title: Agreement between athlete-recalled and clinically documented concussion histories in former collegiate athletes.
abstract: BACKGROUND
  Athlete-recalled and clinically documented concussion histories have been used in research on former athletes, but both have limitations. Comparisons of these 2 types of concussion histories are needed to improve the accuracy of estimates of concussion history for future research and clinical care.
  
  
  OBJECTIVE
  To estimate the agreement between athlete-recalled and clinically documented concussion histories during college and to explore reasons for differences.
  
  
  METHODS
  Cohort study (diagnosis); Level of evidence, 3.
  
  
  METHODS
  Athlete-recalled concussion histories were provided by a convenience sample of 130 former collegiate athletes using an online questionnaire, and they were individually linked to previously collected clinical data that tracked medically diagnosed concussions at the host institution from 1996 to 2012. The intraclass correlation coefficient (ICC2,1) was used to assess agreement between athlete-recalled and clinically documented concussion histories. Descriptive analyses were performed to assess reasons for disagreement.
  
  
  RESULTS
  Agreement between athlete-recalled and clinically documented concussion histories was low (ICC2,1 = 0.21; 95% confidence interval, 0.05-0.37), but it was higher for women (ICC2,1 = 0.65; 95% confidence interval, 0.44-0.79) and for athletes playing more recently (2005-2012; ICC2,1 = 0.39; 95% confidence interval, 0.01-0.67). Of the 53 athletes who self-reported college sports-related concussions, 40% believed that they sustained impacts that should have been diagnosed as concussions but were undetected, and 21% admitted nondisclosure of suspected concussions. Common reasons for nondisclosure included the following: did not think injury was serious enough (91%), did not know it was a concussion (73%), and did not want to leave the game/practice (73%).
  
  
  CONCLUSIONS
  Given the low agreement between athlete-recalled and clinically documented concussion histories, methodologic research is needed to improve the quality of tools used to assess concussion histories in former athletes.
authors.affiliation: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Matthew A. Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Center for the Study of Retired Athletes, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA zkerr@datalyscenter.org.
authors.forename: Zachary Y
authors.initials: ZY
authors.lastname: Kerr
authors.affiliation: Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Matthew A. Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Jason P
authors.initials: JP
authors.lastname: Mihalik
authors.affiliation: Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Matthew A. Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Center for the Study of Retired Athletes, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Guskiewicz
authors.affiliation: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Wayne D
authors.initials: WD
authors.lastname: Rosamond
authors.affiliation: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Kelly R
authors.initials: KR
authors.lastname: Evenson
authors.affiliation: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Matthew A. Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Center for the Study of Retired Athletes, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Marshall
mesh_terms: D000328:Adult; D056352:Athletes / Q000523:psychology; D001265:Athletic Injuries / Q000175:diagnosis*; D001924:Brain Concussion / Q000175:diagnosis*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008499:Medical Records; D011939:Mental Recall; D057566:Self Report; D012737:Sex Factors; D014342:Truth Disclosure; D014495:Universities
keywords: concurrent validity; concussion; epidemiology; injury; traumatic brain injury