2015 ISAKOS Biennial Congress ePoster #2606
The Team Physician and the Athletic Trainer: Do We Agree?
Fotios P. Tjoumakaris, MD, Egg Harbor Township, NJ UNITED STATES
Nicholas Lombardi, BS, Egg Harbor Township, NJ UNITED STATES
Luke Austin, MD, Egg Harbor Township, NJ UNITED STATES
Matthew Pepe, MD, Egg Harbor Township, NJ UNITED STATES
Kevin Freedman, MD, Bryn Mawr, PA UNITED STATES
Katherine Bagnato, ATC, Egg Harbor Township, NJ UNITED STATES
Bradford Tucker, MD, Philadelphia, PA UNITED STATES
Rothman Institute of Orthopaedics, Egg Harbor Township, NJ, USA
FDA Status Not Applicable
Summary: The purpose of this study was to determine the rate of agreement between the physician and ATC’s with regard to student athlete injury and diagnosis.
It is standard practice in high school athletic departments for certified athletic trainers (ATC’s) to formulate a diagnosis and treatment plan for injured high school student athletes. In select instances, athletes are then referred on for definitive medical management and treatment by a supervising team physician. Improving the agreement of ATC’s and physicians likely results in more accurate diagnoses which translates to improved treatment of the injured athlete. The purpose of this investigation was to determine the rate of agreement between the physician and ATC’s with regard to student athlete injury and diagnosis.
Between 2010 to 2012, a prospective athletic injury database was maintained by a regional healthcare system athletic training staff. All athletes injured during this time were included in the database. All patients that were referred on for physician evaluation and treatment were identified and included in this analysis. Specific diagnosis (both by ATC and physician), physician subspecialty, and diagnostic concordance were analyzed and determined by review of medical records and radiographic imaging.
344 incidents met our inclusion criteria (both ATC and physician evaluation). 305 (88.7%) of the ATC and physician diagnoses were in agreement. Of the 39 diagnoses that were discordant, 3 (7.7%) required surgical management. 16 of the 39 “disagreements” (41%) involved fractures and 9 (23.1%) involved sprains. Concordance between the ATC and physician was high when the diagnosis was a dislocation (100%), abrasion/laceration (100%), concussion (98.5%), strain (91.7%) or contusion (88.9%).
ATCs are highly skilled professionals who are well trained in the evaluation of acute athletic injuries, with a nearly 90% rate of agreement with the covering physician. It has been reported that in the absence of a confirmed diagnosis, precision amongst health care providers can be used to infer accuracy. Utilizing this principle implies that as the physician and ATC improve agreement, there is a better likelihood of arriving at the “correct” diagnosis and treatment plan. This study identified areas where further education and communication may be necessary amongst providers, namely with fractures and joint sprains. Better care for student athletes can lead to quicker diagnoses, rehabilitation and recovery.