Sports Medicine Research: In the Lab & In the Field: Better Attitudes May Improve Concussion Reporting Habits (Sports Med Res)


Monday, August 5, 2013

Better Attitudes May Improve Concussion Reporting Habits

Knowledge, Attitude, and Concussion-Reporting Behaviors Among High School Athletes: A Preliminary Study

Register-Mihalik JK., Kim N., Guskiewicz KM., Valovich McLeod TC., Linnan LA, Mueller FO., Marshall SW.  Journal of Athletic Training. 2013; 48(3).

Take Home Message: Over half of the athletes recalled concussive events in this study but did not report their problem to their supervising adult. Additionally, both concussion knowledge and attitude may play a role in reporting concussive events.

Many athletes continue to practice and play games while experiencing concussion-related symptoms. Knowledge and attitude regarding concussions are changeable factors that may contribute to concussion-reporting and care-seeking behaviors; however, few researchers have investigated concussion knowledge or attitude and reporting frequency. Therefore, the purpose of this study was to examine the influence of concussion knowledge and attitude on concussion reporting among high school athletes. The authors collected 167 surveys (10% return rate) from 25 out of 28 high school that received the 1,669 surveys. An athlete could participate in this study if he or she was listed on the roster as a member of the varsity football, cheerleading, boys’ soccer, girls’ soccer, boy’s lacrosse, or girls’ lacrosse team. The survey contained questions about athlete’s knowledge, attitudes, and beliefs regarding concussion, as well as whether they reported their past concussive and bell-ringer events, and how they handled those events. A total of 89 (53%) athletes recalled having at least 1 possible concussion or bell-ringer event; however, only 15 athletes indicated that they reported the event. Athletes recalled a total of 84 concussions and 584 bell-ringer events but they only reported 41 and 71 of these events to a coach or medical professional, respectively. The athletes provided 3 common reasons for failing to report a concussion or bell-ringer event: 1) the athlete thought it was only minor (70%), 2) they wanted to stay in the game (36.5%), or 3) they wanted to avoid letting their teammates down (27%). The athletes were fairly knowledgeable about concussions and correctly answered 55% to 100% of the questions on the knowledge portion of the survey. An athlete with a more favorable attitude toward wanting to understand and report a concussion was less likely to report that he or she continued to play in games or practices while symptomatic. Athlete knowledge and attitude total scores were not associated with reporting recalled concussion or bell-ringer events in games. Though, an athlete with more concussion knowledge or a more favorable attitude towards concussion often recalled more events in practice, particularly bell-ringer events. Finally, an athlete with more concussion knowledge or a more favorable attitude towards concussion typically reported bell-ringer events to a coach or medical professional more often compared with individuals with lower scores.

This study highlights that most high school athletes do not report concussions. Athletes described an alarming amount of bell-ringer events but yet they only reported 12% of the events to a coach or medical professional. These events might have been concussions, where athletes continued to play in a vulnerable state. This study also emphasizes that even though concussion knowledge in this study was higher than previously reported there is room for more education since athletes do not consider bell-ringer events concussions, and the most common reason an athlete did not report his/her concussion was because they thought it was only a minor problem. This study also suggests that concussion knowledge and athlete’s attitude plays a role in athlete’s reporting behaviors. Athletes with a positive attitude toward reporting a concussive injury may have a better understanding of the importance of reporting concussion injuries. This may suggest that if we increase an athlete’s knowledge about concussions we could affect their attitude, which may encourage athletes to report a concussion. While we can implement more education programs today it will be beneficial to see more research to determine which education strategies and lesson plans may be most effective at increasing knowledge and changing attitudes. 

Question for Discussion: How can you teach students to have a better attitude with their concussion reporting habits?

Written by: Jane McDevitt PhD, ATC, CSCS
Reviewed by: Jeffrey Driban

Related Posts:

Register-Mihalik JK, Guskiewicz KM, McLeod TC, Linnan LA, Mueller FO, & Marshall SW (2013). Knowledge, Attitude, and Concussion-Reporting Behaviors Among High School Athletes: A Preliminary Study. Journal of Athletic Training PMID: 23848520


Carolin S said...

This was a very interesting article. From my past experiences as an athletic trainer at a high school, I have learned that many coaches, athletes, and even parents do not take concussions seriously. They believe that their kid is fine and it will eventually go away. They do not know of the dangers or even the symptoms that can come with a concussion. When I presented the parents, athletes, and coaches with a brief presentation of the dangers of concussions, they were opened and aware of this injury. The coaches and parents knew what exactly a concussion was and the athletes knew the different signs and symptoms. Also, since I presented this information, the athletes felt comfortable enough to come to me when they felt a sign or symptom and I was made aware of the injury. Granted, not all athletes would come up to me because as you stated, they didn't want to miss out on a game or they didn't want to let down their team. But if you stress the importance of telling someone about a concussion or stress upon the dangers of the injury, I think we can begin to eliminate this problem. This article was dead on and I do believe that if the topic of concussion was brought up and presented, then the athletes, coaches, and parents would have a better understanding of this serious injury. The first step begins with us and one small step can help change a bunch of lives. Do you have any other techniques that may help give awareness on concussions?

Carolin S, Kent State Grad Student

Jane McDevitt said...


Thank you for your comment. When you gave your presentation was it to all the parents and coaches for the year, or did you give presentations per season? I do not currently have any other techniques then what you are doing. The head start website provides a lot of free concussion education material. I have had people working a stand with concussion education flyers and materials to give out at athlete physical days before the school year, but who knows how many people read it. Also, I was surprised at the amount of parents that do now show up with the child to the pre participation physical days. My suggestion is keep doing what you are doing face to face presentations seem to be very beneficial.

Becca Burkhart said...

As an athletic trainer and athlete, I can understand why athlete's would not want to report a concussion, but I also see that concussions can lead to extremely dangerous injuries. I think today athlete's do have a better understanding on what a concussion is and most have to go through some kind of baseline test, but I believe that athlete's are still scared to be pulled from play. It is hard being an athlete and being told that you have to sit on the bench especially if you are a starter. This article was on point with how most athlete's deal with concussions and why. There is no way to eliminate pulling the athlete from play because that is the safest measure, but I do not know if more athlete education will help increase the number of reported concussive like hits.

Kaitlyn Kelly said...

As an athletic training student and a collegiate athlete I do understand that some athletes may try to down play their concussion signs and symptoms so they are not held out of practice or games. I also know that this has become a larger problem with athletes. Do you believe that with more and better student athlete training about concussions this is something that could be lessened? I feel that the article really hit on how athletes do deal with their concussions, and wondered if the athletes would still act this way if they knew exactly why athletic trainers held them out of competition.
Thank you

Morgan Hooven said...

This article was very dead on about concussions and how athletes do not want to report them. Although it seems that athletes and coaches are aware of concussions, I don't believe they know the seriousness of the injury. I feel that education of concussions should repeatedly be done so athletes are continuously reminded of the effects and importance of reporting them.

Jenna Robinson said...

I think that with all of the knowledge and education that varsity and collegiate athletes receive on concussions and head trauma, the number of concussions unreported should not be as high as they are in this study. Concussions are injuries that shouldn't be taken lightly and I think that more should be done about educating athletes on what to do when a situation like so occurs in a game or any activity for that matter. Pushing athletes, as a coach or an athletic trainer, on how serious this injury can turn out to be, will hopefully change his or her attitude about concussions. Also, teaching the athletes that witnesses to a blow to the head or a serious tackle, should confront coaches for the safety of their own teammate.

Jason Shermer said...

I just did a paper on long-term effects of concussions and found more research into this field than expected. From my experience I find that a lot of parents are from the era of being more "Tuff" and sitting out from a concussion is weak, they don't understand how much has changed about concussions because they do not keep up on research or know how/where to even do so. I believe the research on this field of long-term effects could be a very useful tool in helping educate the sports team at schools.

Jane McDevitt said...

I feel that athlete education is very beneficial. However, the education should be specific to the athlete. Research is showing many predictive factors for who may take longer to recovery (e.g., sex, concussion history, s/s reported at time of injury) as well as what are the most common mechanisms (e.g., athlete to athlete contact, head to ground) that athletes sustain concussions. I would like to see research done on specific concussion education (e.g., a presentation to women's soccer is going to be different than men's soccer and women's field hockey) and determine if that is more beneficial than general concussion education.

Kaitlyn Johnson said...

In today’s age concussions are being reported more than they were before. However, I have also noticed that athletes are delaying telling the athletic trainer about their concussion. Even though these athletes understand the signs and symptoms of concussions, they are not telling anyone about their concussion until at least a day after they have suffered one. From what I have seen the athlete does this because they either do not want to stop playing or they just think it that their headache will subside. Some things I feel that could be done is to definitely keep educating these athletes and the coaches about what can happen if they do not report their concussion. Do this throughout the season and not just in the beginning. If you keep repeating the importance of concussions and what can happen if they do not report them, it will more likely stick in the heads, then just hearing it at the beginning of the season.

Jess Schlesman said...

Having played sports my whole life and now at a collegiate level, I find this article to be very true. I personally have witnessed many teammates shake off concussion-like symptoms because they do not want to lose playing time. Now as an athletic training student I realize how dangerous this really is. However, most athletes are educated on concussions and the effects of these injuries, but I do not think that is going to help with the amount of reporting. Athletes don't always make the smartest decisions when it comes to pulling themselves out of play. I do think it is important to keep educating athletes about concussions though, and even more so the coaches. I feel as though coaches sometimes play a role in the athletes decision of reporting whether they are aware or not.

Will Bradley said...

Do you think that if athletes were educated on not only concussions, but the dangers of second impact syndrome also, that compliance with reporting bell-ringing events and head injuries would significantly increase?

Jane McDevitt said...

Kaitlyn, I think you have a great point. If you do it once at the beginning of the season many athletes that join late or do not play a fall sport would miss the concussion speech. I think concussion education should be given at the beginning of each season and given specifically to one team at a time. That way it is geared toward their mechanisms and risk factors and would give more time for questions.

Jess, I also believe that sometimes athletes are not rational with their injuries and making sure parents and coaches are aware of the common mechanisms and signs and symptoms will help with reporting concussions because if they suspect a concussion they can pull the athlete out to get checked out.

Will, yes I do think using scare tactics would work and including increased awareness of concussion I think that is one of the reasons why reporting has increased.

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