Despite sex differences in the clinical incidence of SRCs and time loss from participation in high school sports, the numbers of missed school days are relatively similar between sexes.

Context Mandated concussion education has aimed to improve student-athlete knowledge; however, some collegiate student-athletes continue to not disclose concussion. Concussion knowledge may not be the only factor influencing reporting, as student-athlete sex, sport, and pressure from external stakeholders (eg, coaches, teammates, fans, parents or family) have all been documented as influencing collegiate concussion-reporting behavior. Objective To examine factors associated with concussion nondisclosure in collegiate student-athletes. Design Cross-sectional study. Setting Four National Collegiate Athletic Association Division I and two Division II universities. Patients or Other Participants A total of 1125 collegiate student-athletes completed the survey, and 741 provided viable responses and were included for data analysis. Main Outcome Measure(s) We used a 10- to 15-minute electronic or paper-and-pencil survey that asked about personal and sport demographics, diagnosed concussions and nondisclosed concussion history, concussion knowledge, and level of agreement regarding pressure to play after a head impact experienced during collegiate sport participation. Significant univariable factors were entered into a multivariable logistic regression analysis. Results Sex (P = .005), sport-risk type (P < .001), diagnosed concussion history (P < .001), concussion knowledge (P = .017), and pressure from coaches (P < .001), teammates (P < .001), fans (P = .024), and parents or family (P = .003) were factors associated with concussion nondisclosure in individual univariable logistic regressions. After we conducted multivariable analyses, male sex (P = .001), high concussion-risk sport participation (P = .048), diagnosed concussion history (P < .001), increased concussion knowledge (P = .013), and experiencing pressure from coaches to continue playing after sustaining a hit to the head (P = .002) were factors associated with concussion nondisclosure in collegiate student-athletes. Conclusions Our results suggest that concussion-education programs should go beyond the identification of signs and symptoms to include the dangers of continuing to play, long-term consequences, and transparency about concussion protocols. Comprehensive concussion-education programs should involve coaches and athletes to improve the reporting culture.

Context: Vestibular and ocular motor assessment is an emerging clinical assessment for sport-related concussion (SRC). The increased use of these assessments by clinicians calls for examination of outcomes in populations that may impact clinical practice. Objective: Compare vestibular and ocular motor impairments in high school and collegiate athletes within 72 hours of SRC. Second, examine the distribution of impairments in these populations based upon pre-established clinical cut-off scores. Design: Cross-sectional study. Setting: High school (HS) and collegiate athletics (COL). Patient or Other Participants: Data were collected from 110 athletes (HS: n=47, age=15.40±1.35 years; COL: n=63, age=19.46±1.28 years) within 72 hours of sustained SRC. Main Outcome Measure(s): Total and change scores were calculated for the Vestibular/Ocular Motor Screening (VOMS) assessment, along with average near point of convergence (NPC) distance. Separate Mann Whitney U tests were used to compare group differences and Chi-square analyses were used to examine athlete distribution above clinical cutoff scores for all VOMS outputs (a priori Alpha level<0.5). Results: No significant differences were found between high school and collegiate athletes for VOMS total scores, change scores, and NPC distance. A significantly larger proportion of the sample reported scores above the cutoff for all total scores (p<0.001) and change scores in horizontal vestibulo-ocular reflex (VOR; 59.01%, p<0.001), vertical VOR (60.91%, p<0.001), and visual motion sensitivity (60.91%, p<0.001). However, a significantly larger proportion reported smooth pursuit change scores (85.45%, p<0.001) and NPC distance (73.64%, p=0.01) below the cutoff scores. Conclusions: During the acute phase of SRC, high school and collegiate athletes present with similar vestibular and ocular motor impairments as measured by the VOMS, but vestibular tasks appear to cause greater symptom provocation in concussed athletes. Lastly, VOMS change scores may offer more clinical utility in assessing specific impairments following SRC compared to total scores.

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Context Previous researchers have examined factor structures for common concussion symptom inventories. However, they failed to discriminate between the acute (<72 hours) and subacute (3 days–3 months) periods after concussion. The Sport Concussion Assessment Tool (SCAT) is an acute assessment that, when compared with other concussion symptom inventories, includes or excludes symptoms that may result in different symptom factors. Objective The primary purpose was to investigate the symptom factor structure of the 22-item SCAT symptom inventory in healthy, uninjured and acutely concussed high school and collegiate athletes. The secondary purpose was to document the frequency of the unique SCAT symptom inventory items. Design Case series. Setting High school and college. Patients or Other Participants A total of 1334 healthy, uninjured and 200 acutely concussed high school and collegiate athletes. Main Outcome Measure(s) Healthy, uninjured participants completed the SCAT symptom inventory at a single assessment. Participants in the acutely concussed sample completed the SCAT symptom inventory within 72 hours after concussion. Two separate exploratory factor analyses (EFAs) using a principal component analysis and varimax extraction method were conducted. Results A 3-factor solution accounted for 48.1% of the total variance for the healthy, uninjured sample: cognitive-fatigue (eg, feeling “in a fog” and “don't feel right”), migraine (eg, neck pain and headache), and affective (eg, more emotional and sadness) symptom factors. A 3-factor solution accounted for 55.0% of the variance for the acutely concussed sample: migraine-fatigue (eg, headache and “pressure in the head”), affective (eg, sadness and more emotional), and cognitive-ocular (eg, difficulty remembering and balance problems) symptom factors. Conclusions The inclusion of unique SCAT symptom inventory items did not alter the symptom factor structure for the healthy, uninjured sample. For the acutely concussed sample, all but 1 unique SCAT symptom inventory item (neck pain) loaded onto a factor.