Study Reveals Inequities in High School Concussion Protocols

New Jersey father Tshon Wells’ son suffered a ruptured blood vessel in his brain following a concussion on the football field. When recalling the serious injury from years ago, he said his son was “dizzy.”

“He said he was seeing stars. Then he got a pounding headache where he couldn’t keep his eyes open,” said Wells. His son was taken to the hospital that night, and Wells was told that if they had waited another 10 minutes to get him there, his son may have died. The young football player was involved in a nasty collision during practice that day and, afterward, was told to get up and sit on the sidelines. “There were no initial tests done. I don’t know if the coaches were trained in that,” Wells added.

A study published in the journal Concussion, conducted by Kean University’s assistant professor, Dr. James Stavitz, PhD, found disparities in responses to concussions in high school football. A qualitative or interview-based study, titled  “Exploring Athletic Trainers’ Experience and Perceptions Associated with a Multifaceted Approach to Concussion Management,” found that not all student-athletes were given the proper assessment, care, time to heal, and follow-up after a concussion or suspected concussion on the field. “I interviewed 20 different athletic trainers and got 20 different answers,” Stavitz stated in an exclusive interview with NJ Urban News.

The study found that the vast diversity across the state in athletic budgets and demographics made a difference in the athletic trainers’ preparation and ability to assess youth in these emergency scenarios properly. Wells added that better equipment care could have protected his son.

Because no two concussions are the same, present the same, or require the same management, best practices for athletic trainers call for a multifaceted approach. The study found that every suspected concussion, among other steps, should include a clinical evaluation and symptom checklist. An athletic school counselor from Paterson Public Schools said that coaches there have required training in concussion protocol. “Everyone’s approach to concussions is different,” Stavitz advised. “How do we make a fluid process where everybody uses the same approach, no matter the demographics or resources available?”

In addition to money, time is a variable, as the study found that trainers are often under pressure from coaches, parents, and the athletes themselves to return to the field quickly. Former emergency room registered nurse Shalmirah Figueroa, MSN, RN, who has treated many concussions, said that if there is one thing she would advise high school athletic personnel, it would be to give athletes time to heal. “The trauma to the brain needs to heal. Some kids go back too soon. Most concussions need a few days or longer to heal,” she said. As more information on CTE (chronic traumatic encephalopathy) is made known, Stavitz agrees and says that returning athletes to the field too quickly can compromise their recovery and lead to worsening outcomes. 

Stavitz pointed out the importance of high school athletics, noting that New Jersey is one of the first states to have legislation around concussion protocol. As a New Jersey high school defensive back player, Dr. Stavitz recalls no concussion protocol in his high school football program. “I was told to put a bag of ice on my head. There was no baseline test,” he remembered. 

With the study’s publication, Stavitz hopes that all student-athletes in the state will receive the same assessment and treatment for concussions, with one set of state standards that every athletic trainer abides by during each occurrence, no matter the football program’s budget and demographics. After more research, he wants to share the importance and outcomes with athletic directors around the state during in-depth presentations. 

Dr. Stavitz teaches at Kean’s graduate-level athletic training education department. This study was conducted as part of Kean University’s commitment to research, as the university is pursuing designation as a Carnegie R2 institution.