Knowledge Of Concussion Symptoms Research Articles

Predictors of Concussion Symptom Reporting Intention among Collegiate Athletes.

Underreporting of concussion symptoms in college athletics presents a challenge for sports medicine clinicians in evaluating and diagnosing such injuries. Some athletes do not report concussion symptoms because they do not recognize that they have a brain injury, however many athletes intentionally withhold symptoms to avoid removal from sport participation. To examine individual factors that influence college athletes' intentions to report concussion symptoms. Cross-sectional study. Collegiate athletics. 2,649 student-athletes from 23 sports, across 22 colleges/universities. The primary outcome was intention to report concussion symptoms. Predictor variables included demographics (age, race/ethnicity, sex, sport type, number of years in sport, number of previous concussions, and perceived concussion symptom knowledge), athletic identity, attitudes toward symptom reporting, perceived social pressure (injunctive and descriptive norms), and perceived behavioral control (capacity and autonomy). Hierarchical ordinary least squares regression revealed positive effects of attitude (b = .063; P = .005), descriptive norms (b = .131; P < .001), injunctive norms (b = .107; P < .001), and capacity (b = .196; P < .001) on intention to report symptoms. Athletic identity and participation in collision sports had small negative indirect effects on intention, while perceived concussion knowledge had a small positive indirect effect. The full regression model explained 14.24% of the variance in concussion reporting intention. These findings may help clinicians develop more focused interventions that address key social and individual determinants of underreporting, including attitude, injunctive and descriptive norms, and capacity to report. Athletic identity, sport type, and perceived understanding of concussion symptoms also influence reporting intention to a lesser extent. Previous research in this area has often failed to address a diverse population of college-age athletes from different sports and NCAA divisions.

Does the Association Between Concussion Measures and Social Context Factors Differ in Black and White Parents?

Middle school (MS) parents may benefit from education supporting timely concussion identification and care-seeking in their young children (aged approximately 10 to 15 years). However, such education may not consider individual needs and different social context factors, including lower socioeconomic status, disadvantaged social determinants of health, and different racial and ethnic backgrounds. To examine the relationship between social context factors and concussion knowledge, attitudes, and communication in MS parents and to explore the possible role of race and ethnicity (Black or White) as an effect measure modifier. Cross-sectional study. Online survey. A nationally representative sample of MS parents who completed an online survey (n = 1248). Parent outcomes were a history of concussion education, concussion symptom knowledge and attitudes, and communication with children about concussion. Main exposures were parental race and ethnicity (Black or White) and social context factors. Uni- and multivariable statistical analyses were performed to achieve the study aims. Black parents were more likely than White parents to have received concussion education (69.5% versus 60.5%, P = .009), although median concussion knowledge scores were higher for White parents than for Black parents (40 versus 37, P < .001). Few associations were found for social context factors with concussion knowledge, attitudes, and communication in Black and White parents separately. Among MS parents, race and ethnicity may not influence the association between social context factors and concussion-related knowledge, attitudes, or communication. However, differences were present by race and ethnicity regarding previous concussion education and other parental outcomes, concussion symptom knowledge in particular.

A-28 Systemic Failures Impacting Concussion Symptom Non Disclosure and “Toughing it out” Among Black Athletes

Abstract Purpose Despite socio-political and community efforts to shift the narrative among college and professional sports toward injury disclosure, “toughing it out” narratives continue to impact players and, more specifically, Black players. Symptom nondisclosure narratives disproportionately affect Black athletes' concussion symptom knowledge and willingness to disclose a concussion. The purpose of this study is a call for accountability, fellowship, and active caring of Black college and professional athlete’s in order to promote concussion symptom disclosure. Data Selection A literature review of peer-reviewed articles from 2018 to 2022 from PubMed and Google Scholar was conducted. Keywords include racial disparities, concussions, identity, and professional and college athletes. Informal analyses were used to identify and analyze themes across articles, including health disparities, concussions, and nondisclosures. Data Synthesis Black athletes are more likely to under-report concussion symptoms than their white counterparts. Power and privilege within the context of institutionalized racism inform disparities in concussion psychoeducation. Black athlete identity formation within white institutions further informs willingness to report symptoms. Consequently, concussion non-disclosure can put athletes at risk for repetitive head injury, persisting neurocognitive, and psychological deficits. Conclusions Recognizing the role of systemic racism in concussion symptom reporting is critical. Neuropsychologists are responsible for understanding intersectionality, institutional racism, and Black athlete identity. To this end, concussion symptom non-disclosure needs to be conceptualized as suppression of Black athletes' voices and wellbeing. A shift towards fellowship and active caring is needed to understand athlete identity among Black athletes and how these narratives influence symptom disclosure over time.

Reasons for the Reporting Behavior of Japanese Collegiate Rugby Union Players Regarding Suspected Concussion Symptoms: A Propensity Analysis.

While previous research has identified the reasons for the concussion-reporting behavior of rugby union players, the influence of confounding factors such as concussion experience, education, and knowledge of concussion symptoms, any of which may have influenced the results, has not been considered. This study aimed to clarify the reasons for the reporting behavior of college rugby union players regarding suspected concussion symptoms by adjusting for confounding factors using the propensity score. A questionnaire about both concussion knowledge and concussion-reporting behavior was administered to 240 collegiate rugby union players. Of the 208 (86.7%) valid respondents to the questionnaire, 196 (94.2%) had experienced any one symptom of a suspected concussion, such as headache, at least once, and 137 (65.9%) reported symptoms to someone else. This study's results revealed two important reasons for reporting symptoms: (1) the willingness of players to report experienced symptoms to someone else, along with realizing a concussion, and (2) the willingness of players to report suspected concussion symptoms, despite the absence of a doctor or trainer. These results suggest that providing educational opportunities to recognize suspected concussion symptoms and establishing a team culture of reporting physical problems to someone else is important for improving concussion-reporting behavior.

Reporting of Concussion Symptoms by a Nationwide Survey of United States Parents of Middle School Children

This cross-sectional study assessed concussion symptom knowledge of parents of middle school (MS) children (aged 10–15 years) through a free-response item that solicited concussion symptoms and compared findings to a pre-validated scale-based measure. A self-administered online questionnaire was sent to a panel of randomly selected United States residents who were recruited by a third-party company, aged ≥ 18 years, and identified as parents of MS children. Via a free-response item, parents listed what they believed were concussion symptoms. Multiple sections later, parents identified potential concussion symptoms via a scale measure, which featured 25 items (22 actual symptoms, three distractor symptoms) with three response options: yes, no, maybe. Free-response item responses were coded into specific symptoms. The 1062 eligible parents that provided complete data commonly identified the symptoms of dizziness (90.2%), blurred vision (87.4%), and balance problems (86.4%) on the scale-based measure. However, these and other symptoms were less commonly identified via the free-response item (dizziness: 44.4%; blurred vision: 16.5%; balance problems: 3.5%). Concussion symptoms commonly reported via the scale-based measure were reported less frequently within the free-response item. Future research must explore strategies to help clinicians working with parents and their children to measure and assess concussion symptom reporting and knowledge.

Cognitions That Support Concussion Reporting in Collegiate Athletes: An Analysis of a Worksheet Activity.

Sports related concussions continue to be a public health concern and improving reporting behavior a focus of educational programs. While educational programs have addressed changes in knowledge of concussion symptoms, it has been challenging to design educational programs which have lasting effects on reporting behavior. The current analysis describes an intervention in which thoughts about reporting behavior are actively written down in a worksheet exercise to "pre-arm" athletes with cognitions designed to enhance reporting behavior prior to the injury event. A total of 503 male and female college athletes participating in collision (football, field hockey, ice hockey, lacrosse, and soccer) and contact sports (baseball, basketball, and softball) from 7 colleges/universities competing across all three NCAA divisions provided data collected during a randomized trial of a peer concussion education program. Qualitative analysis revealed 10 themes that would improve reporting including short-term benefits, faster recover, safe and healthy return to play, reporting helps the team, reporting protects the brain, risk aversion, long-term benefits, coach will be supportive, teammates will be supportive and understanding, and academic performance will be affected. Athletes had awareness of key risks involved in concussions and understood both short- and long-term consequences. These findings have important implications for understanding how to change athletes' thoughts about reporting concussions.

Factors associated with concussion symptom knowledge and attitudes towards concussion care-seeking among parents of children aged 5–10 years

Background: Understanding parents’ concussion-related knowledge and attitudes will contribute to the development of strategies that aim to improve concussion prevention and sport safety for elementary school children. This study investigated the association between parent- and child-related factors and concussion symptom knowledge and care-seeking attitudes among parents of elementary school children (aged 5–10 years). Methods: Four hundred parents of elementary school children completed an online questionnaire capturing parental and child characteristics; concussion symptom knowledge (25 items, range = 0–50; higher = better knowledge); and concussion care-seeking attitudes (five 7-point scale items, range = 5–35; higher = more positive attitudes). Multivariable ordinal logistic regression models identified predictors of higher score levels. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) excluding 1.00 were deemed statistically significant. Results: Select parent and child characteristics were associated with higher score levels for both outcomes. For example, odds of better knowledge level in parents were higher with increased age (10-year increase aOR = 1.59; 95% CI = 1.10–2.28), among females (aOR = 3.90; 95% CI = 2.27–6.70), and among white/non-Hispanics (aOR = 1.79; 95%CI = 1.07–2.99). Odds of more positive concussion care-seeking attitude levels were higher among parents with a college degree (aOR = 1.98; 95%CI = 1.09–3.60). Child sports participation was not associated with higher score levels for either outcome. Conclusions: Certain elementary school parent characteristics were associated with parents’ concussion symptom knowledge and care-seeking attitudes. While the findings suggest providing parents with culturally and demographically relevant concussion education might be helpful, they also emphasize the importance of ensuring education/prevention regardless of their children’s sports participation. Practical Applications: Pediatric healthcare providers and elementary schools offer an optimal community-centered location to reach parents with this information within various communities.

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.

Helmet use in equestrian athletes: opportunities for intervention.

Background:Equestrian athletes (horse riders) are at high risk for head injury, including concussions.Materials & methods:Adults riders were recruited via social media posting to complete a branching survey collecting data on demographics, riding experience, helmet use, injury history and concussion symptom knowledge. Results are reported as frequencies and percentages, with associations tested using chi-square with significance level p < 0.05.Results:Of the 2598 subjects, about 75% reported always wearing a helmet. Of those who did not, the most common reasons were that helmets are unnecessary (57.4%) or do not fit well (48.6%). Many indicated improper storage conditions and/or did not follow manufacturer’s replacement recommendations. Most (75.4%) reported a high level of comfort with recognizing concussion signs, with half experiencing a prior head injury.Conclusion:This information suggests opportunities for intervention to improve helmet use through increased fit, while the responses indicate a need for further education on proper helmet use.

Factors associated with concussion-symptom knowledge and attitudes toward concussion care seeking in a national survey of parents of middle-school children in the US

BackgroundDeveloping appropriate concussion prevention and management paradigms in middle school (MS) settings requires understanding parents’ general levels of concussion-related knowledge and attitudes. This study examined factors associated with concussion-symptom knowledge and care-seeking attitudes among parents of MS children (aged 10–15 years). MethodsA panel of 1224 randomly selected U.S. residents, aged ≥ 18 years and identifying as parents of MS children, completed an online questionnaire capturing parental and child characteristics. The parents’ concussion-symptom knowledge was measured using 25 questions, with possible answers being “yes”, “maybe”, and “no”. Correct answers earned 2 points, “maybe” answers earned 1 point, and incorrect answers earned 0 point (range: 0–50; higher scores = better knowledge). Concussion care-seeking attitudes were also collected using five 7-point scale items (range: 5–35; higher scores = more positive attitudes). Multivariable ordinal logistic regression models identified predictors of higher scores. Models met proportional odds assumptions. Adjusted odds ratios (aORs) with 95% confidence intervals (95%CIs) (excluding 1.00) were deemed statistically significant. ResultsMedian scores were 39 (interquartile range: 32–44) for symptom knowledge and 32 (interquartile range: 28–35) for care-seeking attitude. In multivariable models, odds of better symptom knowledge were higher in women vs. men (aOR = 2.28; 95%CI: 1.71–3.05), white/non-Hispanics vs. other racial or ethnic groups (aOR = 1.88; 95%CI: 1.42–2.49), higher parental age (10-year-increase aOR = 1.47; 95%CI: 1.26–1.71), and greater competitiveness (10%-scale-increase aOR = 1.24; 95%CI: 1.13–1.36). Odds of more positive care-seeking attitudes were higher in white/non-Hispanics vs. other racial or ethnic groups (aOR = 1.45; 95%CI: 1.06–1.99) and in older parental age (10-year-increase aOR = 1.24; 95%CI: 1.05–1.47). ConclusionCharacteristics of middle school children's parents (e.g., sex, race or ethnicity, age) are associated with their concussion-symptom knowledge and care-seeking attitudes. Parents’ variations in concussion knowledge and attitudes warrant tailored concussion education and prevention.

A Cross-Cultural Examination of Parental Knowledge of Concussion in Sicily, Italy

ABSTRACT Forty parents of youth soccer players of ages 5–17 years, in Sicily, Italy completed a survey measuring knowledge of concussion symptoms and facts. Parents averaged 16 out of 23 correct responses (69.5%) on the survey, with no significant correlation between parental age and education and knowledge. Italian parents were more familiar with somatic symptoms (92.5%-100% correct) than emotional/behavioral (27.5%-57.5% correct) and sleep symptoms (45.0%). Comparisons to U.S. and Australian research showed general agreement on knowledge of concussion symptoms, but less awareness of other concussion facts among Italian parents. More research on cross-cultural concussion education and barriers to concussion resources is warranted.

Concussion Symptom Underreporting Among Incoming National Collegiate Athletic Association Division I College Athletes.

Accurate diagnosis of sport-related concussions relies heavily on truthful self-reporting of symptom severity. Previous studies have emphasized lack of knowledge as a factor in symptom nondisclosure. This study sought to examine concussion knowledge and the relationship of knowledge to reasons for symptom nondisclosure. Cross-sectional study. Data were collected during preparticipation athletic evaluations via electronic survey. One hundred fifty-six incoming National Collegiate Athletic Association Division I student-athletes. Survey items included previous concussion diagnosis, concussion fact and symptom knowledge, reasons and situational contexts for nondisclosure, and stakeholder attitudes. Participants, on average, had substantial concussion symptom and fact knowledge. Unexpectedly, participants with higher concussion fact knowledge endorsed more reasons that athletes may hide symptoms. Concussion symptom knowledge was unrelated to reasons for nondisclosure. Athletes believed that symptom reporting was less likely in high-stakes versus low-stakes situations and consistently identified their teammates as holding attitudes that support underreporting and athletic trainers as engaging in behaviors that support player safety. Greater concussion knowledge did not reduce the number of reasons that participants viewed as drivers for concussion nondisclosure. In other words, participants understood why athletes choose to hide symptoms even when they also understood the symptoms, risks, sequelae, and consequences of concussion (and potential harm of nondisclosure). Situational contexts and important stakeholder attitudes also appeared to importantly influence symptom disclosure decisions. A multifaceted approach that goes beyond current educational strategies to addresses situational, social, and athletic pressures may be needed to initiate a widespread cultural shift away from concussion nondisclosure.

Sport-Related Concussion Education and the Elaboration Likelihood Model: Need for Cognition as Mediator Between Health Literacy and Concussion Education Efficacy

The current study examines the ways the elaboration likelihood model of persuasion can be applied to message design of concussion education programs. Results from a survey of collegiate athletes ( N = 353) illustrate that it is not only students’ generalized ability to understand health information (health literacy) that determines knowledge of concussion symptoms but also one’s motivation to think deeply about concussion protocols (need for cognition [NFC]). Current results show that NFC mediated the relationship between health literacy and the collegiate athletes’ knowledge of concussion symptoms. Collegiate athletes’ concussion protocols aimed at increasing concussion reportage rates should be multimodal (rather than standardized textual lecture-based approaches) to be better fitting individualized approaches to cognitive processing of complex health-related messages and to begin to address the sociocultural contexts and complexities associated with athletes’ stay-on-the-field bias, which makes the burden of behavioral change particularly difficult in concussion education efforts.

C-45 A Descriptive Analysis of Change in Concussion Knowledge in Collegiate Student-Athletes Participating in a Novel Peer Concussion Education Program

Abstract Objective This pilot study investigated the effect of a novel peer concussion education program on concussion knowledge in a sample of collegiate student-athletes. Method A pre-posttest design was employed to determine the effect of the program on concussion knowledge in a sample of 50 student-athletes (34 Men’s Lacrosse and 16 Women’s Soccer) participating at the NCAA Division II level of competition. Male participants made up 68% of the sample (n = 34). The majority of participants were white (88%). Concussion knowledge was assessed with a checklist adapted from Gioia and Collins’ (2006) Acute Concussion Evaluation and McLeod et al.’s (2007) questionnaire. This checklist included 19 actual symptoms and 8 false symptoms. Results A repeated-measures T Test was conducted to analyze pre-test and post-test scores of total concussion symptom knowledge. The results revealed a significant increase in concussion symptom knowledge after participation in the program, t(48) = 4.2, p &lt; 0.001, d = 0.59. A domain analysis indicated that at baseline, cognitive symptoms were accurately identified at a rate ranging from 68 to 90%, sensory/physical at a rate ranging from 74 to 98% and affective ranging from 42 to 68%. At posttest, these ranges increased to 92-98% for cognitive, 88 to 100% for sensory/physical and 84 to 88% for affective symptoms. Non-symptoms were incorrectly endorsed at a rate ranging from 54 to 92% at baseline and 56 to 76% at posttest. Conclusions The program appears to have potential for increasing knowledge of actual concussion symptoms; however, incorrect endorsement of non-symptoms persisted at a relatively high rate despite participation in the program.

Predictors of Collegiate Student-Athletes' Concussion-Related Knowledge and Behaviors.

This study aimed to explore student-athletes' concussion-related knowledge and attitudes toward reporting symptoms, demographic predictors of knowledge and attitudes, and determine whether responses to the survey changed following an online educational intervention. A total of 108 Division I student-athletes enrolled at a large southern university completed a survey evaluating knowledge regarding concussion-related terminology, symptoms and recovery trajectories, as well as attitudes toward reporting symptoms following a possible concussion. Student-athletes completed the questionnaire both 24-48 h before and one week after reviewing the educational presentation. At baseline, participants correctly identified 72% of concussion symptoms included in the questionnaire, as well as correctly identified 75% of items related to the typical recovery trajectory post-concussion. A total of 54% of baseline attitudes toward reporting symptoms matched clinical best practices. Multiple analysis of variance (MANOVA) revealed that male sex and non-Caucasian race were associated with worse baseline knowledge of concussion symptoms. Concussion knowledge was not associated with attitudes toward reporting symptoms. Paired samples t-tests indicated that knowledge of concussion-related terminology improved modestly following the educational presentation. Some subsets of collegiate student-athletes show relatively lower knowledge about symptoms of concussion than others. As a result, these groups may benefit from increased educational efforts to ensure they recognize when a concussion may have occurred. Additionally, as knowledge and attitudes were unrelated and the intervention had a modest effect on knowledge but not attitudes, future work should explore interventions that are designed to directly alter attitudes.

Reporting Skill: The Missing Ingredient in Concussion Reporting Intention Assessment.

Extant literature suggests that a substantial portion of athletes may not report a possible concussion and that concussion knowledge is insufficient to predict concussion reporting behavior. One area that has not been explored is reporting skill; that is, mastery of the actions required to report a concussion. This study evaluated the relationship between reporting skill and reporting intention, introducing a measure of the reporting skill construct. Reporting intentions will be more closely associated with reporting skill than with concussion/symptom knowledge. The relationship between concussion (or symptom) knowledge and reporting intentions will differ by level of reporting skill. Repeated cross-sectional study. Level 2. A set of items was administered to young adults aged 18 to 24 years from the Survey Sampling International panel. Exploratory/confirmatory factor analyses were conducted on 2 waves of data to develop the scale (n = 899). Hypotheses were tested using structural equation modeling on the responses from the third wave of participants (n = 406). Knowing the actions to take in reporting was more important than having knowledge of concussions or concussion symptoms. Reporting skill, not concussion or concussion symptom knowledge, was associated with higher intentions to report symptoms. Among those with higher levels of reporting skill, concussion symptom knowledge (but not general concussion knowledge) was associated with higher intentions to report symptoms. Reporting skill is an important and, until now, missing ingredient in the concussion literature and practice. Incorporating reporting skill development in concussion education and team activities to teach athletes how to report is likely to improve actual reporting intentions. While further study is needed with particular sports and additional age groups, reporting skill holds promise as a new avenue for increased concussion reporting.

Knowledge of and attitudes towards concussion in cycling: A preliminary study

The aim of this study wasto investigate the knowledge of and attitudes towards concussion in cycling. An abbreviated Rosenbaum Concussion Knowledge and attitudes Survey (RoCKAS) was distributed online via social media and completed by 1990 respondents involved in cycling. The RoCKAS comprised separate sections to determine a concussion knowledge index (CKI) providing a score between 0-33, and a concussion attitudes index (CAI) with possible scores between 7-20. Mean scores were 25.9 ± 11.0 and 17.7 ± 3.0 for CKI and CAI, respectively. However, there remained several concussion knowledge misconceptions and disparity between reported knowledge and attitudes and actions, with 16% of respondents admitting to riding despite having concussive symptoms and 18.7% stating they would hide a concussion to stay in an event. The results of this survey indicate those involved with cycling reported reasonable knowledge of concussion symptoms and safe/desirable attitudes towards concussion education. However, despite reporting safe attitudes, the actions of those involved in cycling may be of greater concern, as a considerable number of respondents were still willing to take risks by continuing to cycle knowing they had concussive symptoms.

Concussion reporting and perceived knowledge of professional fighters

ABSTRACTObjective: For concussions to be effectively managed in sports, they need to be correctly identified and reported. The extent to which professional athletes correctly recognize concussions, and their willingness to report symptoms, is not yet well understood. Given the risk of head injuries leading to concussions across combat sports, insight into professional fighters’ knowledge and reporting of concussive symptoms is essential to improve concussion management.Methods: To investigate understanding and reporting patterns of concussions sustained while training or competing, 257 fighters completed a self-report questionnaire assessing self-perception of concussion knowledge, trust of ringside medical providers, and reported number of previous head injuries. Fighting history, including number of knockouts, was obtained from self-report (amateur) and published (professional) records.Results: Significant gaps in fighters’ perceived knowledge of concussion symptoms and long-term effects of multiple concussions emerged. Approximately 40% of fighters reported returning to training or competition the same day a head injury was sustained, while 21% of fighters endorsed concealing symptoms of head injury from medical providers and coaches.Conclusions: Confusion surrounding terms used to describe head injuries amongst fighters (e.g., concussions, knockouts), coupled with limited understanding of concussive symptoms and a desire to return to competition, likely contributes to significant underreporting of symptoms.

Calling Injury Timeouts for the Medical Evaluation of Concussion: Determinants of Collegiate Football Officials' Behavior.

Sports officials can play an important role in concussion safety by calling injury timeouts so that athletic trainers can evaluate athletes with possible concussions. Understanding the determinants of whether officials call an injury timeout when they suspect a concussion has important implications for the design of interventions that better support officials in this role. To assess the knowledge of US collegiate football officials about concussion symptoms and to determine the associations between knowledge, perceived injunctive norms, and self-efficacy and calling injury timeouts for suspected concussions in athletes. Cross-sectional study. Electronic survey. Of the 3074 US collegiate football officials contacted, 1324 (43% response rate) participated. Concussion knowledge, injunctive norms (belief about what others would want them to do), and behavioral self-efficacy (confidence in their ability to call injury timeouts for suspected concussions in athletes during challenging game-day conditions). Officials reported calling approximately 1 injury timeout for a suspected concussion every 4 games during the 2015 season. Structural equation modeling indicated that officials with more concussion-symptom knowledge had greater behavioral self-efficacy. Independent of an official's symptom knowledge, injunctive norms that were more supportive of calling an injury timeout were associated with greater self-efficacy. Concussion education for officials is important because when officials are aware of concussion symptoms, they are more confident in calling injury timeouts. Beyond increasing symptom knowledge, fostering sports environments that encourage concussion safety in all stakeholder groups can support officials in calling injury timeouts. Athletic trainers can help create sports environments that support proactive concussion identification by educating stakeholders, including officials, about the importance of concussion safety. When officials believe that other stakeholders support concussion safety, they are more likely to call injury timeouts if they suspect a concussion has occurred.

Calling Injury Timeouts for the Medical Evaluation of Concussion: Determinants of Collegiate Football Officials' Behavior.

Sports officials can play an important role in concussion safety by calling injury timeouts so that athletic trainers can evaluate athletes with possible concussions. Understanding the determinants of whether officials call an injury timeout when they suspect a concussion has important implications for the design of interventions to better support officials in this role. To assess the knowledge of US collegiate football officials about concussion symptoms and to determine the associations between knowledge, perceived injunctive norms, and self-efficacy in calling injury timeouts for suspected concussions. Cross-sectional study. Electronic survey. Of the 3074 US collegiate football officials contacted, 1324 (43% response rate) participated. Concussion knowledge, injunctive norms (belief about what others would want them to do), and behavioral self-efficacy (confidence in their ability to call injury timeouts for suspected concussions in athletes during challenging game-day conditions). Officials reported calling approximately 1 injury timeout for a suspected concussion every 4 games during the 2015 season. Structural equation modeling indicated that officials with more concussion-symptom knowledge had greater self-efficacy. Independent of an official's symptom knowledge, injunctive norms that were more supportive of calling an injury timeout were associated with greater self-efficacy. Concussion education for officials is important because when officials are aware of concussion symptoms, they are more confident in calling injury timeouts. Beyond increasing symptom knowledge, fostering sports environments that encourage concussion safety can support officials in calling injury timeouts. Athletic trainers can help by educating stakeholders, including officials, about the importance of concussion safety. When officials believe that other stakeholders support concussion safety, they are more likely to call injury timeouts if they suspect a concussion has occurred.