Identify coach reported factors influencing decisions about potential concussion in youth sports.

Youth concussion in sport is an established public health concern. Coaches are the primary stakeholders deciding about removal from play for suspected concussion on the sidelines of competition and practice in most youth sports organizations.  Estimates indicate over 2 million adults coach youth sports.  Legislation across the U.S. and guidance from the Centers for Disease Control and the Concussion in Sport Group recommend players with suspected concussion be removed from play and not return prior to medical clearance and a graduated return to play protocol be followed.

Qualitative semi-structured 1:1 interviews with coaches of youth community or school sponsored athletic programs in Illinois.  Interview data was analyzed according to a constructivist grounded theory methodology employing constant comparative methods with an inductive approach to theme emergence.  

Sixteen coaches of recreational, competitive and scholastic athletic teams participated.  Coaches were primarily white (94%) males (81%) with an average age of 47.  Ten were volunteer coaches.   Analytic themes related to decision making include:   1) personal experience drives decisions more than concussion training, 2) coaches fear the legal liability of missing a concussive event on the field, and 3) discomfort with the ambiguity of making decisions on the field.   Coach perceived factors for improving comfort with decision making were:  1) availability of checklists or tools for use on the sidelines, 2) improve shared decision making with all stakeholders, and 3) access to medical professionals on the sidelines.  

There is a possible misalignment between coaches’ actual practices on the field and best practice guidelines.  Coaches report behaviors on the sidelines that are distinct from practice guidelines and public health initiatives related to removal from play and return to play when events on the field present the potential for concussion.