and authorized clearance for each HCP (doctor of osteopathic medicine, medical doctor, nurse practitioner, physician assistant) and medical facility (neurologist's office; team physician, primary care physician or pediatrician's office [PCP]; hospital; urgent/ready care) for each case of SRC. We calculated Kaplan-Meier curves and Peto tests to evaluate differences in the median time to authorized clearance between HCPs and facilities. Only cases with a date on which clearance to return to play was authorized (80.3%; n = 12 856) were included in the authorized clearance and time-to-return analyses. RESULTS: An athletic trainer was at least 1 of the initial examiners in 71.3% (n = 11 404) of SRC cases; 81.2% (n = 12 990) had only 1 initial examiner. We observed an association between the initial examiner and the medical facility providing clearance for athletic director (χ(2) = 52.6, P < .001, V = .06), athletic trainer (χ(2) = 172.0, P < .001, V = .12), coach (χ(2) = 161.5, P < .001, V = .11), doctor of osteopathic medicine (χ(2) = 59.4, P < .001, V = .07), and nurse practitioner (χ(2) = 10.0, P = .04, V = .12). Clearance was authorized most frequently by a medical doctor (63.9%, n = 8218) and at a PCP (70.8%, n = 9099). Median (interquartile range) time ...