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More teen knowledge about concussion may not increase reporting

(Reuters Health) - High school athletes with access to a certified athletic trainer are more knowledgeable about concussions and their consequences, but that doesn’t make them more likely to report a concussion, a U.S. study finds.

“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 said by email.

Although experts estimate that athletic trainers are present in 86 percent of U.S. high schools, only about 37 percent of high schools employ one full-time. In high schools with no athletic trainer, athletes are five times more likely to not report concussion symptoms because they didn’t know they had a concussion, Wallace told Reuters Health.

Sports-related concussions account for about 4 percent to 9 percent of high school injuries and have symptoms such as headaches, confusion, nausea, amnesia and trouble sleeping.

“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.

She and her colleagues surveyed 715 student athletes ages 13 to 19, including 438 students who had access to an athletic trainer. Athletes answered 83 questions about their own concussion history, concussion knowledge, responses in specific scenarios, signs and symptoms of a concussion and reasons why an athlete would not report a concussion.

Overall, 55 percent of high school athletes underreported concussions. Eighty-seven percent of athletes from schools without athletic trainers understood the dangers of concussions, as compared to 94 percent from the schools with athletic trainers.

Similarly, 61 percent of athletes from schools without athletic trainers understood the signs and symptoms of a concussion, compared to 78 percent from the schools with athletic trainers.

Overall, in the schools without athletic trainers, 16 percent more athletes thought they could continue playing if they believed they had a concussion and 12 percent more athletes thought they could continue playing with concussion symptoms. This knowledge gap is prominent and should be addressed, the study authors write in a special concussion-themed issue of the Journal of Athletic Training.

“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.”

At the same time, access to an athletic trainer wasn’t linked to a higher proportion of concussions being reported, the study found.

In the survey, about 46 percent of the students said they had experienced a potential concussion during play and only 21 percent had reported it to an authority figure at the time. About 19 percent of these incidents were reported in schools without athletic trainers, compared to 25 percent in schools with athletic trainers, a difference too small to rule out the possibility it was due to chance.

“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.

One limitation of the study is that the students came from 14 schools in two Michigan metro areas and participated in football, volleyball, basketball, wrestling, gymnastics, soccer or cheerleading, which may limit how broadly the results can be generalized, the authors note.

The Michigan students received state-mandated concussion education based on the Centers for Disease Control and Prevention HEADS UP program. Wallace and colleagues recommend that this or a similar education program be used to target schools without an athletic trainer in order to talk about the signs, symptoms and dangers of concussion.

“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.”

SOURCE: http://bit.ly/2pjWyFD Journal of Athletic Training, March 2017.