Knowledge of Concussion and Reporting Behaviors in High School Athletes With or Without Access to an Athletic Trainer

Abstract

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.

Access to Athletic Trainer Services in California Secondary Schools

“…26 The AT may be one of the only health care providers with whom these students interact and from whom they receive care or health-related education. 27 This is especially problematic in California, which was ranked 39th in the nation in 2018 for providing nurses in public schools, with only 1 school nurse for every 2240 public school students. 28 Of particular concern is that schools with UHP in the role of AT had a greater %Free than schools with a certified AT.…”

Improving Concussion-Reporting Behavior in National Collegiate Athletic Association Division I Football Players: Evidence for the Applicability of the Socioecological Model for Athletic Trainers

“…In the past decade, the number of studies that examined factors associated with CRB has increased. [12][13][14][15]18,33 In most cases, these authors [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] have assessed individual-level factors; few 1,2 investigated the influence of microsystem, mesosystem, exosystem, or macrosystem factors that influence CRB. As our results indicate, important stakeholders also recognized higher-order influences affecting student-athletes' CRB perceptions and attitudes.…”

“…The most well-known systems theory is the Bronfenbrenner socioecological model (SEM), 4 which posits that human behavior is a function of synergistic and reciprocal influences between the individual and the settings in which he or she operates (microsystem), the interaction among those settings (mesosystem), the environments that indirectly affect the settings (exosystem), and cultural ideologies (macrosystem). Several researchers 2,[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] have used elements of this model to make similar arguments. Register-Mihalik et al 2 recommended that in order for athletic trainers (ATs) to design more effective interventions, they should consider factors at multiple levels, such as community or interpersonal levels of influence.…”

“…Register-Mihalik et al 2 recommended that in order for athletic trainers (ATs) to design more effective interventions, they should consider factors at multiple levels, such as community or interpersonal levels of influence. Although CRB researchers have referred to the Bronfenbrenner SEM, 1,2 have tested part of the model, [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] or have adapted the model by collapsing across systems categories, 1,2 to our knowledge, no investigators have used the full Bronfenbrenner model to assess factors that contribute to CRBs. Consideration of microsystem, mesosystem, exosystem, and macrosystem factors, in addition to individual-level factors, is critically important if novel interventions are to be designed, implemented, and examined for effectiveness.…”

“…Most authors [5][6][7][8][9][10][11][12][13] who investigated factors influencing CRB have primarily assessed individual-level factors, such as a player's intention to report his or her symptoms. Only a handful of studies 12,[14][15][16] have examined the attitudes and beliefs of important individuals in the student-athlete's life (microsystem level).…”