title: Knowledge, attitude, and concussion-reporting behaviors among high school athletes: a preliminary study.
abstract: BACKGROUND
  Many athletes continue to participate in practices and games while experiencing concussion-related symptoms, potentially predisposing them to subsequent and more complicated brain injuries. Limited evidence exists about factors that may influence concussion-reporting behaviors.
  
  
  OBJECTIVE
  To examine the influence of knowledge and attitude on concussion-reporting behaviors in a sample of high school athletes.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Participants completed a validated survey instrument via mail.
  
  
  METHODS
  A total of 167 high school athletes (97 males, 55 females, 5 sex not indicated; age = 15.7 ± 1.4 years) participating in football, soccer, lacrosse, or cheerleading.
  
  
  METHODS
  Athlete knowledge and attitude scores served as separate predictor variables.
  
  
  METHODS
  We examined the proportion of athletes who reported continuing to participate in games and practices while symptomatic from possible concussion and the self-reported proportion of recalled concussion and bell-ringer events disclosed after possible concussive injury.
  
  
  RESULTS
  Only 40% of concussion events and 13% of bell-ringer recalled events in the sample were disclosed after possible concussive injury. Increased athlete knowledge of concussion topics (increase of 1 standard deviation = 2.8 points) was associated with increased reporting prevalence of concussion and bell-ringer events occurring in practice (prevalence ratio [PR] = 2.27, 95% confidence interval [CI] = 1.60, 3.21) and the reporting prevalence of bell-ringer-only events overall (PR = 1.87, 95% CI = 1.38, 2.54). Athlete attitude scores (increase of 1 standard deviation = 11.5 points) were associated with decreases in the proportion of athletes stating they participated in games (PR = 0.74, 95% CI = 0.66, 0.82) and practices (PR = 0.67, 95% CI = 0.59, 0.77) while symptomatic from concussions.
  
  
  CONCLUSIONS
  Most recalled concussion events in our study were not reported to a supervising adult. Clinicians should be aware that knowledge and attitude influence concussion reporting. Clinicians and administrators should make concussion education a priority and encourage an optimal reporting environment to better manage and prevent concussive injuries in young athletes.
authors.affiliation: Emergency Services Institute, WakeMed Health and Hospitals, Raleigh, NC.
authors.forename: Johna K
authors.initials: JK
authors.lastname: Register-Mihalik
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Guskiewicz
authors.forename: Tamara C Valovich
authors.initials: TC
authors.lastname: McLeod
authors.forename: Laura A
authors.initials: LA
authors.lastname: Linnan
authors.forename: Frederick O
authors.initials: FO
authors.lastname: Mueller
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Marshall
mesh_terms: D000293:Adolescent; D001265:Athletic Injuries; D001924:Brain Concussion / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D010865:Pilot Projects; D012574:Schools; D057566:Self Report; D013177:Sports / Q000523:psychology; D013334:Students / Q000523:psychology; D011795:Surveys and Questionnaires