• Johna K Register-Mihalik, Kevin M Guskiewicz, Tamara C Valovich McLeod, Laura A Linnan, Frederick O Mueller, and Stephen W Marshall.
• Emergency Services Institute, WakeMed Health and Hospitals, Raleigh, NC.
• J Athl Train. 2013 Sep 1; 48 (5): 645-53.

ContextMany 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.ObjectiveTo examine the influence of knowledge and attitude on concussion-reporting behaviors in a sample of high school athletes.DesignCross-sectional study.SettingParticipants completed a validated survey instrument via mail.Patients Or Other ParticipantsA 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.ResultsOnly 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.ConclusionsMost 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.

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