Sport-Related Concussion: Knowledge and Reporting Behaviors Among Collegiate Club-Sport Athletes
Beidler E, Bretzin A, Hanock C, Covassin T. J Athl Train. 2018. [Epub ahead of print]
Take Home Message: Many club-sport athletes had good concussion knowledge; however, many viewed concussions as not serious enough to report.
Many collegiate-club sports lack medical coverage. Hence, club-sport athletes are responsible for their own injury knowledge and return-to-play decisions. This can be problematic with injuries like concussions because there are no standards for club sports regarding concussion management. To develop concussion education programs for club-sport athletes we need to identify their knowledge and current concussion reporting practices. Therefore, the authors surveyed 410 club-sport athletes (60% male) from 4 different institutions to identify concussion knowledge and reporting habits. They also assessed whether there were differences in concussion knowledge and reporting between traditional club sports (e.g., lacrosse, soccer, volleyball) and non-traditional club sport (e.g., rugby, quidditch, boxing) athletes. The authors modified an established survey to determine concussion knowledge. The first 29 questions assessed whether an athlete could correctly identify concussion signs and symptoms (15 correct, 14 distractors). The remaining 14 questions pertained to general concussion knowledge and complications related to multiple concussive injuries and return to play while still symptomatic. Overall knowledge scores ranged from 0 to 43, with a high score representing greater concussion knowledge. The authors adapted a questionnaire to determine sport-related behavior. Specifically, athletes answered 12 questions about possible reasons for not reporting a concussion. On average, the sign and symptom knowledge score was 23 out of 29. Almost all athletes recognized headache (93%), confusion (92%), sensitivity to light (90%), and loss of consciousness (90%) as concussion symptoms. The least commonly recognized symptoms were neck pain (28%) and irritability (42%). Total concussion knowledge ranged from 19 to 43 (~85% average score). The most common reasons an athlete cited for failing to report a concussion was believing concussions are not serious enough (40%), fear of losing playing time (31%), not knowing at the time it was a concussion (23%), and/or not wanting to let the team down (21%). There was no difference between traditional and nontraditional club sport athletes in their concussion knowledge. However, concussion reporting behaviors differed. Traditional athletes reported they may fail to report a concussion because they feared losing play time, did not want to see a doctor, and/or failed to see the seriousness of the injury. Conversely, nontraditional athletes were more likely to fail to report a concussion because they thought their parents would get upset. Only 6% of the athletes reported to have access to an athletic trainer, 9% reported no access, and 86% were unsure if they had access.
The authors found that club sport athletes had similar concussion knowledge compared to NCAA athletes. More than 94% of the club sport athletes correctly identified that concussion does not just occur if you lose consciousness and agreed that concussions are injuries to the brain that may cause complications. However, even with the knowledge that concussions are serious injuries with serious complications, 40% of the athletes thought a concussion was not a serious enough report. This disconnect between knowledge and reporting could be due to the lack of sports medicine coverage. This problem is highlighted by the fact that over 80% of club-sport athletes are unsure whether they had access to an athletic trainer. It is also interesting to note the differences in reporting behaviors between traditional and nontraditional club-sport athletes. The strongest motivators to not report a concussion within the traditional club sport athletes were similar to high school and NCAA athletes, which suggests that traditional sport athletes are highly motivated by competition. Since many high school athletes never participate in collegiate-varsity level sports, but instead opt for club sports after graduation this is an important yet understudied population. Currently, we need to focus more on addressing the lack of medical coverage for these athletes, ensuring they know who to report injuries to, and developing and directing education programs towards this population.
Questions for Discussion: Does your institution have medical coverage for club sport athletes? Have you been successful in enabling your athletes to report concussion symptoms?
Written by: Jane McDevitt
Reviewed by: Jeffrey Driban
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Consensus Statement on Concussion in Sport-The 5th International Conference on Concussion in Sport Held in Berlin, October 2016