The prevalence of undiagnosed concussions in athletes
Meehan WP, Mannix RC, O’Brien MJ, Collins WC. Clinical Journal of Sports Medicine. 2013; ahead of print.
Take Home Message: Over 30% of athletes reported a previously undiagnosed concussion and these athletes may be at risk for more severe symptoms after a future impact.
Many athletes fail to report their concussion signs and symptoms (Kauet, 2003 Labotz,2005; McCrea,2004; Williamson, 2006), which predisposes them to sustaining a second blow when the brain is still recovering from the first impact. However, we still don’t know how common undiagnosed concussions may be. Identifying under-reporting rates will help medical personnel clarify where additional measures can be taken to ensure athletes’ safety. Therefore, the purpose of this study was to determine whether patients from 2 sport clinics sustained previous concussions that went undiagnosed. The authors evaluated 486 patients that were seen between October 2009 and September 2010 due to a sports-related concussion. The patients provided demographic (e.g., age, gender) and clinical information (e.g., day of injury, sport), and completed the Post Concussion Symptom Scale (part of the Sport Concussion Assessment Tool 2). Then, they answered the following question: “Have you ever sustained a blow to the head which was not diagnosed as a concussion, but was followed by one or more of the signs and symptoms in the Post Concussion Symptoms Scale?” The patients answering yes to this question were defined as having a previously undiagnosed concussion. A total of 148 (30%) patients reported that they had sustained a blow to the head that resulted in concussion signs and symptoms, but were never diagnosed with a concussion. There were no differences in gender, age, or number of previous concussions between those that reported an undiagnosed concussion to those that did not. Athletes who reported a previously undiagnosed concussion were more likely to have lost consciousness with their current injury compared with those with no previously undiagnosed concussion (30.6% vs. 21.8%). Also, athletes that reported undiagnosed concussion had a higher initial Post Concussion Symptom Scale score (mean = 33) with their current injury compared to patients that did not report a previously undiagnosed concussion (mean = 25).
Nearly one-third of the athletes seen at the 2 sport clinics reported previously undiagnosed concussions. This rate is lower than previous research, which may be due to the inclusion of all sports and not just football athletes, who may less likely to report their concussions. It could also be attributed to the increased media attention and improved education that resulted in more athletes reporting their concussion symptoms. However, 30% is still an alarming rate of undiagnosed concussions. Additionally, those athletes with previously undiagnosed concussions had more symptoms and higher rates of loss of consciousness with their current injury compared with athletes without a previously undiagnosed concussion. Failure to report concussion signs and symptoms may increase the risk of deleterious effects on the brain. A prospective study designed to determine the reasons behind the undiagnosed concussions may allow researchers to educate athletes to seek proper medical attention. In the meantime, we must be aware that almost a third of concussions may be missed and that these athletes may be at risk for more severe symptoms after a future impact. This may be valuable information when we educate our athletes, coaches, and parents about the consequences of missed concussions.
Questions for Discussion: What do you think the best method is to deliver concussion education to the public? Other than education how can we reduce the number of undiagnosed concussions?
Written by: Jane McDevitt PhD, ATC, CSCS
Reviewed by: Jeffrey Driban
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