Concussion Awareness Research Articles

Wrestling-related concussions and closed head injuries predominantly occur in high school age athletes.

Sports-related concussions (SRC) and closed head injuries (CHI) have recently garnered national attention given mounting concern for long-term neurological sequelae resulting from repetitive head trauma. Despite historically dangerous techniques in wrestling that involve impacts to the head, there is a paucity of epidemiologic data in regard to wrestling-related concussions (WRCs) in the United States (USA). The National Electronic Injury Surveillance System (NEISS) database was queried (2000-2018) to report national estimates and demographic characteristics of patients 6-25 years of age presenting to US emergency departments (EDs) with WRCs and CHIs. The average annual number of patients presenting to US EDs with WRCs or CHIs was 3465 (95% confidence interval [CI]: 2489-4441). Over one-third of patients were between 15 (17.7%; 95% CI: 15.8%-19.7%) and 16 (17.0%; 95% CI: 14.9%-19.1%) years of age, which comprised the peak age groups during which such head injuries were sustained. The vast majority of patients were male (96.3%; 95% CI: 94.8%-97.7%). Lastly, 6.2% (95% CI: 4.3-8.2%) of patients did not present to the ED on the same day that the injury was sustained. Due to the unique nature and culture of the sport, wrestlers may be more likely to attribute SRC or CHI symptoms to normal training-related fatigue, which can lead to underreporting or delayed diagnosis. It is therefore imperative that appropriate safety initiatives and concussion awareness campaigns be implemented in youth wrestling to decrease the incidence of SRCs at local and national levels.

Removal From Activity Following Sport-related Concussion In Sex-comparable Sports

As sport-related concussion (SRC) awareness has increased, timely reporting and immediate removal from play have become a focal point of proper management. Delayed removal may result in additional injury and protracted recovery. Research has demonstrated that girls are more honest and likely to report their concussion symptoms compared to boys. However, it is unknown if these reporting behaviors correspond with immediate removal from play in girls compared to boys in sex-comparable sports. PURPOSE: To compare the incidence of high school athletes not removed from activity following SRC in sex-comparable sports in Michigan. METHODS: An epidemiological study of athletes diagnosed with SRC participating in Michigan High School Athletic Association-sponsored basketball, baseball/softball, and soccer from 2016-2019 was performed. All SRCs were recorded in a Head Injury Reporting System by certified athletic trainers, administrators, or coaches. Removal from activity indicated the athlete was removed from play at the time of an injury event. Lack of removal does not indicate mismanagement at the time of the event, but that the injury was not reported. Incidence was calculated by dividing SRCs not removed by total SRCs in each sport. Risk ratios were calculated by dividing the incidence of girls not removed by boys not removed in each sport. RESULTS: A total of 3696 (2425 female, 1271 male) SRCs were reported, with the most occurring in girls’ soccer (n = 1024). Overall, 442 girls and 182 boys were not removed from activity, resulting in incidences of 0.18 (95% CI, 0.17-0.20) and 0.14 (95% CI, 0.12-0.16), respectively. Across all sports, girls were 1.27 (95% CI, 1.09-1.49) times as likely to not be removed from activity compared to boys. Girls had 1.16 (95% CI, 0.91-1.50), 1.19 (95% CI, 0.77-1.84), and 1.41 (95% CI, 1.12-1.78) times the risk of not being removed from basketball, softball, and soccer, respectively, when compared to the equivalent boy sports. CONCLUSIONS: Girls were at greater risk of not being removed from activity compared to boys in sex-comparable sports. Although girls are more likely to report symptoms of SRC, there is still a gap in their removal from play, potentially due to a delayed onset or recognition of symptoms. Future research and initiatives should target reporting and removal in female sports.

Concussion knowledge, attitudes and behaviour in equestrian athletes

ObjectiveTo determine knowledge, attitudes and behaviour towards concussion in adult equestrian athletes. DesignNationwide, cross-sectional, questionnaire. MethodsParticipants were recruited via advertisements circulated through social media, community presentations and equestrian organisations. Participants were sent a web link to an online questionnaire previously designed for high school athletes and modified to ensure relevance to equestrian activities. The percentage of correct responses per item and a total knowledge score were calculated. Differences in concussion knowledge by age, sex, level of experience and previous history of concussion were explored using t-tests, 95% confidence intervals (CI) and effect sizes. ResultsThe questionnaire was completed by 1486 participants (Mean age=39.1±15.4). Knowledge of what concussion was, how to recognise it and key symptoms (except poor sleep) was high (>80%). In contrast, awareness of guidelines was moderate (56%) and inability of helmets to prevent concussion was low (12%). Significantly higher levels of knowledge of concussion were identified in females compared with males (t=-6.55 p<0.001, 95%CI=-3.26 to -1.75). The majority (87%) of participants reported that a helmet should be replaced after a fall, yet 46% reported re-using a helmet following a hit to the head. ConclusionsKnowledge of and attitudes towards concussion were positive. However, there were knowledge gaps and discrepancies between some attitudes and behaviour on some aspects of concussion. Targeted campaigns to promote awareness of concussion and improve recognition and onward management are needed. Education related to equestrian activities such as helmet use and injury mechanisms is needed to change behaviour and minimise the risk of injury.

Effects of a faculty training program on knowledge and awareness of student concussion and academic performance

Objective The purpose of this pilot study was to determine the feasibility of implementing a concussion educational program to college faculty and to explore the effect of the program on faculty knowledge regarding concussion and the effect on learning and return to school. Methods: The study utilized a mixed method design, with a pretest and post-test to measure concussion knowledge before and after a didactic presentation on concussion and academic performance. Semi-structured interviews gathered information on faculty’s perception of concussion and academic performance. Results: Faculty demonstrated improved scores on post-test knowledge assessment of concussion and academic performance. Faculty reported that they would be more likely to observe for signs of concussion in students, and would be more willing to adhere to recommendations for academic accommodations. Conclusions: The results of the study indicate that a didactic presentation on concussion and academics may be a feasible method for training college faculty.

Tackling Concussion Liability Head-On: Stakeholders’ Standard of Care

The catastrophic consequences associated with the mismanagement of concussions can threaten the health and well-being of student-athletes. The primary purpose of this article is to increase awareness of concussions and provide stakeholders—parents, coaches, and athletic trainers—with an appropriate framework for concussion care at every level of play. The culmination of court rulings, legislature, and cautionary tales will educate stakeholders of the shared legal and ethical responsibility of creating and implementing appropriate concussion management procedures, which includes fostering a culture where student-athletes feel safe to report symptoms and remove themselves from the competition.

Return to Learn: Academic Effects of Concussion in High School and College Student-Athletes.

While awareness and understanding of concussion have improved drastically, post-concussion management in academic settings is still at its infancy. The aim of the study was to examine to what extent concussion influences academic performance and to whether there would be a difference in concussion effects on academic performance between high school and college students. This cross-sectional survey study included students, who were between 14 and 24 years old and sustained a sport-related concussion within the previous year. The study used a modified chain-referral sampling method, by distributing a questionnaire link to 3,000 randomly stratified athletic trainers, who worked in high school or college settings. These athletic trainers were then asked to forward the questionnaire link to students in their team, who have sustained a concussion within the previous year. The questionnaire recorded responses regarding demographics (age, sex, race/ethnicity, number of previous concussions); 22 concussion-related symptoms in a binary scale (presence/absence); perception of difficulties in math, reading, writing, computer use, and attention in a 5-point Likert scale; and asymptomatic duration of academic engagement in a 7-point Likert scale. There were 130 respondents with a history of concussion in the past year (n = 59 high school, n = 71 college). While recovering from concussion, significantly more college students (84.5%) reported “difficulty concentrating” than high school students (68.6%: p = 0.049). High -school students experienced more difficulty with math than college students (p = 0.002), whereas college students experienced more difficulty with reading (p = 0.013) and computer use (p = 0.026) than high school students. Asymptomatic duration of cognitive activity was influenced by age (p = 0.0004), where younger students were less tolerant in performing academic tasks after a concussion than older students. Our data indicate that concussions can induce negative symptoms in the academic setting regardless of age. The post-concussion difficulties in academic performance may be a grade-dependent manner, where concussions triggered difficulty in math among high school students and in reading and computer use among college students. It is clear that there is a need for guidelines and accommodations to support students with concussion in academic settings, and the guideline should reflect the age-dependent response to concussions.

The youth concussion awareness network (You-CAN) - a school-based peer-led intervention to improve concussion reporting and social support: the protocol for a cluster randomized trial

BackgroundConcussion prevalence is increasing in the pediatric population, and is a matter of public health concern. Concussion symptoms can be physical, cognitive, emotional and behavioural, and last longer in high school aged youth than adults. Concussions are underreported in youth due to their lack of knowledge, social environment, perceived outcomes of reporting, norms, and self-efficacy. The Youth Concussion Awareness Network (You-CAN) is a school-based peer-led program designed to increase high school students’ intent to report a concussion, and provide social support to a peer. This study aims to investigate whether participation in You-CAN, a program grounded in service learning principles, impacts concussion knowledge, attitudes, intent to report a suspected concussion to an adult, and intent to provide social support to a peer. Secondary aims include assessing the implementation fidelity and acceptability of the intervention.MethodsThis longitudinal study will use a cluster randomized trial design. Three high schools from six randomly selected Canadian school boards will participate and be randomized to three study arms: (1) You-CAN led by school staff; (2) You-CAN led by school staff and research team; and (3) untreated comparison group. Intervention arms 1 and 2 will deliver the You-CAN program and create a Concussion Council at their school. The Concussion Council will deliver a concussion awareness campaign and participate in an online showcase with other participating schools. In addition, arm 2 will have monthly video-calls with the research team. A survey based on the Theory of Planned Behaviour will be administered school-wide with all arms (1, 2, 3) at two time points (beginning {T0} and end {T1} of the school year). Exit interviews will be completed with the Concussion Councils and participating school staff.DiscussionThis study will provide evidence of the effectiveness of a school-based peer-led concussion program on increasing concussion knowledge, attitudes, subjective norms, perceived behavioural control, intent to report a concussion to an adult, and intent to provide social support to a peer amongst Canadian high school students. It will also provide important information about the implementation and acceptability of the You-CAN program for high school students and staff.Trial registrationThis trial is registered with the ISRCTN registry (ISRCTN64944275, 14/01/2020, retrospectively registered).

Sports-Related Concussion in Adolescent Gaelic Games Players.

Gaelic games are some of the most popular sports played by Irish adolescents, and the Gaelic Athletic Association has undertaken educational initiatives to improve awareness of a sports-related concussion (SRC). However, SRC underreporting is common among adolescent athletes internationally, potentially due to poor knowledge or attitudes toward SRC. This study aimed to examine previous experiences with, knowledge of, and attitudes toward reporting SRCs, as well as views on future education in adolescent Gaelic games players and their parents. The hypotheses were as follows: (1) A significant number of adolescent Gaelic games players will have experienced an SRC, (2) nondisclosure of SRCs will be common, and (3) adolescents will display poorer attitudes toward reporting than parents. Cross-sectional study. Level 3. Adolescent male and female Gaelic games players (n = 113) and parents (n = 151) completed an anonymous questionnaire examining previous experiences with, knowledge of, and attitudes toward reporting SRCs, as well as views on future SRC education initiatives. Overall, 57.5% of adolescent Gaelic games players suspected they had suffered an SRC previously, and a greater number of suspected SRCs were reported than were medically diagnosed. Adolescent players (mean score, 11.4/14) and their parents (mean score, 11.8) displayed good knowledge of SRC signs and symptoms. However, adolescents were less likely to report an SRC during an important game or if an important game was coming up. Both adolescents and their parents would like more SRC education, particularly in the format of online videos or medical professional-led workshops. Underreporting of SRC occurs in adolescent players, despite good knowledge of SRC signs and symptoms. Education is required to highlight the importance of completing a return-to-play program after an SRC regardless of match importance. A multifaceted educational strategy that targets the wider Gaelic games community in the preferred formats identified by key stakeholders is required.

Novel Assessment for Interpreting and Documenting an Absence of Suspicion of Injury Including Protocols based on Recognizable Clinically-Relevant Neurophysiological Methods

ObjectiveOur goal was to develop and validate a neurophysiological assessment that provides objective evidence useful for interpreting and documenting an absence of suspicious injury by the sports-neuro community.BackgroundAs concussion awareness gains public notoriety, the pressure on athletic organizations for timely diagnosis has risen, leading to an increase in assessments detecting brain injuries. Furthermore, legislation has mandated evaluations of suspicious injuries before returning athletes to play. However, validation and standardization of these current tests have been remiss, and their data is often not familiar to athletic trainers.Design/MethodsWe conducted exams on 18 University of Cincinnati athletes from various sports teams. The 18 athletes were assessed after being pulled-from-play, sometimes including failed pulled-from-play, to document the athlete’s return-to-play. All 18 athletes were referrals sent by athletic trainers unsure of the presence of neurotrauma. The list of assessments includes: stereopsis measurements, phoria, oculomotor performance, near-point of convergence, pupil responses, visual suppression, and balance.ResultsAfter examination of the 18 participants, 4 were diagnosed having high suspicion of concussion while the other 14 were cleared to return-to-play. Of the 14 cleared athletes, 0 were found to exhibit any persistent or newly developed symptoms. These results suggest that this assessment can provide useful data for clinical concussive injury evaluation. These demographics can also be examined for developing normative data and increased sensitivity with baselines.ConclusionsWe feel that current concussion assessments for athletic organizations are inadequate. We identified a series of neurophysiological tests that are more clinically-relevant, easy to perform, and document as evidenced from the evaluations used on the University of Cincinnati athletes for diagnostic and return-to-play decisions. This assessment’s functionality goes beyond the sideline, providing valuable insight for documenting presence or absence of suspicious injury post-competition. We feel this model has enhanced clinical utility compared to the current widespread concussion sideline assessments.

US Centers for Disease Control and Prevention's HEADS UP Branding and Evaluation Process.

For 15 years, the US Centers for Disease Control and Prevention's (CDC) HEADS UP education campaign has focused on increasing awareness of concussion among children to reduce adverse outcomes from this injury. To keep pace with the rapid expansion in media coverage, research, state laws and education efforts on concussion, the CDC embarked on a comprehensive evaluation effort to assess the campaign's brand. The CDC conducted a multi-step process to evaluate HEADS UP. This included surveying partner organisations and focus groups targeting key audiences. The analysis demonstrated that most (70%) partner organisations have used the materials for 4 years or longer and more than half (51%) found the materials very useful or extremely useful. Focus groups with the campaign's target audiences yielded insights and opportunities to refresh the CDC HEADS UP brand. The need for more compelling images, prevention facts and use of eye-catching colours was signaled by all the campaign's target audiences. Updates focused on the use of data visualisation, more emotionally compelling images, and more engaging colours. The CDC also created a new tagline to focus on concussion prevention that encourages children and young people to think about protecting their brains from concussion so they can have a safer future. This paper describes the process used to update the branding of an educational health promotion campaign in order to meet the needs of key audiences. Findings can help others working to keep their educational campaigns relevant and aligned with an expanding and changing public health problems.

Concussion in Youth Sport: Developmental Aspects

Sport-related concussion (SRC) is a growing health concern, particularly in younger, at-risk athletic populations. These injuries commonly present with a wide range of clinical signs (i.e., poor coordination, behavioral, mood changes) and symptoms (i.e., headache, dizziness, difficulty concentrating), along with neurocognitive and vestibular/ocular impairments. This review of SRCs in youth athletes focuses on individuals 5–18 years of age and includes an overview of concussion (i.e., definition, signs/symptoms, epidemiology), as well as concussion education and awareness. This is followed by a review of SRC assessment and management strategies, along with common recovery, return-to-play, and treatment approaches. Finally, suggestions are made for future research and recommendations pertaining to SRC in youth athletes.

Awareness and Perceived Value of Eye Tracking Technology for Concussion Assessment among Sports Medicine Clinicians: A Multinational Study

ABSTRACT Objective The awareness of concussion as a serious and frequently occurring sports injury and its management has evolved significantly. One viable objective diagnostic tool is eye tracking technology. The authors hypothesized that while clinicians may be aware that assessing eye movements in concussed athletes can be beneficial, it is possible that, due to the novelty of the eye tracking technology and limited exposure, only a few actually use it in their practice. The study aimed to assess the awareness of eye movement deficits associated with concussion amongst sports medicine clinicians and to determine the utilization and perceptions of the eye tracking technology for concussion diagnosis. Methods An online 18-question survey was distributed internationally from January until December 2017 and completed by 171 sports medicine clinicians (sport physicians, therapists, general practitioners, neuropsychologists) from 32 countries. Results Respondents indicated that subjectivity of assessments remained a major limitation of established diagnostic tools. Eye tracking technology, despite its potential to attenuate this limitation, was only used by 12% of respondents. To diagnose concussion, 77% did not use any eye movement assessment tools other than own clinical assessment. With the exception of abnormal pupil light reflex, which was checked by 68%, eye movement deficits were inspected by less than half of the respondents (46.3 ± 12%). Conclusion Even among sports medicine clinicians who regularly attend to patients with concussions, there is insufficient awareness that concussion can lead to abnormal eye tracking behavior. Lack of exposure to the sensitive eye tracking equipment may be a limiting factor for using eye movement metrics for concussion diagnostics. Facilitating the awareness of objective methods, like eye tracking technology, may help assure the appropriate continuum of identification and treatment for concussed athletes. Increasing educational opportunities and practical experience of clinicians regarding concussive symptoms and potential innovative technology is strongly advocated.

HEADS UP to Brain Injury Awareness

HEADS UP is an educational initiative developed by the Centers for Disease Control. The goal is to raise awareness of concussion and other serious brain injuries to ultimately protect children and teenagers by improving prevention, recognition, and response. Initially, HEADS UP materials addressed the health care profession due to their important role in diagnosing and managing concussions, but the HEADS UP initiative now includes a focus on sports programs and schools as significant organizations to share concussion information with coaches, parents, and school professionals.

Racial and Ethnic Differences in Emergency Department Utilization and Diagnosis for Sports-Related Head Injuries.

Background: Prior studies have shown racial differences in concussion awareness and outcome.Objective: To assess if racial or ethnic differences exist in Emergency Department (ED) utilization and diagnosis for children with sports-related head injuries.Methods: We performed a retrospective, cross-sectional analysis of ED visits from 2008 to 2017 using National Electronic Injury Surveillance System (NEISS) data. Population-weighted ED visits for children age 7–18 years with a sport-related injury were included. We compared the probability of an ED visit being for an injury to the head or diagnosed as a concussion between children of different races/ethnicities. Analyses were adjusted for age, gender, sport, year, and location where the injury occurred.Results: We identified 11,529,994 population-weighted ED visits for pediatric sports-related injuries, of which 1,497,717 (13.0%) were injuries to the head and 619,714 (5.4%) received a diagnosis of concussion. Black children were significantly less likely than non-Hispanic white children to have their ED visit be for an injury to the head [Odds Ratio (OR) 0.72, 95%CI 0.65–0.79] or concussion (OR 0.58, 95%CI 0.50–0.68). Black children presenting to the ED with an injury to their head were less likely than non-Hispanic white children to be diagnosed with a concussion (OR = 0.71, 95%CI 0.59–0.85).Conclusions: Racial differences exist in both ED utilization for pediatric sports-related head injuries and in the diagnosis of concussion. Further work is needed to understand these differences to ensure all brain injured athletes receive optimal care, regardless of race.

Incidence, Awareness, and Reporting of Sport-Related Concussions in Manitoba High Schools.

Federal and provincial governments in Canada are promoting provincial legislation to prevent and manage sport-related concussions (SRCs). The objective of this research was to determine the incidence of concussions in high school sport, the knowledge of the signs, symptoms, and consequences of SRC, and how likely student athletes are to report a concussion. A cross-sectional survey of athletes (N = 225) from multiple sports in five high schools in one Manitoba school division was conducted. Participants in this study were well aware of the signs, symptoms, and consequences of SRC. Cognitive and emotional symptoms were the least recognized consequences. SRC is prevalent in high schools in both males and females across all sports. Of the 225 respondents, 35.3% reported having sustained an SRC. Less than half (45.5%) reported their concussion. Athletes purposely chose not to report a concussion in games (38.4%) and practices (33.8%). Two major barriers to reporting were feeling embarrassed (3.4/7) and finding it difficult (3.5/7) to report. There was, however, strong agreement (Mean 5.91/7, SD 0.09) when asked if they intend to report a concussion should they experience one in the future. The results suggest that high school athletes would benefit from more SRC education. Coaches and team medical staff must be trained to be vigilant for the mechanism, signs, and symptoms of injury in both game and practice situations. This study will also inform the implementation of pending legislation in Manitoba and perhaps other provinces in Canada.

Prevention and Management of Sport-Related Concussions in Uganda: A Case Study

Head injuries in sports often go unnoticed and untreated with a risk of increasing the severity of neurological difficulties for affected athletes. While there is much research on athletes in developed countries, the data on athletes from developing countries is lacking. Using a descriptive case study approach, this report focuses on concussions from four main sports (football, athletics, basketball and rugby). Emphasis was placed on those athletes who had been identified with a sport-related concussion (SRC). The phases of emergency, intermediate, rehabilitative, and return to sports participation were considered in this study. Three SRC cases from both male and female athletes were observed and interviewed for post-injury management from the emergency phase to return to sports participation. There was evidence of lack of specific pre-season screening of athletes for concussion history and standard care for concussed athletes in all the three cases observed using the best medical practice framework. Our study shows barriers such as knowledge among the sports resource providers; a law and policies to mandate care, and the absence of specific facilities for managing athletes with concussions. Implementation of sports health care policies is necessary to mandate care for athletes. Strategies for prevention and management of concussions are necessary, especially through increasing the awareness and knowledge using the Concussion Awareness Training Tool (CATT). Further studies with larger samples are encouraged to ascertain the magnitude of existing barriers.

Developing and Piloting a School-Based Online Adolescent Student-Athlete Concussion Surveillance System.

Despite increased awareness of concussions, epidemiologic surveillance efforts have been scarce, especially among adolescents. This project, which was developed with school stakeholders (certified athletic trainers [ATCs], nurses, athletic directors), piloted a public secondary school-based online surveillance tool for interscholastic and intramural sports and physical education-related concussions in New Jersey during 2014-2017 school years (SY). Participating public high schools (5 within 4 districts) and career-technical-vocational education districts (2 with 5 campuses) completed forms anonymously online via PsychData within 5days. There were 208 concussions reported, 115 in 2015-2016 SY and 93 in 2016-2017 SY. In fall 2015, 86 concussions were reported, including 16 from summer preseason. In fall 2016, 56 concussions were reported; 3 occurred during preseason. There were 7 concussions reported in winter 2016 and 16 in winter 2017. Twenty-two concussions were reported in spring of both 2016 and 2017. Most online forms were completed in <10minutes, usually using either desktop computers or tablets/iPads. School nurses followed by ATCs were primary sources of data entered online, usually by ATCs. Cooperation of nurses and ATCs at participating schools suggested online surveillance was valued and viable. Data inform future concussion prevention education and ongoing injury surveillance.

Impact of an inter-professional concussion awareness program for intramural athletes on students’ readiness for inter-professional learning

Abstract Sports-related concussions are the third leading cause of traumatic brain injuries in student athletes throughout the country. In a survey of all NCAA member institutions, most respondents (92%) indicated that their school had a concussion management plan and most respondents (76%) indicated that their institution had a process for annual athlete concussion education.1 However, it is unclear how much education and training on concussion that intramural athletes receive at the college level. Two inter-professional teams comprised of graduate students from four health science disciplines presented 30–45 min concussion awareness programs to student intramural athletes. The objectives of this program were to promote effective communication, to improve readiness for inter-professional training, and to better understand each discipline's scope of practice related to concussion prevention, diagnosis, and management. Training teams were assessed pre- and post-presentation utilizing a modified “Readiness of health care students for inter-professional learning” (RIPLS) instrument and a knowledge assessment. Inter-professional education team competencies and oral communication skills were assessed utilizing a presentation scoring rubric. Significant differences were identified between pre- and post-presentation results in both the RIPLS and knowledge assessments. Student instructors' perceptions were that when they engaged in their discipline-specific role in concussion management, they gained a better understanding of the roles of other health professionals and increased their overall knowledge. This project allowed inter-professional student teams to increase their readiness for inter-professional training, knowledge, and scope of practice of other disciplines related to concussion prevention, diagnosis, and management strategies.

Concussion Awareness of Sports Physicians

Concussion Awareness of Sports Physicians

Parental knowledge of concussion: Evaluation of the CDC's “Heads up to parents” educational initiative

Background: Potential negative outcomes associated with sport-related concussion drive the need for resources to educate parents about prevention, recognition, and management of concussion in the youth athlete. Parents play a critical role in the recognition and management of concussion for their child. Purpose: This study aims to (a) investigate current knowledge of concussion among parents whose children age 5–18 years play a club sport and (b) identify effects of an online video versus online print educational intervention on concussion knowledge change and learning. Methods: 140 parents whose children played a club sport answered questions regarding their knowledge of sport-related concussion pre- and post-random assignment to an educational intervention: CDC Concussion Awareness video or CDC Concussion Fact Sheet for Parents. Results: Participating parents demonstrated a moderate level of pre-intervention knowledge, but critical gaps in knowledge were identified. Knowledge of concussion improved slightly following intervention regardless of intervention type. Conclusions: This study confirms the presence of gaps in knowledge of concussion in parents whose children play club sports. Without the protection of concussion legislation, those athletes who participate in club sports are at particular risk due to lack of concussion knowledge and education. This study confirms that education can have a positive impact on parental knowledge of concussion. Practical applications: Pre-knowledge of concussion is the greatest predictor of post-knowledge of concussion, therefore pre-assessment of target audience knowledge followed by a custom educational intervention taking into account principles of adult learning, would be the most beneficial to increasing concussion knowledge.