Concussion Nondisclosure in Youth Sports

Abstract

Context: Studies regarding sport-related concussion (SRC) reporting behaviors and reasons for nondisclosure primarily focus on older athletic populations. Youth athletes participating in contact sports are also at risk for SRC; however, little is known about their SRC disclosure patterns and reasons for nondisclosure. Objective: To examine self-reported SRC history and reasons for SRC nondisclosure of youth athletes ages 8-14 years. Design: Cross-sectional study. Setting: Youth athletes in organized football, ice hockey, lacrosse, and soccer. Patients or Other Participants: 411 youth athletes (male: 70.0% (n=287/410); median age: 11 (IQR 10-13) years). Main Outcome Measures: A 15-minute survey including self-reported demographics, diagnosed and non-disclosed SRC history, and reasons for nondisclosure of suspected SRCs. Results: Ten percent of respondents (n=41/411) recounted one or more diagnosed SRC; 12.7% (n = 52/411) did not report a suspected SRC, and 13.1% (n = 53/404) indicated they continued to practice and 12.3% (n = 50/425) reported they continued to play in a game after a suspected SRC. Significant associations between sport and nondisclosure exisited (p < .001), but not self-reported concussion history (p = .14). In sex comparable analyses boys lacrosse players had higher frequency of nondisclosure compared to girls (p = .05). Most common reasons for nondisclosure were not wanting to lose playing time 66.7% (n=32/48), miss a game 56.3% (n=27/48), and let the team down 43.8% (n=21/48); and uncertainty over injury severity and presence of SRC 43.8% (n=21/48). Conclusions: Ten percent of youth athletes self-reported at least one diagnosed SRC. However, youth athletes also report continuing to practice or play within a game after a suspected SRC. Reasons for nondisclosure at this age are similar to those reported in high school and college athletes. Recent research suggests negative consequences of continued play with SRC, especially in acute stages. Future educational initiatives should emphasize these risks, and focus on reasons why athletes of both sexes withhold reporting.