Under-reporting of Concussion in a Division III Conference's Basketball, Soccer and Wrestling Teams: Incidence, Causes, and Implication for Education

Context. Concussions are a common athletic injury that is evident in all levels of athletics. The tendency for athletes to under-report concussion is apparent in the literature. Reasons for under-reporting include not wanting to let down teammates/coaches, and not recognizing symptoms as being a concussion. Reasons for under-reporting need to be explored so as to increase awareness for athletic trainers and better educate the athletes. Objective. The purpose of this study was to identify the incidence and potential reasons for under-reporting of concussion in one DIII conference's basketball, soccer, and wrestling teams. Additionally, a secondary purpose was to assess whether athletes recognize common symptoms associated with concussion. Design. This study was a descriptive prospective questionnaire analysis of under-reporting of concussions. Setting. Basketball, soccer, and wrestling teams of a NCAA DIII conference in the East and Mideast part of the country. Patients and other participants. Participants were 6 (n=6) certified athletic trainers from a Division III conference in the East and Mideast part of the country. Their mean years of experience as an ATC was 8.5+/-6.98 yrs. There were also 40 basketball and soccer athletes who participated with a mean age of 19.83+/-1.26 yrs of which a majority participated in men's soccer (37.5%). Interventions. Concussions were determined on a self-report basis and by athletic trainers (when reported). Participants were contacted via e-mail and given a link to their respective questionnaires. Two online questionnaires were used for this study. One was for the athletic trainers to determine the number of athletes on their respective teams and the number of concussions reported to them during the season. A second questionnaire was given to the athletes to determine the number of concussions sustained, number reported, reasons for not reporting, and whether the athlete is able to recognize common symptoms of a concussion. A follow-up e-mail was sent to participants within two weeks to remind them to complete the questionnaire. Main outcome measures. The expectations of this study will be that there is an under-reporting effect occurring. It is expected that common reasons for under-reporting will include not wanting to let down teammates/coaches, and an inability to recognize a concussion. Additionally, it is expected that athletes will be unable to recognize common symptoms associated with concussion. Results. Six athletic trainers and 40 athletes responded to the questionnaires for a return rate of 26% and 12%, respectively. Of the 40 athletes responding, 6 (n=6) sustained a concussion with 50% (n=3) not reporting. Each potential reason for under-reporting was selected equally on the questionnaire, which were not realizing, not thinking it was serious, not wanting to let down, and not wanting to be pulled. The athletes' most recognized symptoms were headache (95%; n=38), sensitivity to light (85%; n=34), dizziness (82.5%; n=33), confusion/disorientation (82.5%; n=33), and blurry vision (82.5%; n=33). The least recognized symptoms were inappropriate emotions (27.5%; n=11), sadness (30%; n=12), and sleeping too much (37.5%; n=15). Conclusion. There is an under-reporting of concussion in college basketball and soccer. Under-reporting in basketball and soccer occurred similar to those found in previous studies in other contact sports. The ability of athletes to recognize common signs and symptoms of concussion is inconsistent, with athletes being able to recognize somatic and cognitive symptoms more than emotional and sensory symptoms. Future efforts and research should focus on how to best educate athletes about concussions so that there will be minimal under-reporting.