Knowledge, attitude, and concussion-reporting behaviors among high school athletes: a preliminary study

J Athl Train. 2013 Sep-Oct;48(5):645-53. doi: 10.4085/1062-6050-48.3.20. Epub 2013 Jul 12.


Context: Many athletes continue to participate in practices and games while experiencing concussion-related symptoms, potentially predisposing them to subsequent and more complicated brain injuries. Limited evidence exists about factors that may influence concussion-reporting behaviors.

Objective: To examine the influence of knowledge and attitude on concussion-reporting behaviors in a sample of high school athletes.

Design: Cross-sectional study.

Setting: Participants completed a validated survey instrument via mail.

Patients or other participants: A total of 167 high school athletes (97 males, 55 females, 5 sex not indicated; age = 15.7 ± 1.4 years) participating in football, soccer, lacrosse, or cheerleading.

Intervention(s): Athlete knowledge and attitude scores served as separate predictor variables.

Main outcome measure(s): We examined the proportion of athletes who reported continuing to participate in games and practices while symptomatic from possible concussion and the self-reported proportion of recalled concussion and bell-ringer events disclosed after possible concussive injury.

Results: Only 40% of concussion events and 13% of bell-ringer recalled events in the sample were disclosed after possible concussive injury. Increased athlete knowledge of concussion topics (increase of 1 standard deviation = 2.8 points) was associated with increased reporting prevalence of concussion and bell-ringer events occurring in practice (prevalence ratio [PR] = 2.27, 95% confidence interval [CI] = 1.60, 3.21) and the reporting prevalence of bell-ringer-only events overall (PR = 1.87, 95% CI = 1.38, 2.54). Athlete attitude scores (increase of 1 standard deviation = 11.5 points) were associated with decreases in the proportion of athletes stating they participated in games (PR = 0.74, 95% CI = 0.66, 0.82) and practices (PR = 0.67, 95% CI = 0.59, 0.77) while symptomatic from concussions.

Conclusions: Most recalled concussion events in our study were not reported to a supervising adult. Clinicians should be aware that knowledge and attitude influence concussion reporting. Clinicians and administrators should make concussion education a priority and encourage an optimal reporting environment to better manage and prevent concussive injuries in young athletes.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Athletic Injuries
  • Brain Concussion / epidemiology*
  • Cross-Sectional Studies
  • Female
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Male
  • Pilot Projects
  • Schools
  • Self Report*
  • Sports / psychology
  • Students / psychology
  • Surveys and Questionnaires