Concussion reporting, return to learn, and return to play experiences in a sample of private preparatory high school students

Waltzman D, Daugherty J, Snedaker K, Bouton J,Wang D. Brain Inj. 2020 Jul 28;34(9):1193-1201.

Take-Home Message

More than 1 in 5 private high school students may not be disclosing concussions, often because they want to continue to play or believe it is not a serious enough injury.


Student-athletes must understand the importance of reporting potential concussion injuries to receive proper treatment and accommodations. Previous research has reported many reasons why athletes fail to report concussions; however, much of the research has been done in public schools. It remains unclear if these findings apply to students in private schools that may have different regulations and often require students to compete in at least one sport. Therefore, the authors collected survey data from 1,999 student-athletes (52% female) from 10 different private high schools in New England with at least 1 full-time licensed athletic trainer. The athletes answered a survey that contained questions regarding demographics, concussion history, reporting behaviors, and how long it took to return to full school workload and return to activity (<1week, 1-3 weeks, >3 weeks).

The researchers found that most of the athletes participated in contact sports (46%). Soccer was the most common sport (14%). Almost a third of the student-athletes reported that they had a concussion (31%), and 22% reported that they had hidden/not reported a concussion. The non-disclosure rate was higher in older athletes and with athletes playing a contact sport. When asked why they failed to report the concussion, most replied that they wanted to continue to play (58%) or they did not think it was serious enough (54%). Most student-athletes reported returning to full academic workload within 1 week (43%) or within 1-3 weeks (44%). Additionally, most student-athletes (51%) returned to activity within 1-3 weeks, and 26% required more than 3 weeks to return.


Over a hundred athletes reported that they hid a potential concussion. What is more alarming is that many of these students participated in a contact sport, where the risk of a concussion is high. Many student-athletes reported that they wanted to keep playing, even though researchers previously suggested that a delay in reporting could delay recovery. Furthermore, many athletes took greater than 3 weeks to recover from a concussion. Due to the survey grouping of recovery times, it is difficult to decide whether this is a normal timeline (~21 days) or more prolonged. Lastly, the common reasons reported as to why the student-athletes did not report a concussion are not new, which may suggest our education strategies are failing to change a student’s belief that concussions are serious brain injuries and need to be reported. Medical professionals should be aware of the common reasons for non-disclosure of potential concussion injuries among private high school students. Open discussions should be encouraged to promote player safety, and it may be beneficial to support peer-led discussions about concussions as a new strategy to educate students.

Questions for Discussion

Do you discuss why student-athletes should report concussions? Do you go over the known reasons why student-athletes not report concussions to increase transparency and open conversations?

Written by: Jane McDevitt
Reviewed by: Jeffrey Driban

Related Posts

Cost of Concussion in the Classroom
School’s Need To Be Smarter With Their Return To Learning Guidelines
Concussion Knowledge Getting Better But is Reporting Getting Worse?
Concussion Knowledge Does Not Translate into Healthy Reporting Habits
Self-Reported Concussion Details Takes A Hit with High School Athletes 
Unrecognized Concussion Rates are Almost as High as Reported Concussion Rates
Don’t Delay, Report Your Concussion Today