Sports-Related Concussion: Barriers to Reporting

Although male and female high school athletes had similar knowledge of sports-related concussion (SRC) signs and symptoms, females were more likely to report their concussive symptoms to an authoritative figure, according to the results of a study published in the Journal of Athletic Training.

“For both sexes, blurred visions, loss of consciousness, and dizziness were the most recognized SRC symptoms, whereas memory loss, nausea, and fogginess were the most commonly unrecognized SRC symptoms,” wrote Jessica Wallace, PhD, of Youngstown State University, Ohio, and colleagues. “High school athletic department staffs should emphasize symptom knowledge by explaining what each symptom means and incorporate theory-based interventions to overcome stigmas within the male sport culture. Moreover, all school sport programs must encourage optimal reporting environments in which every male or female athlete feels safe and confident in reporting symptoms of SRC to an authoritative figure.”

During the last decade, there has been increased awareness of concussion, and SRC is now recognized as a public health concern among young athletes, according to the study. When SRC goes unidentified or unreported, they can lead to increased risk of subsequent injury and long-term consequences for the injured athlete.

With this study, Wallace and colleagues examined sex differences in knowledge of SRC symptoms and whether males or females were more likely to report suspected SRC.

In the cross-sectional study, 288 high school athletes (68.8% males) completed a validated survey about their knowledge of SRC. The mean age of respondents was 15.6. The survey included identifying symptoms of SRC from a list of 21 symptoms and reasons why athletes would not report their concussion. Knowledge scores ranged from 0 to 21, with 21 indicating greater knowledge. Included sports were football, wrestling, volleyball, basketball and soccer.

The majority of respondents had never sustained a concussion. The researchers found a sex difference in total concussion symptom knowledge (P=0.03). Female respondents had more total SRC symptom knowledge compared with males (average score of 15.06 vs. 14.36).

The most commonly known symptom of SRC was blurred vision, identified by more than 80% of males and females. Fogginess was identified least often.

The top three reasons for not reporting a concussion was similar between males and females:

• They did not think it was serious
• They did not want to lose playing time
• They did not want to let their team down

Several reasons were identified why male athletes were more likely than females to not report a concussion:

• They thought their coach would get mad (P<0.01)
• Their teammates would think they were weak (P<0.01)
• Their coach would think that they were weak (P=0.01)
• Their parents would be upset (P=0.03)
• It was the end of the season and they did not want to miss a game (P≤0.01)
• They did not want to lose playing time (P<0.01)
• Their team was going to be in the playoffs when it happened (P=0.05)
• They did not want to let their team down (P=0.01)

“It is concerning that athletes are still not reporting SRCs because they do not identify them as being serious enough injuries to require medical attention. It is also worrisome that the failure to report a concussion due to fear of removal from play remains an obstacle that needs to be overcome in high school athletics,” the researchers wrote. “Even if concussion knowledge can be increased, the determination and competitive spirit of our athletes cannot be altered.”

Wallace J, et al. Sex differences in high school athletes’ knowledge of sport-related concussion symptoms and reporting behaviors. J Athl Train. Epub 2017 Apr 18.