Objective To examine the concussions management protocols (CMPs) from the 65 institutions within the NCAA Power 5 conferences for compliance with the NCAA 2015 concussion guidelines.

Design Descriptive Study.

Setting N/A.

Participants 65 universities of NCAA conferences: Atlantic Coast, Southeastern, Big Ten, Big 12, and Pacific-12

Interventions The 65 publicly-available CMPs were evaluated for compliance with the 47 NCAA rules and guidelines (combined N=3,055). Each CMP was reviewed and graded “yes” or “no” for each recommended or required item and compliance was reported descriptively.

Outcome measures Overall compliance rate, mean, item-level, category-level, and institution-level compliance with the 47 items. Each institution’s athletic training staff size, academic performance, and athletic performance were examined as independent predictors with quasi-binomial regression.

Main results CMPs varied substantially in length (range: 4-66 pages) and level of detail. The overall compliance rate for all components across all institutions was 94.3% (2,880/3,055). Twelve components achieved 100% institutional (65/65) compliance, and the lowest levels of compliance were clustered in “Return-to-Learn” (RTL). There were 22 institutions that achieved a 100% compliance rate; the lowest institutional compliance was 59.6%. There were no significant associations between the independent predictors and institutional compliance.

Conclusions Overall compliance with NCAA concussion management requirements was high, but there remains room for improvement. There was low compliance with RTL as well as limited details provided in the reducing head trauma component. Items with lower compliance (reducing head trauma, return-to-learn) tended to be outside the core competencies of the medical staff, indicating an area for improvement.

Competing interests None.