OpenLB
Open Library of Bioscience
Advanced Search
The Journal of school health
04, 2022;92 (4): 406-417.

Factors Related to Concussion Knowledge, Attitudes, and Reporting Behaviors in US High School Athletes: A Systematic Review.

Krista M Beran, Katherine N Scafide
Author Information
  1. Krista M Beran: Doctoral Candidate, (kberan@gmu.edu), College of Health and Human Services, George Mason University, 4400 University Dr., Fairfax, VA 22030. ORCID
  2. Katherine N Scafide: Associate Professor, (kscafide@gmu.edu), College of Health and Human Services, George Mason University, 4400 University Dr., Fairfax, VA 22030. ORCID
PMID: 35075658 DOI: 10.1111/josh.13140

Abstract

BACKGROUND: Sport-related concussions are a major public health problem with only 50% of concussed teens reporting their symptoms. The purpose of this systematic review was to identify individual and institutional factors that contribute to concussion knowledge, attitude, and reporting behaviors among US high school athletes.
METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocol was used to direct the process of this systematic review. A search for English, peer-reviewed, quantitative studies published between 2010 and 2020 was conducted in 5 scholarly databases. The Joanna Briggs Critical Appraisal Tools were used to assess study quality.
RESULTS: Twenty-two studies met criteria for inclusion in this systematic review. The study designs were mostly cross-sectional (N = 18). Synthesis revealed individual factors including gender, age, race/ethnicity, grade level, and concussion history were associated with differences in concussion knowledge, attitude, and/or reporting behaviors. Institutional factors identified included school location, concussion education, access to an athletic trainer, sport played, and team climate. Six studies found concussion education had a positive impact on knowledge and reporting behaviors.
CONCLUSION: This systematic review identified certain populations which may be more vulnerable to underreporting concussion symptoms; therefore, a targeted approach to education and management may be more effective.

Keywords

adolescent athlete brain concussion reporting sports

References

  1. Langlois JA, Rutland-Brown W, Wald MM. The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil. 2006;21(5):375-378.
  2. Register-Mihalik JK, Linnan LA, Marshall SW, Valovich McLeod TC, Mueller FO, Guskiewicz KM. Using theory to understand high school aged athletes' intentions to report sport-related concussion: implications for concussion education initiatives. Brain Inj. 2013;27(7-8):878-886.
  3. Kroshus E, Baugh CM, Daneshvar DH, Viswanath K. Understanding concussion reporting using a model based on the theory of planned behavior. J Adoles Health. 2014;54(3):269-274.e2.
  4. Faul M, Xu L, Wald M, Coronado V. Traumatic brain injury in the United States: emergency department visits, Hospitalizations and Deaths 2002-2006. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2010 Available at: https://www.cdc.gov/traumaticbraininjury/pdf/blue_book.pdf. Accessed July 16, 2021.
  5. Finkelstein E, Corso P, Miller T. The Incidence and Economic Burden of Injuries in the United States. Oxford, UK: Oxford University Press; 2006.
  6. DePadilla L, Miller GF, Everett Jones F, Peterson AB, Breiding MJ. Self-reported concussions from playing a sport or being physically active among high school students-United States, 2017. MMWR Morb Mortal Wkly Rep. 2018;67:682-685.
  7. Kroshus E, Garnett B, Hawrilenko M, Baugh CM, Calzo JP. Concussion under-reporting and pressure from coaches, teammates, fans, and parents. Soc Sci Med. 2015;134:66-75.
  8. Kroshus E, Babkes Stellino M, Chrisman SPD, Rivara FP. Threat, pressure, and communication about concussion safety: implications for parent concussion education. Health Educ & Behav. 2018;45(2):254-261.
  9. Kroshus E, Baugh CM, Hawrilenko M, Daneshvar DH. Pilot randomized evaluation of publically available concussion education materials: evidence of a possible negative effect. Health Educ Behav. 2015;42(2):153-162.
  10. Kroshus E, Baugh CM, Stein CJ, Austin SB, Calzo JP. Concussion reporting, sex, and conformity to traditional gender norms in young adults. J Adolesc. 2017;54:110-119.
  11. Register-Mihalik JK, Guskiewicz KM, McLeod TCV, Linnan LA, Mueller FO, Marshall SW. Knowledge, attitude, and concussion-reporting behaviors among high school athletes: a preliminary study. J Athl Train. 2013;48(5):645-653.
  12. Wallace J, Covassin T, Beidler E. Sex differences in high school athletes' knowledge of sport-related concussion symptoms and reporting behaviors. J Athl Train. 2017;52(7):682-688.
  13. Heads Up. Centers for Disease Control and Prevention, Heads Up website. 25, 2021. Available at: https://www.cdc.gov/headsup/index.html. Accessed July 21, 2021.
  14. National Center for Injury Prevention and Control. Implementing return to play: learning from the experiences of early implementers. Atlanta, Georgia: Centers for Disease Control; 2015 Available at: https://www.cdc.gov/headsup/pdfs/policy/rtp_implementation-a.pdf. Accessed July 16, 2021.
  15. Mrazik M, Perra A, Brooks BL, Naidu D. Exploring minor hockey players' knowledge and attitudes toward concussion: implications for prevention. J Head Trauma Rehabil. 2015;30(3):219-227.
  16. Knowledge. Oxford Reference, 2021. Available at: https://www.lexico.com/definition/knowledge. Accessed July 14.
  17. Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991;50(2):179-211.
  18. Fishbein M, Ajzen I. Attitude, Intention, and Behavior: An Introduction to Theory and Research. Boston, MA: Addison-Wesley Publishing Company; 1975.
  19. Sarmiento K, Donnell Z, Hoffman R. A scoping review to address the culture of concussion in youth and high school sports. J Sch Health. 2017;87(10):790-804.
  20. Clark R, Stanfill AG. A systematic review of barriers and facilitators for concussion reporting behavior among student athletes. J Trauma Nurs. 2019;26(6):297-311.
  21. Moher D, Liberati A, Tetzlaff J, Altman DG, Group TP. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.
  22. Critical Appraisal Tools. Joanna Briggs Institute. 2021. Available at: https://jbi.global/critical-appraisal-tools. Accessed August 17, 2021.
  23. Moola S, Munn Z, Tufanaru C, et al. Chapter 7:Systematic reviews of etiology and risk. In: Aromataris E, Munn Z, eds. JBI Manual for Evidence Synthesis. Adelaide, South Australia: JBI; 2020 Available at: https://synthesismanual.jbi.global. Accessed July 16, 2021.
  24. Tufanaru C, Munn Z, Aromataris E, Campbell J, Hopp L. Chapter 3:Systematic reviews of effectiveness. In: Aromataris E, Munn Z, eds. JBI Manual for Evidence Synthesis. Adelaide, South Australia: JBI; 2020 Available at: https://synthesismanual.jbi.global. Accessed July 16, 2021.
  25. Kurowski B, Pomerantz WJ, Schaiper C, Gittelman MA. Factors that influence concussion knowledge and self-reported attitudes in high school athletes. J Trauma Acute Care Surg. 2014;77(3 Suppl 1):S12-S17.
  26. Myrdal CN, Huang S, Beach HN, Waterbrook AL. Comparison of knowledge, perception and attitudes of concussion in previously concussed versus non-concussed youth soccer players. Phys Sportsmed. 2017;45(3):286-292.
  27. Nanos KN, Franco JM, Larson D, Mara K, Laskowski ER. Youth sport-related concussions: perceived and measured baseline knowledge of concussions among community coaches, athletes, and parents. Mayo Clin Proc. 2017;92(12):1782-1790.
  28. Miyashita TL, Diakogeorgiou E, VanderVegt C. Gender differences in concussion reporting among high school athletes. Sports health. 2016;8(4):359-363.
  29. Wallace J, Covassin T, Moran R. Racial disparities in concussion knowledge and symptom recognition in American adolescent athletes. J Racial Ethn Health Disparities. 2018;5(1):221-228.
  30. Carpenter S, Lininger M, Craig D. Intrapersonal factors affecting concussion reporting behaviors according to the theory of planned behavior in high school football players. Int J Sports Phys Ther. 2020;15(3):374-379.
  31. Anderson BL, Gittelman MA, Mann JK, Cyriac RL, Pomerantz WJ. High school football players' knowledge and attitudes about concussions. Clin J Sport Med. 2016;26(3):206-209.
  32. Register-Mihalik JK, Valovich McLeod TC, Linnan LA, Guskiewicz KM, Marshall SW. Relationship between concussion history and concussion knowledge, attitudes, and disclosure behavior in high school athletes. Clin J Sport Med. 2017;27(3):321-324.
  33. Glang AE, Koester MC, Chesnutt JC, et al. The effectiveness of a web-based resource in improving postconcussion management in high schools. J Adolesc Health. 2015;56(1):91-97.
  34. Hunt TN. Video educational intervention improves reporting of concussion and symptom recognition. Athletic Train Educ J. 2015;10(1):65-74.
  35. Kurowski BG, Pomerantz WJ, Schaiper C, Ho M, Gittelman MA. Impact of preseason concussion education on knowledge, attitudes, and behaviors of high school athletes. J Trauma Acute Care Surg. 2015;79(3 Suppl 1):S21-S28.
  36. Cournoyer J, Tripp BL. Concussion knowledge in high school football players. J Athl Train. 2014;49(5):654-658.
  37. Bramley H, Patrick K, Lehman E, Silvis M. High school soccer players with concussion education are more likely to notify their coach of a suspected concussion. Clin Pediatr. 2012;51(4):332-336.
  38. Donnell Z, Hoffman R, Sarmiento K, Hays C. Concussion attitudes, behaviors, and education among youth ages 12-17: results from the 2014 YouthStyles survey. J Safety Res. 2018;64:163-169.
  39. Wallace J, Covassin T, Nogle S, Gould D, Kovan J. Concussion knowledge and reporting behavior differences between high school athletes at urban and suburban high schools. J Sch Health. 2017;87(9):665-674.
  40. Wallace J, Covassin T, Nogle S, Gould D, Kovan J. Knowledge of concussion and reporting behaviors in high school athletes with or without access to an athletic trainer. J Athl Train. 2017;52(3):228-235.
  41. Brown TC, Fry MD, Wilkinson TJ, Breske MP, Iwasaki S. Motivational climate and athletes' likelihood of reporting concussions in a youth competitive soccer league. J Sport Behav. 2019;42(1):29-47.
  42. Register-Mihalik JK, Williams RM, Marshall SW, et al. Demographic, parental, and personal factors and youth athletes' concussion-related knowledge and beliefs. J Athl Train. 2018;53(8):768-775.
  43. Newton M, Fry M, Watson D, Gano-Overway L, Kim M-S, Magyar M. Psychometric properties of the caring climate scale in a physical activity setting. Revisa de Psicologia del Deporta. 2007;16:67-84.
  44. Smith RE, Cumming SP, Smoll FL. Development and validation of the motivational climate scale for youth sports. J Appl Sport Psychol. 2008;20(1):116-136.
  45. McDonald T, Burghart MA, Nazir N. Underreporting of concussions and concussion-like symptoms in female high school athletes. J Trauma Nurs. 2016;23(5):241-246.
  46. McCrea M, Hammeke T, Olsen G, Leo P, Guskiewicz K. Unreported concussion in high school football players. Clin J Sport Med. 2004;14(1):5-17.
  47. McGroarty NK, Brown SM, Mulcahey MK. Sport-related concussion in female athletes: a systematic review. Orthop J Sports Med. 2020;8(7):2325967120932306.
  48. Chrisman SP, Quitiquit C, Rivara FP. Qualitative study of barriers to concussive symptom reporting in high school athletics. J Adolesc Health. 2013;52(3):330-335.e3.
  49. Harvey HH. Reducing traumatic brain injuries in youth sports: youth sports traumatic brain injury state laws, January 2009-December 2012. Am J Public Health. 2013;103(7):1249-1254.
  50. Jimenez N, Virtue A, Segar K, Stoep AV, Rivara FP. Effect of school services on academic performance after traumatic brain injury in Hispanic and non-Hispanic students. J Sch Health. 2019;89(7):519-526.
  51. DePadilla L, Miller GF, Everett JS. Characteristics of schools with youth sports concussion-related educational policies and practices. J Sch Health. 2020;90(7):520-526.
  52. Daugherty J, Waltzman D, Snedaker KP, Bouton J, Zhang X, Wang D. Concussion experiences in New England private preparatory high school students who played sports or recreational activities. J Sch Health. 2020;90(7):527-537.
  53. Rivara FP, Schiff MA, Chrisman SP, Chung SK, Ellenbogen RG, Herring SA. The effect of coach education on reporting of concussions among high school athletes after passage of a concussion law. Am J Sports Med. 2014;42(5):1197-1203.
  54. DeBarr KA, Pettit ML. Concussion! Friday night lights and informed consent-a commentary. J Sch Health. 2019;89(5):341-344.
  55. Shendell DG, Gonzalez L, Listwan TA, Pancella J, Blackborow M, Boyd J. Developing and piloting a school-based online adolescent student-athlete concussion surveillance system. J Sch Health. 2019;89(7):527-535.
  56. Conrick KM, Moore M, Abbotts L, et al. Community-engaged approach to the development and implementation of a student-centered return to learn care plan after concussion. J Sch Health. 2020;90(11):842-848.
  57. McAvoy K, Haarbauer-Krupa J. What schools need to know about the Centers for Disease Control and Prevention's guideline on diagnosis/management of mild traumatic brain injury in children-a commentary. J Sch Health. 2019;89(12):941-944.
  58. McAvoy K, Eagan-Johnson B, Dymacek R, Hooper S, McCart M, Tyler J. Establishing consensus for essential elements in returning to learn following a concussion. J Sch Health. 2020;90(11):849-858.

MeSH Term

Adolescent
Athletes
Athletic Injuries
Brain Concussion
Cross-Sectional Studies
Health Knowledge, Attitudes, Practice
Humans
Journal Article Systematic Review

Word Cloud

Created with Highcharts 10.0.0concussionreportingsystematicreviewfactorsknowledgebehaviorsstudieseducationsymptomsindividualattitudeUSschoolReportingSystematicusedstudyidentifiedmayBACKGROUND:Sport-relatedconcussionsmajorpublichealthproblem50%concussedteenspurposeidentifyinstitutionalcontributeamonghighathletesMETHODS:PreferredItemsReviewsMeta-AnalysisprotocoldirectprocesssearchEnglishpeer-reviewedquantitativepublished20102020conducted5scholarlydatabasesJoannaBriggsCriticalAppraisalToolsassessqualityRESULTS:Twenty-twometcriteriainclusiondesignsmostlycross-sectionalN = 18Synthesisrevealedincludinggenderagerace/ethnicitygradelevelhistoryassociateddifferencesand/orInstitutionalincludedlocationaccessathletictrainersportplayedteamclimateSixfoundpositiveimpactCONCLUSION:certainpopulationsvulnerableunderreportingthereforetargetedapproachmanagementeffectiveFactorsRelatedConcussionKnowledgeAttitudesBehaviorsHighSchoolAthletes:Reviewadolescentathletebrainsports

Similar Articles

Cited By