High School Athletes Continue To Underreport Concussion Symptoms


The past years have seen great strides in concussion education for high school athletes. Now, most football players (as well as athletes in other contact sports) receiving training on the symptoms, long-term risks, and prevention techniques for concussions at the start of each season.

Unfortunately, a new study suggests many athletes are still falling through the cracks and unknowingly putting themselves at risk for severe brain trauma.

“The underreporting of concussions is estimated to be high, and the No. 1 reason athletes do not report a concussion is because they do not want to lose playing time,” lead study author Jessica Wallace of Youngstown State University in Ohio told Reuters Health via email.

Recent efforts have led to more athletic trainers being present in schools part-time, but only 37% of high schools employ one full-time. Even worse, in the 14% of schools where no athletic trainer is present, athletes are up to five times more likely to not report concussion symptoms. Wallace says most didn’t know they even had an injury.

“This study sheds light on the multiple reasons why student-athletes may not report a concussion, including not thinking the injury was serious enough to require medical attention or not wanting to let the team down,” Wallace said.

For the study published in a special concussion-themed issue of the Journal of Athletic Training, Wallace and colleagues surveyed over 700 student athletes between the ages of 13 and 19. This included 438 students with access to an athletic trainer. Each participant answered 83 questions regarding their own history of concussions, concussion knowledge, theoretical scenarios, signs and symptoms of concussions, and potential reasons an athlete may not report a brain injury.

Over half (55%) of the high school athletes underreported concussions or symptoms. Also, athletes at schools without athletic trainers were less likely to understand the dangers of concussions compared to those at schools with trainers (87% vs. 94%).

Similarly, the athletes without access to athletic trainers were less likely to understand the signs and symptoms of concussions compared to their peers at schools with athletic trainers (61% vs. 78%).

Overall, the athletes at schools without athletic trainers were 16% more likely to believe they could continue playing if they may have suffered a concussion, and 12% more thought they could continue playing despite concussion symptoms.

The study authors say the data shows a large knowledge gap that needs to be addressed.

“The athletic trainer serves a vital role in the health and safety of high-school athletes,” Wallace said. “One of the athletic trainer’s responsibilities is to help educate athletes, coaches and parents about concussions that appear to be happening within high schools.”

Despite this, the study also found that access to an athletic trainer was not necessarily linked to a higher rate of concussions being reported.

Among all athletes, approximately 46% reported experiencing a potential concussion during play while only 21% reported the potential injury to an adult at the time. Roughly 19% of these incidents occurred in schools without athletic trainers, compared to 25% in schools with athletic trainers.

“This multifaceted issue includes many reasons why students may choose not to disclose an injury, including knowledge, intention and attitude,” said Johna Register-Mihalik of the University of North Carolina at Chapel Hill, who developed the concussion survey used in the current study but was not part of the study team.

The team says they can’t definitively say if their findings from students at 14 schools in two Michigan metro areas is representative of athletes across the country, but they believe it warrants more research and efforts to decrease the knowledge gap.

“Improving concussion protocol will extend into other issues with student athletes, such as lack of mental health disclosure and allowing play when athletes are injured or sick,” Register-Mihalik said. “Involving parents, coaches and students can create a safe playing environment.”

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