• Michael McCrea, Thomas Hammeke, Gary Olsen, Peter Leo, and Kevin Guskiewicz.
• Neuroscience Center, Waukesha Memorial Hospital, WI 53188, USA. michael.mccrea@phci.org
• Clin J Sport Med. 2004 Jan 1;14(1):13-7.

ObjectiveTo investigate the frequency of unreported concussion and estimate more accurately the overall rate of concussion in high school football players.DesignRetrospective, confidential survey completed by all subjects at the end of the football season.Setting And ParticipantsA total of 1,532 varsity football players from 20 high schools in the Milwaukee, Wisconsin, area were surveyed.Main Outcome MeasurementsThe structured survey assessed (1) number of concussions before the current season, (2) number of concussions sustained during the current season, (3) whether concussion during the current season was reported, (4) to whom concussion was reported, and (5) reasons for not reporting concussion.ResultsOf respondents, 29.9% reported a previous history of concussion, and 15.3% reported sustaining a concussion during the current football season; of those, 47.3% reported their injury. Concussions were reported most frequently to a certified athletic trainer (76.7% of reported injuries). The most common reasons for concussion not being reported included a player not thinking the injury was serious enough to warrant medical attention (66.4% of unreported injuries), motivation not to be withheld from competition (41.0%), and lack of awareness of probable concussion (36.1%).ConclusionsThese findings reflect a higher prevalence of concussion in high school football players than previously reported in the literature. The ultimate concern associated with unreported concussion is an athlete's increased risk of cumulative or catastrophic effects from recurrent injury. Future prevention initiatives should focus on education to improve athlete awareness of the signs of concussion and potential risks of unreported injury.

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