WASHINGTON – Despite having knowledge of the symptoms and dangers of concussions, high school athletes are largely unwilling to report symptoms and abstain from play, according to a study of Cincinnati-area high school football players.
The vast majority of the athletes (91%) who responded to one of two surveys used in the study agreed with the statement, for instance, that it is "always or sometimes okay to play in a game with a concussion," reported Dr. Brit L. Anderson, a pediatric emergency fellow at Cincinnati Children’s Hospital Medical Center.
"High school football players are being successfully educated about concussions, from many important sources in their lives," Dr. Anderson reported at the annual meeting of the Pediatric Academic Societies. "Unfortunately, student knowledge does not translate into [safe] attitudes."
Of the 120 high school football players who participated in the study, 25% said they had suffered a concussion, and 70% said they had been taught about concussions. Most could identify the common signs and symptoms: Headache was identified by 93%, dizziness by 89%, difficulty remembering and sensitivity to light and sound by 78%, and difficulty concentrating by 76%. Only 53% correctly identified "feeling in a fog" as a symptom.
Almost all the athletes agreed that loss of consciousness is not a requirement for diagnosis of concussion (93%), and that one is at risk of serious injury or death if a second concussion occurs before the first is healed (92%). Many of the students (77%) also knew that an athlete who has had one concussion is more likely to sustain another.
Despite this knowledge, only 54% said they would always or sometimes report concussion symptoms to their coach, 53% said they would continue to play with a headache sustained in play, and 22% responded that "an athlete with a concussion has a responsibility to play in an important game," Dr. Anderson reported.
Dr. Anderson and her colleagues administered one of two similar validated surveys to the athletes to measure their knowledge and their attitudes about reporting symptoms and returning to play; most of the responses were pooled. The surveys were conducted on the first day of a football camp that drew athletes – largely upper-classmen – from local competitive high school football programs.
A mean knowledge and attitude score for each survey was calculated, and athletes with scores above and below the means were compared. There was no significant association between the mean knowledge score and the mean attitude score, nor between the mean attitude score and a history of previous concussion or recent concussion education.
There was a significant association, however, between the mean knowledge score and grade level, with the 9th graders (who comprised just 9% of the survey participants) having significantly lower scores than did the 10th, 11th, and 12th-graders, Dr. Anderson noted.
Notably, in response to one of the surveys, 91% indicated they would play a game with a concussion and 75% said they would "play through any injury in order for their team to win," she said.
Students were asked in the study to list who taught them about concussions; responses were equally divided between families, teachers, coaches, high school athletic trainers, and physicians, she noted.
Dr. Anderson reported that she had no relevant disclosures.