Context: Increased sport participation and sport-related concussion incidence has led to an emphasis on having an appropriate medical professional available to high school athletes. The medical professional best suited to provide medical care to high school athletes is a certified athletic trainer (AT). Access to an AT may influence the reporting of sportrelated concussion in the high school athletic population; however, little is known about how the presence of an AT affects concussion knowledge, prevention, and recognition.Objective: To evaluate knowledge of concussion and reporting behaviors in high school athletes who did or did not have access to an AT.Design: Cross-sectional study. Setting: Survey. Patients or Other Participants: A total of 438 athletes with access to an AT and 277 without access to an AT. Intervention(s):A validated knowledge-of-concussion survey consisting of 83 items addressing concussion history, concussion knowledge, scenario questions, signs and symptoms of a concussion, and reasons why an athlete would not report a concussion. The independent variable was access to an AT.Main Outcome Measure(s): We examined the proportion of athletes who correctly identified knowledge of concussion, signs and symptoms of concussion, and reasons why high school student-athletes would not disclose a potential concussive injury by access to an AT. Frequency statistics, v 2 tests, independent t tests, and linear regression were conducted to analyze the data.Results: The underreporting of concussion among high school athletes was 55%. Athletes with access to an AT had more knowledge of concussion than did athletes without such access (P .001). Chi-square tests did not demonstrate a significant relationship between AT access and a higher percentage reporting concussions.Conclusions: High school athletes with access to an AT had more concussion knowledge, but they did not report suspected concussions to an authority figure more frequently than athletes without access to an AT.Key Words: traumatic brain injuries, secondary school, health care Key PointsCompared with high school athletes who had access to an athletic trainer, those without such access were less knowledgeable about concussion. Access to an athletic trainer was not linked to high school athletes' concussion-reporting percentages. However, such access was related to 10 reasons for not reporting a concussion. The most common reasons for not reporting a concussion were not wanting to lose playing time, not thinking the injury was serious enough to require medical attention, and not wanting to let the team down.

Context: Recent researchers have reported that athletes' knowledge of sport-related concussion (SRC) has increased but that athletes still lack knowledge of all the signs and symptoms of SRC. Understanding the signs and symptoms of SRC and the dangers of playing while symptomatic are critical to reporting behaviors in high school athletes.Objective: To examine sex differences in knowledge of SRC symptoms and reasons for not reporting a suspected SRC to an authoritative figure in high school athletes.Design: Cross-sectional study. 2%]).Main Outcome Measure(s): A validated knowledge-of-SRC survey consisted of demographic questions, a list of 21 signs and symptoms of SRC, and reasons why athletes would not report their SRC. The independent variable was sex. Athlete knowledge of SRC symptoms was assessed by having participants identify the signs and symptoms of SRC from a list of 21 symptoms. Knowledge scores were calculated by summing the number of correct answers; scores ranged from 0 to 21, with a score closer to 21 representing greater knowledge. Reporting-behavior questions asked athletes to choose reasons why they decided not to report any possible SRC signs and symptoms to an authoritative figure.Results: A sex difference in total SRC symptom knowledge was found (F 286 ¼ 4.97, P ¼ .03, d ¼ 0.26). Female high school athletes had more total SRC symptom knowledge (mean 6 standard deviation ¼ 15.06 6 2.63; 95% confidence interval ¼ 14.54, 15.57) than males (14.36 6 2.76; 95% confidence interval ¼ 13.97, 14.74). Chi-square tests identified significant relationships between sex and 8 different reasons for not reporting an SRC.Conclusions: High school males and females had similar SRC symptom knowledge; however, female athletes were more likely to report their concussive symptoms to an authoritative figure.Key Words: mild traumatic brain injuries, secondary school, sport culture Key PointsHigh school males and females had similar concussion knowledge, but females were more likely to use that knowledge to report a sport-related concussion. Males were 4 to 11 times more likely than females to not report a sport-related concussion for reasons focused on the reactions and perceptions of others. Large percentages of male and female athletes did not report a sport-related concussion because they did not think it was serious. Theory-based interventions are warranted to overcome the stigmas associated with the male sport culture.

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