Factors Related to Concussion Knowledge, Attitudes, and Reporting Behaviors in US High School Athletes: A Systematic Review

Abstract

BACKGROUND Sport‐related concussions are a major public health problem with only 50% of concussed teens reporting their symptoms. The purpose of this systematic review was to identify individual and institutional factors that contribute to concussion knowledge, attitude, and reporting behaviors among US high school athletes. METHODS The Preferred Reporting Items for Systematic Reviews and Meta‐Analysis protocol was used to direct the process of this systematic review. A search for English, peer‐reviewed, quantitative studies published between 2010 and 2020 was conducted in 5 scholarly databases. The Joanna Briggs Critical Appraisal Tools were used to assess study quality. RESULTS Twenty‐two studies met criteria for inclusion in this systematic review. The study designs were mostly cross‐sectional (N = 18). Synthesis revealed individual factors including gender, age, race/ethnicity, grade level, and concussion history were associated with differences in concussion knowledge, attitude, and/or reporting behaviors. Institutional factors identified included school location, concussion education, access to an athletic trainer, sport played, and team climate. Six studies found concussion education had a positive impact on knowledge and reporting behaviors. CONCLUSION This systematic review identified certain populations which may be more vulnerable to underreporting concussion symptoms; therefore, a targeted approach to education and management may be more effective.

Assessing concussion knowledge among students with varying levels of sports involvement

“…Previous involvement in sports also increases the likelihood that students have a personal history of concussions [9]. While previous history may provide anecdotal knowledge, individuals with a history of concussion do not demonstrate improved concussion knowledge [7]. Future clinicians must be properly educated to diagnose and manage concussions in their patients.…”

Longitudinal Outcomes of Cumulative Impact Exposure on Oculomotor Functioning in Professional Motorsport Drivers

“…Even with formalized procedures for concussion, concussion education, symptom recognition, and injury management, concussion symptoms are often underreported or unrecognized in athletes of all levels and across sports, including motorsport drivers, necessitating the use of objective tools to assess symptoms in the acute phase postinjury and to document cumulative exposure over the course of the racing season. [21][22][23][24] Oculomotor assessment has been indicated as an objective measure of concussion as part of a multidimensional evaluation. 25,26 Afferent and efferent visual pathways are widely distributed throughout the brain and appear to be particularly vulnerable to disruptions in neurotransmission arising from diffuse shear injury associated with concussive and subconcussive impacts.…”

“…The INDYCAR protocol mandates that drivers are medically evaluated if head accelerations sustained during a contact incident exceed 80 g , with return to racing decisions informed by a range of objective and subjective measures comparing driver functioning to preseason baseline measures. Even with formalized procedures for concussion, concussion education, symptom recognition, and injury management, concussion symptoms are often underreported or unrecognized in athletes of all levels and across sports, including motorsport drivers, necessitating the use of objective tools to assess symptoms in the acute phase postinjury and to document cumulative exposure over the course of the racing season …”

“…Even with formalized procedures for concussion, concussion education, symptom recognition, and injury management, concussion symptoms are often underreported or unrecognized in athletes of all levels and across sports, including motorsport drivers, necessitating the use of objective tools to assess symptoms in the acute phase postinjury and to document cumulative exposure over the course of the racing season. 21 , 22 , 23 , 24 …”

Predictors of concussion reporting intentions in adolescent hockey players

“…an athlete must take the issue of concussion seriously enough to act. Whereas several studies have looked at the effects of interventions on concussion knowledge, attitudes, and reporting behaviour (for an overview see Beran & Scafide, 2022 ), there needs to be more research on the differential effects of concussion knowledge and concussion attitudes on reporting behaviour. However, understanding the relative impact of knowledge vs. attitudes on reporting behaviour in young athletes is crucial for understanding reporting behaviours and developing effective interventions.…”