Concussion Information Research Articles

Association between concussion understanding and stakeholder knowledge translation in collegiate sports

The purpose of this study was to determine if there was an association between concussion understanding and stakeholder knowledge translation in collegiate sports following the mandate of Rowan's Law in Ontario, Canada. To our knowledge, this is the first study to examine concussion knowledge translation within a sport network using social network analysis. A cross-sectional design was used to evaluate 76 collegiate athletes (54 females, 21 males, 1 not identified), aged 20.55 years (SD = 3.4) who completed a survey on sport demographics, concussion knowledge and stakeholders who provided concussion information during the sport season. Athlete concussion knowledge scores and reported stakeholders were examined. An average of three key stakeholders provided concussion information to 82% of the varsity athletes in our study. Athletes reported that a coach or athletic trainer most often provided concussion knowledge. Overall, athlete concussion knowledge scores were the same for athletes who sought concussion knowledge from stakeholders and those who did not. Over 95% of athletes in the study did not access the Rowan's Law website for mandated concussion education. These findings suggest that Rowan's Law is hugely neglected resulting in stakeholder knowledge translation having minimal influence on an athletes’ understanding of concussions. Future recommendations include verified review of mandated concussion education resources and testing of concussion knowledge for all persons associated with sport in Ontario. Due to the number of athletes seeking concussion knowledge in their varsity athlete network, accurate sport specific resources should be provided to support stakeholders who are in direct contact with athletes.

Racial identity and concussion diagnosis and recovery trajectories in collegiate athletes: a LIMBIC MATARS investigation

ABSTRACT Objective To determine if there were concussion diagnosis and recovery disparities between collegiate athletes with Black and White racial identities. Design Retrospective cohort study. Methods Concussion information was extracted from NCAA athlete medical files at LIMBIC MATARS member institutions from the 2015–16’ to 2019–20’ academic years. A total of 410 concussions from 9 institutions were included that provided all independent (i.e. racial identity of Black or White) and dependent variable information (i.e. dates of injury, diagnosis, symptom resolution, and return to sport) that were analyzed using Mann-Whitney U tests. The sample consisted of 114 (27.8%) concussions sustained by Black athletes and 296 (72.1%) sustained by White athletes. Results The overall sample had a median of 0 days between injury occurrence to diagnosis, 7 days to symptom resolution, and 12 days to return to sport. No significant timing differences were observed for concussion diagnosis (p = .14), symptom resolution (p = .39), or return to sport (p = 0.58) between collegiate athletes with Black versus White racial identities. Conclusions These findings may reflect equitable access to onsite sports medicine healthcare resources that facilitate concussion management in the collegiate sport setting. Future work should explore these associations with a larger and more diverse sample of collegiate athletes.

The Influence of Athletic Identity, Passion, and Perceptions of Severity of Concussions on Athletes' Willingness to Report Concussion Symptoms.

The influence of several psychological characteristics on the willingness of athletes to report concussion behaviors has not been well explored. Therefore, the purpose of this study was to understand how athletic identity and sport passion predicted participants' willingness to report symptoms above what was explained by athlete demographics, concussion knowledge, and perceived seriousness of concussions. The study was cross-sectional. Three-hundred and twenty-two male and female high school and club sport athletes completed survey measures of concussion knowledge, athletic identity, harmonious and obsessive passion, and degree to which athletes indicated they would report concussions and concussion symptoms. Athletes scored moderately high on their knowledge of symptoms and other concussion information (mean = 16.21; ± = 2.88) and above the midpoint on their attitudes and behaviors toward reporting concussion symptoms (mean = 3.64; ± = 0.70). There were no differences between gender, t(299) = -.78, P = .44, and previous concussion education, t(296) = 1.93, P = .06, related to concussion knowledge. Results of a hierarchical regression indicated that after entering athlete demographics, concussion knowledge, and perceived seriousness of concussions, of the 3 psychological variables in the final stage of the model, only obsessive passion was a significant predictor of athlete's attitudes to report a concussion. Perceived seriousness of concussion, perceived threat to long-term health, and obsessive passion were the strongest predictors of athlete's willingness to report concussions. Athletes who did not believe concussions posed a threat to their current or future health, and those that held an obsessive passion for sport were most at risk for not reporting concussions. Future research should continue to investigate the relationship between reporting behaviors and psychological factors.

Provision of Concussion Information From Coaches and the Presence of Athletic Trainers: Findings From the 2021 YouthStyles Survey.

Coaches play an important role in concussion safety, and their views on concussion influence those of their athletes and the athletes' reporting behaviors. In this 2021 survey of youth, we examined how often coaches provide concussion safety information to their athletes and the association between coaches' provision of concussion information to athletes and the presence of athletic trainers (ATs) at a team's games and practices. More than 4 in 10 youth who played sports reported that their coaches did not provide any sort of concussion education or information to them in the past 12 months. Among those youth who always or sometimes had ATs at practices or games, 76.3% received some type of coach education on concussion in the past 12 months, compared with 31.9% of those who rarely or never had ATs at practices or games (P < .0001). Increasing access to ATs and adapting current concussion training and educational materials for coaches to increase coach-athlete communication may be beneficial.

Evaluating Quality of Website-Derived Concussion Information (P8-1.005)

<h3>Objective:</h3> This investigation employs a variety of objective scoring systems to evaluate online concussion information quality from 2021 &amp; 2022. <h3>Background:</h3> In modern times, concussions are a popular health-related search topic. As most users often stop at the first page of Google, these websites’ quality should be assessed by multiple tools that objectively determine the accuracy and efficacy of information presentation, with resultant scores that should improve as cumulative exposure grows over time. <h3>Design/Methods:</h3> The websites analyzed in this study were identified from the first page of a Google search for “Concussion”, with 2 searches conducted to assess differences over 2021 and 2022. Two independent reviews were conducted using the DISCERN instrument, Health-on-The-Net (HON) Foundation code and certification status, JAMA Benchmarks, Currency, Relevance, Authority, Accuracy, and Purpose (CRAAP) test, reading ease, and treatment content. After rating completion, kappa rater agreement statistics and descriptive statistics on subsequent consensus ratings were calculated. <h3>Results:</h3> Across both years, investigator agreement was strong (&gt;0.7), highlighting rating methodology and reproducibility. Among website categories reviewed in the 2021 analysis, academic/nonprofit/healthcare had the highest mean for all scoring tools (41.33, 6.67, 3.33, 29.33), with the sole exception of treatment content, which was led by commercial websites (3.67). The 2022 analysis conveyed academic/nonprofit/healthcare quality dominance for DISCERN (38.40), HonCode (6), and Treatment (3.20). However, the commercial category had the topmost JAMA benchmark score, and government websites had the greatest CRAAP (26) rating. Among both analyses, treatments like physical rest and cognitive rest were emphasized, with all websites ignoring aerobic and psychosocial/emotional support. <h3>Conclusions:</h3> Across both annual analyses, academic/nonprofit/healthcare websites maintained the highest mean in most scoring systems compared to commercial and government websites, but all categories did not exhibit rating improvement over time. This investigation provides valuable insight into the current quality of online concussion knowledge and opportunities for future improvement to enhance public awareness. <b>Disclosure:</b> Mr. Mehra has received research support from Medical College of Georgia. Mr. Mehra has received personal compensation in the range of $500-$4,999 for serving as a Graduate SGA Humanitarian with Augusta University. Mr. Brody has nothing to disclose. Miss Mehrotra has nothing to disclose. Mr. Sakhalkar has nothing to disclose. Dr. Maugans has nothing to disclose.

An Advocacy Leadership Training in Neurology for High School Students: A Pilot Study (P11-2.003)

<h3>Objective:</h3> To pilot a program where students can learn about common disabling neurologic conditions and gain leadership and teaching skills. In this program, students will spread awareness about these conditions and advocate for important public health issues. <h3>Background:</h3> There is insufficient awareness about common and disabling neurologic conditions in the general population. Increasing awareness of these conditions is critical in increasing self-efficacy as well as highlighting their importance amongst lawmakers and politicians. High school students may be valuable champions willing to share this knowledge. With support, encouragement, and mentorship, they may gain interest in the field of neurology while also gaining the leadership and media skills necessary to pursue their own advocacy interests. <h3>Design/Methods:</h3> Modeling after the American Academy of Neurology’s widely successful Palatucci Advocacy Leadership Forum, we expanded the already established Headache and Arts program to include a <i>Public Health Ambassador Program.</i> We partnered with established New York State Science Technology Engineering Programs (STEPs) serving underrepresented students. This program involved three assignments to teach important advocacy skills and disseminate information regarding migraine and concussion. Additionally, we developed a Likert scale to better understand if the program inspires students to pursue careers in Science, Technology, Engineering, and Mathematics (STEM). This questionnaire was provided to students before and after the program. <h3>Results:</h3> There were 38 student participants in the research program with 12 from in-person courses and 26 from virtual courses. Students incorporated the migraine and concussion information learned in class into three advocacy-related projects: a knowledge transfer assignment, a letter to the editor, and an elevator pitch. Students also created artwork integrating STEAM knowledge learned throughout the program. <h3>Conclusions:</h3> A program that provides students with tools to spread awareness of neurologic conditions may be an effective way to expand the impact of the program as well as incite interest in advocacy amongst high school students. <b>Disclosure:</b> Tyler Gumpel has nothing to disclose. Ms. Boubour has received research support from The Fulbright Program. Dr. Minen has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Pain Medicine Journal. The institution of Dr. Minen has received research support from NIH. Dr. Minen has received intellectual property interests from a discovery or technology relating to health care. Dr. Minen has received personal compensation in the range of $500-$4,999 for serving as a First Contact-Primary Care Advisory Board Member with American Headache Society . Dr. Minen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for PCORI grant on migraine evidence based map for stakeholders with ECRI .

Perceptions of Concussion and Associated Anxiety in Irish Collegiate Athletes.

Concussion nondisclosure and poor management after a concussion are a concern in Irish collegiate sports. How athletes perceive concussions and appraise their own concussion may affect their decisions and behaviors after a suspected concussion. However, this has yet to be examined in an Irish context. This study aimed to (1) establish concussion perceptions and associated anxiety in Irish collegiate athletes; (2) examine how sex, concussion, and mood disorder history influenced their perceptions; and (3) investigate factors associated with higher anxiety perceptions. Irish collegiate athletes will display negative concussion perceptions and anxiety related to concussion, especially in female athletes and those without a concussion history. Cross-sectional study. Level 3. Irish collegiate athletes [n = 268 (141 women,127 men), mean age = 21.5 ± 2.2 years] from high-risk sports completed a survey including the Perceptions of Concussion Inventory for Athletes (PCI-A), demographics, diagnosed concussion history, self-reported mood disorder history, and a concussion knowledge assessment. Differences in concussion perceptions by sex, concussion history, mood disorder history were examined using Mann-Whitney U tests, and factors associated with anxiety-related concussion perceptions were identified using multivariate logistic regression. Over half (53.0%, n = 142) of participants reported concerns regarding concussion. The thoughts of sustaining a concussion made participants feel upset (63.4%, n = 170), fearful (47.7%, n = 128), and anxious (35.1%, n = 94). Women reported significantly higher anxiety (P < 0.01, r = 0.23), effects (P = 0.04, r = 0.12), and clarity (P = 0.01, r = 0.16) perception scores. Participants with a diagnosed concussion history displayed greater symptom variability perception scores (P = 0.04, r = 0.12), but lower anxiety (P = 0.03, r = 0.13) and treatment (P < 0.01, r = 0.19) beliefs on the PCI-A. No differences were observed for those with a history of a mood disorder (P > 0.05). A significant multivariate model was established (χ2 = 55.44, P < 0.01), with female sex [odds ratio (OR) = 1.53], concussion history (OR = 0.63), effects (OR = 1.31), and treatment (OR = 1.15) subscales associated with greater anxiety. Concerns about sustaining a concussion are prevalent in Irish collegiate athletes. Women displayed more negative perceptions and those with a concussion history displayed fewer perceived benefits of treatment. The findings support the need for concussion awareness campaigns to provide accurate concussion information to mitigate anxiety-related concussion perceptions and injury belief misconceptions.

Developing a conceptual framework to identify and classify sources of parental stress following pediatric concussion

ABSTRACT Objectives To create a conceptual framework that classifies the various stresses parents experience following their child’s concussion. Methods Twelve parents of children with concussion completed a semi-structured interview with the lead author. Questions broadly focused on post-concussion stress, with specific probes for caregiving responsibilities, concussion knowledge, and athletic participation. Data were analyzed using thematic analysis. Results Ten mothers and 2 fathers participated. Five themes stemmed from our analysis: 1) Concussion Knowledge (central theme): stressors related to sources of concussion information; 2) Child Health Factors: stressors related to injury and illness, including concussion; 3) Activity Factors: stressors related to academic and athletic performance; 4) Parent-Injured Child Relationship Factors: stressors related to providing care to the child; and 5) Personal Factors: stressors unrelated to the concussion (e.g. family, social, career, etc.). Child Health Factors was most frequently identified as the primary stressor (n = 9). Conclusions Sources of parental stress were varied following pediatric concussion. Issues relating to the child’s post-injury dysfunction and the uncertain recovery from concussion were key stressors identified by parents. Moving forward, this framework can be used to ground the development of specific parental stress screening tools and interventions, which may benefit the parent’s mental health and the child’s clinical recovery.

Availability and content of concussion guidelines in Australian combat sports

ObjectivesTo examine the availability and content of publicly available concussion information published by peak amateur and professional combat sport governing bodies in Australia. DesignCross-sectional study; document analysis. MethodsPublicly available concussion information was retrieved from the websites of eleven peak Australian amateur and professional combat sport governing bodies. Data on type of source material, concussion definition, provision of medical services, concussion evaluation, and return-to-sport information were extracted. The quality of the information was assessed using a modified version of the Global Rating Scale. ResultsEight out of eleven combat sport governing bodies provided concussion information in source documents ranging from competition rules to position statements to specific policies. Five governing bodies provided information on post-contest concussion evaluation or testing, four of which mentioned the Sport Concussion Assessment Tool. Eight governing bodies provided information on return-to-sport, of which six stipulated mandatory minimum rest periods and four indicated that athletes should complete a graduated return-to-sport protocol. The provided concussion information was generally of low quality, with a median score of 3 out of 9 (range: 1–4). ConclusionsThere is substantial scope and an urgent need for improving concussion guidelines across peak combat sport governing bodies in Australia to improve the health and safety of their athletes.

Postconcussion discharge advice does not improve concussion knowledge in a community sample

ObjectivePoor concussion knowledge in the community has been linked to reduced injury identification. This study investigated if concussion knowledge could be improved by providing standard postinjury advice (written brochure).MethodsThis study...

The burden of unsubstantiated messaging: collegiate athletes’ chronic traumatic encephalopathy mechanism beliefs

ABSTRACT Objective To investigate factors associated with collegiate athletes’ beliefs regarding chronic traumatic encephalopathy (CTE) mechanism. Design Cross-sectional study. Methods A total of 838 collegiate athletes (61.9% men) from seven institutions completed a 10-minute survey that captured information relative to demographics, diagnosed concussion history, formal sport-related concussion education, additional sources of concussion information, and beliefs about multiple concussions and premature return-to-play following a head impact as mechanisms for CTE. Results More than half of collegiate athletes believed that multiple concussions (58.2%) and premature return-to-play (59.1%) may cause CTE. Those who reported getting concussion information from sports news had higher odds of believing multiple concussions and premature return-to-play were CTE mechanisms compared to those who did not get information from sports news sources. Additionally, CTE mechanism beliefs were significantly greater in collegiate athletes who were male, had sustained a previous diagnosed concussion, or had acquired concussion information from the NCAA. Conclusions Sports news’ reporting of CTE storylines, which highlight former male athletes with complex brain injury histories, may influence collegiate athletes’ beliefs about concussion. Therefore, it is recommended that concussion awareness initiatives incorporate information related specifically to CTE to empower collegiate athletes with evidence-based, patient-oriented information and knowledge regarding this condition.

Anxiety-related concussion perceptions of collegiate athletes

ObjectivesThe purpose of this study was to identify collegiate athletes' anxiety-related concussion perceptions and examine factors that may be related to increased anxiety injury beliefs. DesignCross-sectional study. MethodsMale and female Division I, II and III NCAA collegiate athletes (n = 482) completed a 10- to 15-minute survey examining their demographics, diagnosed concussion history, concussion knowledge, and public media sources they have previously acquired concussion information from. The survey also included the Perceptions of Concussion Inventory for Athletes (PCI-A) which results in six outcome variables (anxiety, effects, control, clarity, treatment, and symptom variability). Univariable and a backward stepwise multivariable logistic regression model were utilized to identify variables that were associated with greater (above median) negative anxiety-related concussion perception scores. ResultsCollegiate athletes displayed moderate anxiety-related concussion perceptions (12.8 ± 3.2; scores ranged from 4 — low anxiety to 20 — high anxiety). The majority of participants reported that concussions are upsetting to them (60.7%), with a sizable proportion being worried (46.7%), fearful (40.7%), or anxious (25.0%) about sustaining a concussion. In the multivariable regression, higher perception that concussions have long-term effects (OR = 2.72; 95% CI: 1.79–4.12), greater beliefs of internal control to influence concussion outcomes (OR = 1.78; 95% CI: 1.15–2.75), and female sex (OR = 1.77; 95% CI: 1.15–2.71) were associated with higher anxiety beliefs. ConclusionsThis study for the first time establishes that negative, anxiety-related perceptions about concussions are prevalent in a collegiate athlete population. Addressing these perceptions through evidence-based, educational and management initiatives, such as highlighting that concussions are treatable and most do not result in long-term negative consequences with early diagnosis and proper management, are critical to improve emotions surrounding concussion. This may be particularly important for female athletes in this population.

Assessing Differences in Concussion Symptom Knowledge and Sources of Information Among Black and White Collegiate-Athletes

Basic concussion symptom knowledge is fundamental to concussion identification; however, racial disparities in concussion knowledge exist in high school and youth sports. It is unknown whether similar differences exist in collegiate-athletes. Identifying racial disparities in concussion knowledge and sources of concussion information is essential to inform equitable approaches to knowledge translation and educational interventions. This study examined how Black and White collegiate-athletes differed in their knowledge of concussion symptoms and use of concussion information sources. National Collegiate Athletic Association (NCAA) institutions. Collegiate-athletes. Cross-sectional. Collegiate-athletes completed a questionnaire that assessed personal and sports demographics, concussion symptom knowledge, and use of concussion information sources. Fisher's exact tests and Wilcoxon rank-sum tests examined differences in outcome measures between Black and White collegiate-athletes. A multivariable Poisson regression model examined the association between race and concussion symptom knowledge scores while accounting for sex, sports contact level, NCAA division, concussion history, and specific concussion information sources. Incidence rate ratios (IRRs) with 95% CIs excluding 1.00 were deemed significant. A total of 768 (82.6% White, 17.4% Black) collegiate-athletes completed the questionnaire. Black athletes were more likely to have lower concussion symptom knowledge scores than White athletes (P < .001). In the multivariable Poisson regression model controlling for covariates, this finding was retained (IRR = 0.97; 95% CI, 0.94-0.997). White athletes were more likely to report school-based professional (P < .001), online medical sources (P = .02), and the NCAA (P = .008) as sources of concussion information. Black athletes were more likely to report referees (P = .03) as a source of concussion knowledge. Despite NCAA concussion education requirements for athletes, Black collegiate-athletes were found to have lower concussion knowledge than White collegiate-athletes. The findings highlight the need for equitable strategies to disseminate concussion information to diverse populations by improving the physician-patient relationship and investing in culturally appropriate educational materials.

Collegiate Athletes' Concussion Awareness, Understanding, and -Reporting Behaviors in Different Countries With Varying Concussion Publicity.

Concussions are a global public health concern, and education on the importance of self-reporting may not reach all athletes to the same degree around the world. To determine if differences were present in the concussion awareness, understanding, and -reporting behaviors of collegiate athletes' in 3 countries with varied degrees of concussion publicity. Cross-sectional survey. Collegiate sports medicine clinics. Collegiate athletes in the United States (n = 964; high publicity), Ireland (n = 302; moderate publicity), and Jordan (n = 129; low publicity). The degree of concussion publicity was categorized based on the extent of national public health awareness initiatives, care guidelines, research publications, and mass media coverage. Participants completed a 10- to 15-minute survey on concussion awareness, understanding, and -reporting behaviors. The main outcome measures were concussion education (awareness; 21 options; select all sources of concussion information), concussion knowledge (understanding; maximum score of 49), and diagnosed/nondisclosed concussion history (reporting behaviors; self-report yes/no items). A higher proportion of Jordanian athletes reported never having received concussion information previously (73.6%) than Irish (24.2%) or US athletes (9.4%). Knowledge differed among countries (P < .0001, η2 = .28), with US athletes displaying higher total knowledge scores (40.9 ± 4.5) than Jordanian (35.1 ± 5.6) and Irish (32.1 ± 3.5) athletes. Greater percentages of Irish and US athletes reported a history of a diagnosed concussion (31.8% and 29.6%, respectively) and history of concussion nondisclosure (25.2% and 15.5%, respectively) than Jordanian athletes (2.3% and 0.0% for history of a diagnosed concussion and history of concussion nondisclosure, respectively). In the United States, where concussion publicity is high, formal legislation exists, and sports medicine resources and concussion awareness and understanding were increased. More culturally appropriate concussion initiatives are needed globally to ensure that athletes around the world can identify concussive injuries and understand the dangers of continued sport participation while concussed.

Concussion Symptom Characteristics and Resolution in 20 United States High School Sports, 2013/14-2017/18 Academic Years.

High school (HS) sport-related concussions (SRCs) remain a public health concern in the United States. To describe patterns in symptom prevalence, symptom resolution time (SRT), and return-to-play time (RTP) for SRCs sustained in 20 HS sports during the 2013/14-2017/18 academic years. A convenience sample of athletic trainers reported concussion information to the HS RIOTM surveillance system. Symptom prevalence, average number of symptoms, and SRT and RTP distributions were examined and compared by event type (practice, competition), injury mechanism (person contact, nonperson contact), sex, and contact level (collision, high contact, and low contact) with chi-square tests and Wilcoxon rank-sum tests. Among all SRCs (n=9542), headache (94.5%), dizziness (73.8%), and difficulty concentrating (56.0%) were commonly reported symptoms. On average, 4.7±2.4 symptoms were reported per SRC. Overall, 51.3% had symptoms resolve in<7 d, yet only 7.9% had RTP<7 d. Differential prevalence of amnesia was seen between practice and competition-related SRCs (8.8% vs 13.0%; P<.001); nonperson-contact and person-contact SRCs (9.3% vs 12.7%; P<.001); and female and male SRCs in low-contact sports (5.8% vs 17.5%; P<.001). Differential prevalence of loss of consciousness was seen between practice and game-related SRCs (1.3% vs 3.2%; P<.001); and female and male SRCs in high contact sports (1.2% vs 4.0%; P<.001). Differential longer SRT (>21 d) was seen between new and recurrent SRCs (9.4% vs 15.9%; P<.001). Headache was the most commonly reported symptom. Notable group differences in the prevalence of amnesia, loss of consciousness, and SRT may be associated with more severe SRCs, warranting further attention.

Use of sport-related concussion information sources among parents of United States middle school children

ObjectiveParents may use various information sources to obtain information about sport-related concussions (SRC). This study examined SRC-related information sources used by parents of United States middle school children (age: 10–15 years). MethodsA panel of 1083 randomly selected U.S. residents, aged ≥18 years and identifying as parents of middle school children, completed an online questionnaire capturing parental and child characteristics, and utilization and perceived trustworthiness of various sources of SRC-related information. Multivariable logistic regression models identified factors associated with utilizing each source. Adjusted odds ratios (OR) with 95% confidence intervals (95%CIs) excluding 1.00 were deemed significant. ResultsDoctors/healthcare providers (49.9%) and other healthcare-related resources (e.g., Centers for Disease Control and Prevention, WebMD) (37.8%) were common SRC-related information sources; 64.0% of parents utilized ≥1 of these sources. Both sources were considered “very” or “extremely” trustworthy for SRC-related information among parents using these sources (doctors/healthcare providers: 89.8%; other healthcare-related resources: 70.9%). A 10-year increase in parental age was associated with higher odds of utilizing doctors/healthcare providers (adjusted odd ratio (ORadjusted) = 1.09, 95%CI: 1.02–1.16) and other healthcare-related resources (ORadjusted = 1.11, 95%CI: 1.03–1.19). The odds of utilizing doctors/healthcare providers (ORadjusted = 0.58, 95%CI: 0.40–0.84) and other healthcare-related resources (ORadjusted = 0.64, 95%CI: 0.44–0.93) were lower among parents whose middle school children had concussion histories versus the parents of children who did not have concussion histories. ConclusionOne-third of parents did not report using doctors/healthcare providers or other healthcare-related resources for SRC-related information. Factors associated with underutilization of these sources may be targets for future intervention. Continuing education for healthcare providers and educational opportunities for parents should highlight accurate and up-to-date SRC-related information.

What they know and who they are telling: Concussion knowledge and disclosure behaviour in New Zealand adolescent rugby union players

ABSTRACT The purpose of this study was to survey high school rugby players from a range of ethnic, geographic and socioeconomic backgrounds in New Zealand (NZ) to gain an understanding of concussion knowledge, awareness of NZ Rugby’s (NZR) guidelines and attitudes towards reporting behaviours. Male and female high school rugby players (n= 416) from across NZ were surveyed. The findings indicated that 69% of players had sustained a suspected concussion, and 31% had received a medical diagnosis of concussion. 63% of players indicated they were aware of NZR’s guidelines. Māori and Pasifika players were less likely to be aware of the guidelines compared to NZ European, Adjusted OR 0.5, p = 0.03. Guideline awareness was significantly higher for those from high decile schools when compared to low (Unadjusted OR 1.63, p = 0.04); however, when ethnicity and school locations were controlled for this became non-significant (Adjusted OR= 1.3, p=0.37). The coach was the key individual for the provision of concussion information and disclosure of symptoms for players. The findings of this study will inform the development and delivery of NZR’s community concussion initiative and how these examined factors influence a high school player’s concussion knowledge and reporting behaviour.

Exploring Gaps in Concussion Knowledge and Knowledge Translation Among Coaches of Youth Female Hockey.

To better understand the level of concussion knowledge of youth female hockey coaches and to identify preferred methods of knowledge translation for this population. Cross-sectional survey. Participants independently completed written surveys before in-person concussion information sessions or online surveys through link provided in emails. Convenience sampling yielded 130 coaches of youth female hockey from Canada. Knowledge level on concussion, resources from which coaches obtained information on concussion, opinions on the current level of concussion knowledge, and knowledge translation. Coaches demonstrated adequate knowledge on concussion, achieving 84% correct on true-false questions and 92% correct on symptom identification accuracy. However, coaches showed limited awareness of concussion specific to mechanisms for injury (identification) and postconcussion symptoms. Internet resources were rated as the most used resources for concussion yet were not rated very helpful. Nonetheless, coaches indicated online courses and web sites as the most preferred method for concussion knowledge translation. Youth female hockey coaches have overall adequate knowledge of concussion; however, gaps in knowledge do exist. Future efforts to raise the concussion knowledge among coaches of female youth hockey should include information specific to the mechanism of injury, along with sign and symptom identification, with particular attention paid to emotional symptoms. Given the reported preferences and the widespread availability of the Internet, further exploration and research validation of online courses and web sites tailored to the youth female hockey community is encouraged.

Sources of Acquired Concussion Information Reported by Parents of Youth Athletes

Abstract Purpose Examining the relationships between demographics (sex, geographic location) and sources of acquired concussion information, and where parents would take their child for concussion evaluation. Methods A cross-sectional survey collecting demographics and concussion knowledge of parents (male: n=136/359, 38%; female: n=22/359, 62%) of youth athletes (i.e., football, ice hockey, lacrosse, soccer) in Michigan (n=131/359, 36.5%) and Pennsylvania (n=228/359, 62%). Separate Chi-square tests for independence examined the relationship between demographics (sex, geographic location) and sources of acquired concussion information, and where parents would take their child for concussion evaluation. Results Overall, parents recognized common concussion signs and symptoms and had general knowledge of concussion. There was a significant association between sex and acquiring information from sports medicine physicians (male: 31.6%, female: 18.9%; χ2 (1, n=358)=6.83, p=.009), and sports news outlets (male: 32.4%, female: 18.9%; χ2 (1, n=358)=7.62, p=.006). There was a significant association between geographic location and acquiring information from a coach (Michigan: 72.5%, Pennsylvania: 40.4%; χ2 (1, n=359)=32.22, p&lt;.001), recreational league officials/league mandated paperwork (Michigan: 50.4%, Pennsylvania: 26.3%; χ2 (1, n=359)=20.11, p&lt;.001), and youth sport state concussion laws (Michigan: 38.2%, Pennsylvania: 10.5%; χ2 (1, n=359)=37.18, p&lt;.001). There was a significant association between geographic location and where parents would take their child for concussion evaluation (χ2 (3, n=338)=19.76, p&lt;.001). Conclusion Sex and geographic location may influence where parents of youth athletes acquire concussion information and where they may seek medical attention.

Effect of a New Rule Limiting Full Contact Practice on the Incidence of Sport-Related Concussion in High School Football Players

Background: Sport-related concussion (SRC) has been associated with cognitive impairment, depression, and chronic traumatic encephalopathy. American football is the most popular sport among males in the United States and has one of the highest concussion rates among high school sports. Measured head impacts and concussions are approximately 4 times more common in contact practices compared with noncontact practices. The Wisconsin Interscholastic Athletic Association passed new rules defining and limiting contact during practice before the 2014 football season. Purpose: To determine if the SRC rate is lower after a rule change that limited the amount and duration of full-contact activities during high school football practice sessions. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 2081 high school football athletes enrolled and participated in the study in 2012-2013 (before the rule change), and 945 players participated in the study in 2014 (after the rule change). Players self-reported previous concussion and demographic information. Athletic trainers recorded athlete exposures (AEs), concussion incidence, and days lost for each SRC. Chi-square tests were used to compare the incidence of SRC in prerule 2012-2013 seasons with the incidence in the postrule 2014 season. Wilcoxon rank sum tests were used to determine differences in days lost because of SRC. Results: A total of 67 players (7.1%) sustained 70 SRCs in 2014. The overall rate of SRC per 1000 AEs was 1.28 in 2014 as compared with 1.58 in 2012-2013 (P = .139). The rate of SRC sustained overall in practice was significantly lower (P = .003) after the rule change in 2014 (15 SRCs, 0.33 per 1000 AEs) as compared with prerule 2012-2013 (86 SRCs, 0.76 per 1000 AEs). There was no difference (P = .999) in the rate of SRC sustained in games before (5.81 per 1000 AEs) and after (5.74 per 1000 AEs) the rule change. There was no difference (P = .967) in days lost from SRC before (13 days lost [interquartile range, 10-18]) and after (14 days lost [interquartile range, 10-16]) the rule change. Conclusion: The rate of SRC sustained in high school football practice decreased by 57% after a rule change limiting the amount and duration of full-contact activities, with no change in competition concussion rate. Limitations on contact during high school football practice may be one effective measure to reduce the incidence of SRC.