United States Air Force Academy Cadets' Unprompted Knowledge of Concussions and “Bell Ringers” or “Dings”: Perceived Differences and Similarities

Abstract

Context: After a potential concussion mechanism, a cadet is unlikely to have a list of concussion signs and symptoms at their disposal. As such, unprompted concussion knowledge may be an essential factor in personal recognition. Objective: The primary purpose of an overall study was to explore determinants that contributed to United States Air Force Academy (USAFA) cadets to disclose a concussion. This manuscript focuses on one of the eight overall themes discovered of unprompted concussion knowledge. Design: Qualitative study. Setting: Military academy. Patients or Other Participants: USAFA cadets (males=23, females=11, age=19.91±1.14 years). Main Outcome Measure(s): We conducted 34 semi-structured interviews. The transcribed text was analyzed in a five-cycle process. From this process eight overall themes were discovered including unprompted concussion knowledge. Subthemes were also discovered of concussion definition, concussion symptoms, bell-ringer/ding definition, bell-ringer/ding symptoms, and concussion vs. bell-ringer/ding. Results: Many participants were able to largely accurately describe a concussion. The most commonly listed concussion signs and symptoms were dizziness (n=22/34, 64.7%), “can't remember”/“memory loss”/“forgetful” (n=19/34, 55.9%), and headache (n=16/34, 47.1%). USAFA cadet participants identified the most common bell-ringer/ding signs and symptoms as dizziness (n=2/34, 5.9%) and headache (n=2/34, 5.9%). Lastly, cadets described how a bell-ringer/ding differs from a concussion, often describing that concussions are more severe than bell-ringers/dings. Conclusions: Overall, USAFA cadet participants listed common concussion signs and symptoms. However, cadet participants perceived differences between concussion and bell-ringer/ding. While decreasing use of colloquial terms for concussion is recommended, using these terms when examining concussion history may be useful. Concussion educational interventions should continue to focus on describing concussion signs and symptoms using cadets' own words to describe the injury such as “forgetful”, but also differentiating between what may and may not be a concussion, and encourage individuals to seek the care of health care providers to discern concussion symptoms.

Reporting of Concussion Symptoms by a Nationwide Survey of United States Parents of Middle School Children

“…A combination of vestibular/ocular, somatic, cognitive, and sleep symptoms were commonly noted via the free-response item. Findings are similar to previous research using samples of parents of youth athletes [22], college students [23], United States Air Force Academy cadets [25], and the general adult population [24], although specific proportions varied. As in those studies, our study found headache to be the most reported symptom in free response.…”

“…Clinicians could consider adapting the simultaneous use of qualitative and quantitative symptom tracking methods (e.g., starting with questions focused on common symptoms, proceeding to use a checklist, and using re-sponses from each to highlight symptoms identified and missed). As discussed in previous research [25], although the use of colloquial terms is often not recommended, education provided by clinicians may benefit from using such terminology used by patients and their caregivers to help them better identify concussion symptoms and thus, respond accordingly (e.g., seeking care). However, it is necessary to note that utilizing qualitative concussion symptoms assessments may burden clinicians and may not translate to impactful clinical application.…”

“…However, such measurements may be limited in that they may overestimate/artificially inflate knowledge due to two main factors: (1) providing symptoms that a respondent may not have previously considered; and (2) offering limited response options (i.e., two options for a true/false) that default a respondent to having a high probability of correctly responding to a prompt by random means [21]. Previous research has examined knowledge assessed via open-ended, free-response items [22][23][24][25], with a recent study of United States Air Force Academy cadets finding that colloquial terminology (e.g., "feeling loopy") was sometimes used to describe concussion symptoms [25]. As work in the field progresses to develop and evaluate interventions that aim to increase concussion-related knowledge, it is important to consider how such knowledge is measured to ensure that valid measures can be acquired in order to better establish baseline knowledge and changes before and after intervention implementation.…”