What can family medicine providers learn about concussion non-disclosure from former collegiate athletes?

Researchers examined why concussion symptoms often go unreported, in  a scientific study conducted by Elizabeth A. Beverly, Todd R. Fredricks, Andrew Leubitz, Benjamin R. Oldach, Daniel Kana, Michael D. Grant, Jonathon Whipps, and Emily H. Guseman. The researchers identified 3 themes as to why. Full article is here.

Theme 1: Concussions are part of the game

Participants in all 7 focus groups recognized the frequency and seriousness of concussions. Interestingly, most participants believed that concussions were inherent in sports, particularly for collision sports and high contact sports like football, soccer, ice hockey, and rugby.

“It almost seems like part of the game. It's like yeah, you're playing football. You get hit. It hurts. You've got to be tough.” (Focus Group 6, Male ID 30)

Theme 2: Hiding concussion symptoms

Participants in each focus group discussed hiding concussion symptoms in order to avoid being taken out of or missing games. Some participants withheld information from coaches and trainers while others misrepresented or fibbed about their concussions.

“I’d say we’d all experienced it at one point or another. And I remember actually one guy specifically saying like, ‘Oh, did you see the black shiny stuff?’ I was like yeah. He was like, ‘Oh, okay.’ And that was that. We just kept playing, but I never told coaches or trainers or anyone. I guess I thought that if I did, then they were going to make me come out of the game and stop playing. And I felt like I needed to be there and I was still able to do it well enough to be in there. So I was like, oh man, I don’t want to come out because if I do, then I might have to miss the rest of the game. I was like well, I’ll just tough it out and see what happens. Hopefully, I’ll make it the rest of the game. I did so.” (Focus Group 6, Male ID 30)

Theme 3: Misconceptions about concussions in low contact sports

While all participants were familiar with the incidence of concussions in sports, many did not understand that concussions could occur in any and all sports. Some participants felt that concussions were limited to only collision sports or high contact sports. Further, athletes in low contact sports or sports with minimal physical contact with other athletes (e.g., tennis, track and field, swimming) who experienced concussions, attributed their injuries to personal clumsiness rather than their sport.

“I ran into someone head-on and we were both like sprinting and I had a headache. No one told me I had a concussion, I didn’t want to go to the trainer … but I was really confused. I had a really bad headache the whole week and I just had trouble thinking and stuff … That’s why it’s really embarrassing, because who does that?” (Focus group 3, Female ID 14)

Abstract
Background
Despite the risks, concussion symptoms often go underreported by athletes, leading to delayed or forgone treatment and increased potential for concussion recurrence. One of the most serious long-term consequences of sports-related concussions is Chronic Traumatic Encephelopathy (CTE), a disorder associated with progressive neurological deterioration. The purpose of this study was to explore former collegiate athletes’ understanding of concussions and motivations behind concussion non-disclosure in order to better assist family medicine providers in screening for and managing a history of concussions.

Methods

Informed by the theoretical framework Social Cognitive Theory, we conducted focus groups with former collegiate athletes using a field-tested discussion guide. Discussions were transcribed, coded, and analyzed via content and thematic analyses using NVivo 10 software.

Conclusions

Family medicine providers as well as coaches, athletic trainers, teachers, and parents/guardians should reinforce the message that concussions can occur in all sports and inform patients about the signs and symptoms of concussions. Further, providers should ask all patients if they engaged in high school or collegiate athletics; and if yes, to describe their hardest hit to their head in order to obtain a complete medical history.