Abstract
Background:
Delays in receiving timely medical care following an injury can result in adverse health outcomes. Previous research found that school socioeconomic status (SES), geographic location, and school type are associated with general athletic trainer (AT) availability, but it is unclear how these factors are associated with AT accessibility, measured as time from injury to AT evaluation. The purpose of this study was to investigate how institutional factors (SES, geographic location, school type) are associated with time to an AT evaluation following acute injury in the high school setting.
Hypothesis:
Various institutional factors associated with decreased AT availability (i.e., lower school SES, town/rural geographic location, private school type) will predict delays in AT evaluation.
Methods:
This study combined injury surveillance data obtained from High School RIO with results from an online questionnaire (2023-2024 academic year). Time to AT evaluation was categorized as 1) at the time of injury, 2) after injury occurred but within 24 hours, 3) 24-48 hours after injury, 4) 49 hours to greater than one week following injury. School SES was estimated using the percentage of residents with a bachelor’s degree or higher in the zip code of the school. Geographic location was categorized as city/suburb or town/rural. School type was categorized as public or private. Ordinal logistic regressions were used to assess the relationship between institutional factors and time to AT evaluation. Results were reported as adjusted odds ratios (aORs) with 95% confidence intervals (CIs).
Results:
A total of 1,995 injury reports were included in analysis. Most athletes (74%) were evaluated at the time of injury. School SES and geographic location were significantly associated with time to evaluation, while school type was not. A 10% increase in SES was associated with lower odds of an immediate evaluation (aOR = 0.98, 95% CI: 0.98-0.99). The odds of a delayed evaluation were 39% lower for town/rural schools compared to city/suburb schools (aOR = 0.61, 95% CI: 0.48-0.78).
Conclusion:
ATs provide timely access to qualified healthcare for student athletes, as nearly three in four athletes in our dataset were immediately evaluated after sustaining an acute injury. Higher school SES and town/rural geographic location were associated with lower odds of a delayed evaluation. While these factors are not modifiable, schools should work to enhance AT accessibility through structural changes to reduce disparities and help ensure that all student athletes receive equitable and timely medical care following an injury.