The Impact of An Educational Intervention On Concussion Knowledge, Attitudes, and Behaviors of High School-Athletes

Monday, October 28, 2013: 11:40 AM
Plaza International Ballroom E-F (Hyatt Regency Orlando, formerly the Peabody)
Brad G. Kurowski, MD, MS, Courtney L. Schaiper, MS, Wendy J. Pomerantz, MD, MS and Michael A. Gittelman, MD, Cincinnati Childrens Hospital Medical Center, Cincinnati, OH


Concussions are a leading cause of morbidity and mortality in athletes. Recognition of the signs and symptoms by athletes can prevent the risk of longer recovery times and secondary concussions. Prior education has focused on parents and coaches, but not athletes. The purpose of this study was to assess if a pre-season educational lecture regarding concussions improved high school athlete knowledge, attitudes, and behaviors about concussions.


A prospective study was performed to determine the effectiveness of a 20 minute educational lecture on high school-athlete concussion knowledge, attitudes and behavior. Athletes were recruited from high risk fall and winter sports at a large high school. During preseason, a pre-education survey was administered to determine baseline knowledge, attitudes, and behavior about concussions. Athletes then received an educational lecture designed by the study team. A post-education assessment was performed immediately after the educational intervention and at the end of the sports season. The outcomes assessed were changes in knowledge of acute signs and symptoms (ASK) of concussion, general concussion knowledge (GK), and behaviors and attitudes (BA) related to concussion. Paired t-tests were used to evaluate changes between pre-education, immediate post-education and post-season test scores. A post-season survey was also conducted to retrospectively assess actual behaviors.


234 total participants were enrolled. 82.9% were male and mean age was 15.4 (stdev=1.1) years. 47.4% participated in football; 24.4% in soccer; 15.0% in wrestling; and 13.3% in basketball. On pre-participation screening, 35.9% admitted to receiving prior education on concussion; 59.5% received education from their doctor, 36.7% family, 36.7% school, 34.5% athletic trainer, and 31.0% coach. There were significant differences between pre-education and immediate post-education scores on ASK (mean change=1.94, stderr=0.14, p<0.001), GK (mean change=1.12, stderr=0.13, p<0.001), and BA (mean change=1.76, stderr=0.14, p<0.001). There were significant differences between pre-education and post-season scores on ASK (mean change=0.35, stderr=0.17, p=0.04), GK (mean change=-0.44, stderr=0.13, p=0.001), and BA (mean change=0.41, stderr=0.16, p=0.01). There were significant differences between immediate post-education and post-season scores on ASK (mean change=-1.69, stderr=0.17, p<0.001), GK (mean change=-1.56, stderr=0.15, p<0.001), and BA (mean change=-1.39, stderr=0.17, p<0.001). Of the 167 completed post season questionnaires, 25.8% reported being hit in the head and this leading to headaches, dizziness or feeling confused during the season. Of those that reported symptoms, 72% continued playing and 6.6% actually reported being diagnosed with a concussion.


Self-reported concussion knowledge, attitudes and behavior improve immediately after an educational intervention in high-school athletes. The effects are maintained at the end of a sports season, but are decreased compared to the immediate effects. Interestingly, despite a change in self-reported attitude and behavior, actual behaviors reported by athletes were sub-optimal.