Report Concussion Symptoms Research Articles

B - 29 Exploring Sex Differences in Concussion Symptom Reporting between Parents and Children

Abstract Objective Concussion evaluation often entails patient completion of symptom checklists and questionnaires. Prior research indicates children often report higher concussion-related symptoms than parents (Johnson et al., 2020; Liu & Hicks, 2020). Furthermore, research indicates sex differences in reported symptoms among children and adolescents. (Preiss-Farzanegan et al., 2009; Frommer et al., 2011). This study aimed to explore these differences and the relationship between self-reported and parent-reported concussion symptoms by sex. Methods Children who sustained a concussion were examined in an acute concussion clinic for diagnosis and treatment of injury. In addition to the physical examination, parents were given the Post-Concussion Symptom Inventory Parent Assessment Form (PCSI-P) and children were given the appropriate version of the PCSI based on their age. Results 44 children (M = 14.05, SD = 2.49; sex: 12 male, 32 female) and 36 parents were included for analysis. Parents reported higher tiredness (M = 3.4, SD = 1.72) than children self-report (M = 2.57, SD = 1.88; t(34) = 2.84, p = 0.007), and higher irritability (M = 3.03, SD = 2.07) children self-report (M = 2.06, SD = 2.17; t(34) = 2.78, p = 0.009). In male and female self-report, males reported higher levels of feeling dazed (M = 3.33, SD = 1.75) than females (M = 1.58, SD = 1.74; t(28) = 2.20, p = 0.036),and higher levels of slowed response (M = 4.00, SD = 1.23) than females (M = 2.13, SD = 1.96; t(27) = 2.04, p = 0.05). No differences were found between parent reports of male and female children. Conclusion Our findings highlight discrepancies between parent and child reports of concussion-related symptoms, emphasizing the need for self and parent report assessments in clinical concussion evaluations. Furthermore, sex differences in self-reported symptoms underscore the importance of considering sex-related factors in concussion management and treatment.

Non-reporting of sport-related concussion symptoms: a cross-sectional study of community rugby league players in the UK

Recognising and removing players with suspected sport-related concussions is crucial for community sports.ObjectivesQuantify rates and factors associated with non-reporting of concussion symptoms in community rugby league.MethodsOverall, 484 community rugby league...

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.

Knowledge, Attitude, and Behavior of Medical Students with Regard to Concussions: A Cross-Sectional Study.

Concussions, categorized as mild traumatic brain injuries, result from traumatic events and present a significant concern within the field of traumatic brain injuries. Understanding the multifaceted pathophysiology of concussions, their diverse symptomatology, and their appropriate management strategies is crucial for healthcare professionals. This study explores the knowledge, attitudes, and behaviors of medical students at King Faisal University in the Eastern Province of Saudi Arabia regarding concussions. A cross-sectional study design was employed to assess a diverse group of medical students at King Faisal University in the Eastern Province of Saudi Arabia. Participants were surveyed using a questionnaire covering socio-demographic information, knowledge assessment, attitude assessment, and behavior assessment. Of the 315 participants, 68.3% demonstrated good knowledge about concussions. Participants generally recognized concussions as a type of traumatic brain injury (68.9%) and believed it was necessary to report concussion symptoms to a doctor (80.3%). However, certain misconceptions existed, such as the belief that all patients with concussion should rest for seven days (31.7%). Participants primarily obtained information from teachers (100%) and the internet and social media (81.6%). While medical students at King Faisal Universityin the Eastern Province of Saudi Arabia generally exhibited good knowledge about concussions, specific knowledge gaps and misconceptions were seen to exist. To ensure comprehensive understanding and promote appropriate management, continuous education, and awareness campaigns are essential, with healthcare providers playing a pivotal role in knowledge dissemination.

I won't let you down; why 20% of Men's and Women's Super League players underreported suspected concussions

ObjectivesQuantify and identify factors associated with concussion underreporting in Super League rugby league players. DesignCross sectional survey. MethodsDuring the 2022 season preseason, 422 Men's and Women's Super League players completed an online survey quantifying player demographics, rugby playing history, concussion history, prevalence of, and reasons for underreporting concussion, concussion knowledge and long-term implications and perceptions of concussion. ResultsOverall, 20% of respondents stated they did not report concussion-related symptoms to medical staff during the 2020 and 2021 seasons. The two most common reasons for underreporting concussion were ‘didn't want to be ruled out of a match’ (35%) and ‘didn't want to let down team’ (24%). 65% of players reported an appropriate level of knowledge about concussion and potential long-term implications at the start of their senior rugby career, versus 89% now. In relation to concussion knowledge, symptoms were correctly identified on 74% of occasions. 57% of players surveyed were concerned about the potential long-term implications from concussion, and 11% of players would encourage their/family members' children to not play rugby league. ConclusionsThe proportion of Super League players who did not report concussion symptoms was similar to rugby league players in Australia. The main reasons for not reporting concussion appeared to be due to perceptions of what is beneficial for the team, suggesting both performance and medical staff should collectively encourage players to report concussion. A player's attitude towards concussion is potentially an individual modifiable risk factor and should be considered within the concussion management of players.

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.

The Identification and Comparison of Factors Affecting Musculoskeletal and Concussion Injury Disclosure.

Despite the increased risk of musculoskeletal (MSK) injury after a concussion, little is known about the determinants of such a risk. Moreover, the authors of previous reports of increased risk of MSK injury after a concussion have neglected to account for the high level of undisclosed concussions. To explore the association between the intention to disclose a possible concussion and the intention to disclose an MSK injury. Cross-sectional study. Online survey. One hundred seven National Collegiate Athletic Association Division I athletes (females = 79%, age = 19.4 ± 1.4 years). Online survey exploring determinants such as injury knowledge, attitudes, perceived social norms, and perceived behavioral control surrounding concussive and MSK injury disclosure. A significant association between high intention to disclose a concussion and high intention to disclose an MSK injury (χ2 = 19.276, P < .001, Cramer V = 0.482) was observed. Spearman rank correlations suggested no correlation between concussion nondisclosure (25%) and MSK injury nondisclosure (52%). Multivariate binomial regressions indicated that perceived social norms were the strongest determinant (β = 1.365, P = .002) of high intention to disclose concussion, while attitudes toward MSK injury (β = 1.067, P = .005) and perceived social norms (β = 1.099, P = .013) were the strongest determinants of high intention to report MSK injury. Individuals with high intention to report concussion symptoms also demonstrated high intention to report MSK injury. Strong positive associations were seen between known determinants of intention to disclose concussion and adapted versions of those same determinant domains in intention to disclose MSK injury. As those with high intention to disclose concussion also displayed high intention to disclose MSK injury, intention to disclose injuries generally may play a role in explaining the increase in MSK injury after a concussion.

Optimizing Concussion Care Seeking: A Longitudinal Analysis of Recovery

Background: Approximately half of concussions go undisclosed and therefore undiagnosed. Among diagnosed concussions, 51% to 64% receive delayed medical care. Understanding the influence of undiagnosed concussions and delayed medical care would inform medical and education practices. Purpose: To compare postconcussion longitudinal clinical outcomes among (1) individuals with no concussion history, all previous concussions diagnosed, and ≥1 previous concussion undiagnosed, as well as (2) those who have delayed versus immediate symptom onset, symptom reporting, and removal from activity after concussion. Study Design: Cohort study; Level of evidence, 2. Methods: Participants included 2758 military academy cadets and intercollegiate athletes diagnosed with concussion in the CARE Consortium. We determined (1) each participant’s previous concussion diagnosis status self-reported at baseline (no history, all diagnosed, ≥1 undiagnosed) and (2) whether the participant had delayed or immediate symptom onset, symptom reporting, and removal from activity. We compared symptom severities, cognition, balance, and recovery duration at baseline, 24 to 48 hours, date of asymptomatic status, and date of unrestricted return to activity using tests of parallel profiles. Results: The ≥1 undiagnosed concussion group had higher baseline symptom burdens (P < .001) than the other 2 groups and poorer baseline verbal memory performance (P = .001) than the all diagnosed group; however, they became asymptomatic and returned to activity sooner than those with no history. Cadets/athletes who delayed symptom reporting had higher symptom burdens 24 to 48 hours after injury (mean ± SE; delayed, 28.8 ± 0.8; immediate, 20.6 ± 0.7), took a median difference of 2 days longer to become asymptomatic, and took 3 days longer to return to activity than those who had immediate symptom reporting. For every 30 minutes of continued participation after injury, days to asymptomatic status increased 8.1% (95% CI, 0.3%-16.4%). Conclusion: Clinicians should expect that cadets/athletes who delay reporting concussion symptoms will have acutely higher symptom burdens and take 2 days longer to become asymptomatic. Educational messaging should emphasize the clinical benefits of seeking immediate care for concussion-like symptoms.

Concussion education for youth athletes using Pre-Game Safety Huddles: a cluster-randomised controlled trial

ObjectivesDetermine whether Pre-Game Safety Huddles, a novel and low-resource approach to concussion education, increase the expected likelihood of concussion reporting for youth athletes.MethodsA cluster-randomised trial compared Safety Huddles to usual...

Parents and coaches as transformational leaders: Motivating high school athletes’ intentions to report concussion symptoms across socioeconomic statuses

PurposeStudies demonstrate that parents and coaches play a role in an athlete's concussion reporting decision primarily through their influence on the decision environment. Little work, however, has explored how a given parenting/coaching style operates to promote intentions and much less work has examined whether the impact of parenting/coaching on concussion reporting differs by socioeconomic status. Transformational parenting/coaching (i.e., a focus on building autonomy and self-efficacy in athletes) represents one promising approach given its effects on other outcomes (e.g., health, burnout, aggression). We hypothesize that athlete perceptions of transformational parenting/coaching will be associated with their reporting intentions directly and through the athlete's motivation for playing their sport regardless of household income. MethodsA national survey of 1023 high-school athletes measured athlete perceptions of transformational parenting/coaching, sport motivation, and reporting intentions. Structural Equation Modeling was used to examine hypotheses. ResultsTransformational parenting was directly associated with reporting intentions (β: Reporting Intentions = .265; Scenario 1 = 0.206; Scenario 2 = 0.260) and indirectly through increased autonomous/decreased controlled motivation. Transformational coaching was not directly associated with Reporting Intentions (β = 0.008, p = .816) or Scenario 2 (β = 0.046, p = .198) but was for Scenario 1 (β = 0.077, p = .003). Transformational coaching was also associated with reporting intention indirectly through increased autonomous, but not controlled motivation. Athletes with household income of $50,000+ were more likely to report transformational parenting/coaching; however, the effects of transformational parenting/coaching did not differ for athletes from higher versus lower-income households. ConclusionsTransformational parenting/coaching may encourage greater concussion reporting intentions primarily through increased autonomous (i.e., self-directed) sport motivation regardless of socioeconomic status. Cultivating transformational leadership in parents/coaches can have a positive impact on the athlete's intention to report concussion-like symptoms.

In-Season Concussion Symptom Reporting in Male and Female Collegiate Rugby Athletes.

Symptom inventories are generally only collected after a suspected concussion, but regular in-season monitoring may allude to clinical symptoms associated with repetitive subconcussive impacts and potential undiagnosed concussions. Despite sex-specific differences in symptom presentation and outcome of concussion, no return-to-play protocol takes sex into account. The objective of this study was to monitor a cohort of contact-sport athletes and compare the frequency and severity of in-season concussion-like symptom reporting between sexes. Graded symptom checklists from 144 female and 104 male athlete-seasons were administered weekly to quantify the effect of subconcussive impacts on frequency and severity of in-season symptom reporting. In-season, mean symptom severity score (SSS) (p = 0.026, mean difference of 1.8), mean number of symptoms (p = 0.044, mean difference of 0.9), max SSS (p < 0.001, mean difference of 19.2), and max number of symptoms (p < 0.001, mean difference of 6.8) were higher in the females. The females' survey results showed differences between elevated and concussed SSS (p < 0.005, mean difference of 28.1) and number of symptoms reported (p = 0.001, mean difference of 6.6). The males did not have a difference in SSS (p = 0.97, mean difference of 1.12) nor in number of symptoms (p = 0.35, mean difference of 1.96) from elevated to concussed athletes. Rugby players report concussion-like symptoms in the absence of a diagnosed concussion in-season. Female athletes reported elevated symptom frequencies with greater severities than the males, but both sexes reported considerable levels throughout the season.

A - 03 Concussion Symptom Reporting in Sport-Related Concussions During The COVID-19 Pandemic

ObjectiveEvaluation of concussion symptoms is a key element in management of sport-related concussions (SRC). The COVID-19 pandemic has been linked to increased reports of anxiety and depression in the general population, though it is unknown if this increase has also affected reporting of concussion symptoms. The purpose of this study was to determine whether there were differences in reporting of concussion symptoms in adolescents who sustained an SRC before versus during the COVID-19 pandemic.MethodsSubjects (n = 707) aged 12–18 with SRC were evaluated within 14 days of injury (M = 5.64 days, SD = 3.68) at a North Texas Concussion Registry (ConTex) clinic and completed the Sport Concussion Assessment Tool-5 (SCAT-5) Symptom Evaluation. Subjects were grouped by those evaluated before (n = 625) or after (n = 82) March 23, 2020 and were similar in age, sex, and history of treatment for anxiety or depression. T-tests were used to compare the number of endorsed concussion symptoms and symptom severity between groups.ResultsThere was no significant difference in number of concussion symptoms endorsed (M = 10.81, SD = 6.53 vs M = 11.35, SD = 6.25, p = 0.463) or symptom severity (M = 28.33, SD = 24.14, M = 26.79, SD = 20.91, p = 0.540) between before vs during COVID-19 SRC groups.ConclusionsIn this cohort of young athletes, results suggest that despite effects of the COVID-19 epidemic on community mental health, we did not see evidence of a systematic influence on SRC symptom reporting during the pandemic.

Concussion-reporting behaviors among high school athletes in Ireland: Applying the theory of planned behavior

Background Sport-related concussion is a significant public health issue, especially among children and adolescents. A growing body of evidence suggests that athletes who do not immediately report concussion and continue to play while concussed take longer to recover than their counterparts. Yet, many child and adolescent athletes do not immediately report concussion symptoms to a responsible adult. Aim This study examined the utility of the Theory of Planned Behavior (TPB) in predicting concussion reporting intentions and in-season reporting behaviors among high school, Gaelic Athletic Association (GAA) athletes in the Republic of Ireland. Methods High school GAA athletes aged 12-18 years completed surveys at baseline and at three-month follow-up. Concussion-related perceived behavioral control (PBC), attitudes, subjective norms, and reporting intentions were assessed at baseline. In-season concussion reporting behaviors were assessed at three-month follow-up. Hierarchical linear regression models were used to examine the relationship between the constructs of the TPB and baseline reporting intentions. Logistic regression models were used to examine the relationship between the constructs of the TPB and in-season reporting behaviors. All data were collected during the 2016–2017 academic year. Results A total of 153 adolescent athletes were included (n = 102 [66.7%] females; Mage = 14.4 years, [SD = 1.6]). Consistent with the TPB, results revealed that PBC and reporting intentions contributed to the prediction of in-season reporting behaviors. Reporting intentions, in turn, were strongly influenced by PBC, attitudes, and subjective norms. PBC was the strongest predictor of concussion reporting intentions and in-season reporting behaviors; the stronger the athletes’ PBC, the stronger their reporting intentions and the more likely they were to have reported concussion symptoms during the current season. Conclusion Although the findings from the current study must be interpreted cautiously given the small sample size, the findings suggest that the TPB has some utility in the prediction of concussion reporting intentions and reporting behaviors. However, our findings suggest that the TPB should not be used in isolation; other models that incorporate personal factors and environmental constraints may be needed to better our understanding of concussion reporting intentions and behaviors among high school athletes. Concussion education programs that include strategies to enhance PBC over concussion reporting may help improve concussion reporting behaviors among high school athletes.

Elevated In-Season Presentation of Concussion-Like Symptoms in the Absence of Diagnosed Concussion

The objective of this study was to quantify elevated in-season presentation of concussion-like symptoms in the absence of diagnosed concussion in a cohort of collegiate rugby players. It is well known that many sports-related concussions are unreported. Athletes that do not immediately report concussion symptoms and continue to participate in activities are at higher risk for longer recoveries and sustain post-concussion symptoms longer. How regularly athletes experience elevated concussion symptoms in-season is unknown. Athletes from men's and women's rugby teams were recruited and consented in accordance with the Virginia Tech Institutional Review Board. 63 males and 78 females participated over three seasons. Subjects completed a symptom and exposure query (SEQ) weekly throughout their season. The SEQ asked subjects if, in the past week, they experienced the 27 symptoms from the Graded Symptom Checklist for concussion. Subjects graded each symptom on a scale of 0-6, with 0 being no presentation and 6 being the most severe presentation. The graded severities of each symptom were summed to compute the overall Symptom Severity Score (SSS). Surveys that indicated confounding circumstances leading to symptoms were removed from analysis. The 99th percentile of SSS from baseline data was used as a metric of "elevated SSS," which corresponded to an SSS of 11. 1,214 SEQs were collected. There were 77 surveys from 43 athletes, 10 (15.8%) men and 33 (42.3%) women, who reported elevated SSS. In a given season, 16.3% of males and 41.7% of females reported elevated symptoms at least once. The surveys identified 11 additional suspected concussions based on symptom scores beyond the 8 that were clinically diagnosed. This provides some evidence that constellations of concussion symptoms are commonly experienced by collegiate rugby athletes in-season. Some are at severities typically associated with concussion, but most are below current clinical concussion diagnostic thresholds.

Using the health belief model to predict concussion-reporting intentions and behaviour

ABSTRACT Purpose To determine whether Health Belief Model (HBM) factors predict concussion-reporting intentions and behaviour. Methods: Participants completed a cross-sectional survey to measure the HBM constructs of concussion knowledge, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action. We also asked participants to indicate their concussion-reporting intentions and behaviourfor symptom and concussion reporting. Four separate multivariable regressions were conducted to predict concussion-reporting intentions and behaviour based on HBM constructs. Results: Cues to action (β = 0.25, p= .016) predicted symptom reporting intentions (F7,318 = 4.44, p< .001, R2 = 0.089), while perceived benefits (β = 0.12, p= .018), perceived barriers (β = −0.11, p= .034) and cues to action (β = 0.29, p< .001) predicted concussion-reporting intentions (F7,318 = 11.34, p < .001, R2 = 0.200). The HBM did not predict symptom or concussion-reporting behavior (symptom: Χ2 = 5.51, p= .138, Nagelkerke R2 = 0.096; concussion: Χ2 = 5.20, p= .157, Nagelkerke R2 = 0.159). Conclusions: Strategies to reduce perceived barriers and increase benefits of reporting concussion symptoms may improve reporting intentions. This may include cues to action in sharing a positive view toward long-term health and dispelling that reporting a concussion would let down teammates. .

A Social-Marketing Intervention and Concussion-Reporting Beliefs.

Concussion-symptom education remains the primary approach used by athletic trainers to address underreporting of possible sport-related concussions. Social marketing represents an untapped approach to promote concussion reporting by communicating the benefits or consequences of reporting or not reporting, respectively. To apply expectancy value theory and identify how marketing the possible consequences of concealing concussion symptoms influenced young adults' concussion-reporting beliefs to increase the likelihood of reporting. Randomized controlled clinical trial. Laboratory. A total of 468 competitive collegiate club sport athletes at a large US university who engaged in 1 of 46 sports with various levels of concussion risk. Participants were randomly assigned by team to 1 of 3 conditions. The treatment condition was a social-marketing program focused on the possible consequences of the reporting decision. The control condition was traditional concussion-symptom education based on the National Collegiate Athletic Association's publication, "Concussion: A Fact Sheet for Student-Athletes." An additional condition mirrored the traditional symptom education but included a less clinical delivery. Positive and negative beliefs regarding concussion reporting were assessed. We applied expectancy value theory, which posits that changing beliefs in the short term will produce greater reporting intentions in the long term. Club sport athletes exposed to consequence-based social marketing showed higher levels of positive reporting beliefs and lower levels of negative reporting beliefs than athletes exposed to traditional or revised symptom education. We observed no differences between the traditional and revised symptom-education programs. Exposure to consequence-based marketing decreased negative beliefs about reporting (B = -0.165, P = .01) and increased positive beliefs about reporting (B = 0.165, P = .01). Social marketing offers athletic trainers another strategic tool for motivating athletes to report concussion symptoms by translating scientific findings into marketable statements and then communicating the benefits of reporting or the negative consequences of concealing concussion symptoms.

Intentions to report concussion symptoms in nonprofessional athletes: A fuzzy‐trace theory approach

SummaryReducing concussion risks in athletes depends on self‐reporting. Often, athletes decide whether to report concussions or continue playing and risk serious health consequences. Fuzzy‐trace theory (FTT) predicts that reliance on gisty, categorical representations of risky decisions, not amounts of risk/reward, encourages risk avoidance and application of bottom‐line values, or gist principles, thus promoting healthy decisions. Applying FTT, we test whether intentions to report are predicted by gist‐based thinking about risks and values. High school and college students (N= 1,366) were assessed for concussion knowledge, social pressures to not report (by coaches/parents/teammates), categorical gist‐based thinking, endorsement of gist principles expressing values, and intentions to report. As expected, the older group scored higher on gist measures. For young adults, categorical thinking, and gist principles predicted intentions, controlling for sex, knowledge, and social pressures. For adolescents, categorical thinking again predicted intentions. For both age groups, adding FTT's predictors accounted for significantly more variance than baseline models.

Sport Motivation as a Possible Indicator of Concussion Reporting Intentions Among Young Athletes.

To assess the relationship between sport motivation and intentions to report concussion symptoms among young adult athletes. Cross-sectional study (level of evidence: 3). One thousand three hundred five young adult athletes of various sports and levels of competitiveness from the Survey Sampling International panel. Data were collected through an online survey. Ordinary least squares regression was used to examine the relationship between motivation and reporting intentions controlling for competitiveness and perceived risk of injury. Athletes who play their sport for self-regulated (autonomous) reasons have higher intentions to seek care for concussion-like symptoms, whereas those who play to achieve gains external to the sport or avoid punishment (controlled motivation) have lower intentions. A one-point increase in autonomous motivation was associated with an 11.5-point increase in reporting intention (t = 6.629, P < 0.001), whereas a one-point increase in controlled motivation was associated with an 8.1-point decrease in reporting intention (t = -4.562, P < 0.001). Betas from the model suggested that autonomous motivation had a stronger effect than controlled motivation (0.226 vs -0.163). Innovation in care, concussion education, and cultivation of team culture supportive of autonomous motivation could increase concussion reporting. Measuring sport motivation may reveal which athletes require more proactive attention to ensure symptoms are not concealed. Furthermore, messages to reinforce autonomous motivation may increase willingness to report.

Initially concealed concussion lowers in-game performance of NCAA Division I football players: a case series

ABSTRACT Objectives: Many athletes conceal concussion symptoms to continue to play. If athletes and coaches knew that performance drops significantly after a concussion, in turn hurting the team, athletes may be more prone to report concussion symptoms. The objective of our research was to report three cases that support this performance decline after an undisclosed concussion. Methods: This is a case series of three NCAA Division I football players who did not immediately report their concussions. The play in which the concussion occurred was identified via video review then the players’ pre and post-injury performance grades, as scored by their position coaches, were recorded. Additional data regarding their performance in other games and their concussion assessments were also recorded. Results: Three injuries were identified and reviewed. Player 1 had a pre-injury performance score of 76/100 with a post-injury score of 47/100. This was a drop of 29 points for a decrease in his in-game performance by 38%. Player 2 had a pre-injury score of 100/100 with a post-injury score of 60/100. This was a drop of 40 points or a 40% decrease in his in-game performance. Player 3 had a pre-injury score of 67/100 and a post-injury score of 43/100 for a drop of 24 points or a 36% decrease in his in-game performance. Conclusions: We reported three college football players who suffered concussions but did not immediately disclose their symptoms. Each had a marked decrease in performance grades after their concussion. If the performance effect of a concussion can be quantified, athletes and coaches may begin to change their mind-set that a concussion can be ‘played through.’ This case series should serve as a first step in quantifying concussion effects on performance.

High School Student-Athletes’ Awareness of Concussion Education May Differ by Age

Background:A tremendous amount of resources and education have been directed towards those involved in high school athletics to help recognize the signs and symptoms of a concussion and ensure removal from play of potentially concussed athletes. Concussion education policies have been broadly implemented across the country; however, the success of these educational methods at encouraging adolescents to disclose their symptoms has yet to be determined.Purpose:The purpose of this study was to (1) identify how many student-athletes recognized they had been provided concussion education and (2) document disclosure and non-disclosure patterns.Methods:An anonymous survey was distributed to student-athletes at four Connecticut high schools. The survey contained demographic questions (sex, age, primary sport, and prior history of concussion) along with a question asking if the individual had received formal concussion education. The survey then asked in which of six provided situations the athlete would disclose their symptoms and which of eight provided reasons would prevent the athlete from disclosing their symptoms. Respondents were grouped by education status (received or not) and the difference in response frequency was evaluated using Chi-Square tests.Results:A total of 872 athletes (average age 15.8±1.3 years, 410 Males, 462 Females) completed the survey (61.2% response rate). A total of 583 (66.9%) athletes reported having received concussion education. Athletes who reported that they had not received concussion education were significantly younger than athletes that reported that they had received concussion education (p=<0.001). Both the education and non-education groups identified an important game as the least likely situation to disclose symptoms, and practice as the most likely situation. The most common reason for non-disclosure was “Don’t want to miss game” in the education group and “Don’t think I have a concussion” in the non-education group. Significant differences in response rates between groups were found for ‘Don’t think I have a concussion’ (p=0.038) and ‘Others played with concussions’ (p=0.005).Conclusion:Current educational efforts may not be successfully educating younger student-athletes about the importance of recognizing and reporting concussion symptoms. Within our small cohort of Connecticut high schools, approximately 1/3 of individuals reported not receiving education, and more than half of student-athletes report that they would not disclose concussion symptoms during important games despite receiving education. Further work is required to re-evaluate the efficacy of current educational programs available to high school athletes, focusing on non-disclosure reasons reported by varying ages of student-athletes.Table 1.Status of Concussion Education and Disclosure and Non-Disclosure Patterns of High School Student Athletes Education (n=583) No Education (n=289) p-value Age (years)16.0 ± 1.315.5 ± 1.2 <0.001 Gender (Female)50.957.10.086History of Prior Concussion (yes)30.515.6 <0.001 Would tell in a… Practice79.178.5.857Important Game38.936.3.455Regular Game59.760.6.806Unimportant game77.773.6.155Early Season63.066.1.363Late in Season53.249.5.304 What is the reason you wouldn’t tell Don’t Think you have a concussion53.961.2 .038 Don’t want to let team down48.449.1.831Part of the Game12.516.6.100Not Serious Enough44.844.3.893Don’t want to miss game58.051.9.089Don’t want to disappoint parents13.214.9.500Don’t want to disappoint coach36.732.5.224Other played with concussions4.10.7 .005 All values reported as percentage (%), except for age and history of concussions.