O3265: Management of Acute Injuries and Illness in Pediatric Athletes by Athletic Trainers: Compliance with Emergency Medicine and Athletic Trainer Evidence-based Guidelines

Background: Over the last decade the Pediatric emergency department around the country has seen a vast increase in the number of sports-related injuries as more of the general population is becoming involved in recreational sports at an earlier age. Today, close to fifty percent of children (10-18) compete in competitive sports. (Broglio, Steven P, et al. 2014). As a result, sports injuries make up about one-fifth of all injury related visits seen in the emergency department. (CDC). Given majority of pediatric sports related injuries occur within the field of play, Athletic Trainers have adapted the role as crucial first responders. Quick injury diagnosis, and safe disposition management is essential for potential serious injuries. This study analyzed published athletic trainer guidelines vs emergency medicine guidelines to improve management and disposition of pediatric sports injuries.

Methods: A case-based questionnaire describing ten acute injuries and illness in pediatric athletes [closed head injury (4), cervical spine injury (1), blunt chest injury (1), blunt abdominal injury (1), ankle injury (1), knee injury with laceration (1), syncope/heat-related illness (1)] was electronically distributed to members of the National Association of Athletic Trainers (NATA). On-the-field management decisions for each case (transport to the emergency department, transport to an urgent care center, sideline observation, follow up with primary care provider within 2-4 days, immediate return to play) were compared with evidence-based practice guidelines. Practice guidelines utilized were those based on the Pediatric Emergency Care Applied Research Network (PECARN), NATA, American Heart Association, and other evidence-based guidelines.

Results: Analysis was performed on 564 completed questionnaires (9% response rate). The majority of responders were compliant with evidence-based practice guidelines except for blunt chest trauma with tachycardia, blunt abdominal trauma with shortness of breath and tachycardia, closed head injury with loss of consciousness, and closed head injury with repetitive speech. Discrepancies between EM and AT guidelines were identified, and included closed head injury with repetitive speech, closed head injury and height of fall, closed head injury and unequal pupils, and cervical spine injury associated with neck pain and paresthesias.

Conclusion: Athletic trainers were compliant with evidence-based guidelines for the on-the-field management of common pediatric injury and illness except for blunt chest trauma with tachycardia, blunt abdominal trauma with shortness of breath and tachycardia, closed head injury with loss of consciousness, and closed head injury with repetitive speech. In order to provide the best care to pediatric athletes who sustain injury or illness, EM and AT providers should develop collaborative guidelines based on the evidence.