The Reporting of Concussions Among High School Football Players, an Updated Evaluation

Saturday, October 24, 2015: 3:50 PM
143B (Walter E. Washington Convention Center)
Jonathan L. Minor, MD1, James MacDonald, M.D., M.P.H.2 and William P. Meehan, MD1, (1)Division of Sports Medicine, Children's Hospital Boston and Harvard Medical School, Boston, MA, (2)Nationwide Children's Hospital, Columbus, OH


Studies from a decade ago suggested that >50% of concussions sustained by high school football players were unreported.  Given the increased awareness and recent legislation regarding concussions, we sought to determine whether the percentage of concussions sustained by high school football players that go unreported has changed.


We conducted a cross-sectional study using an anonymous questionnaire given to high school football players at the conclusion of the 2014 season. The questionnaire was based on the questionnaire used by McCrea et al, and queried prior concussion history, concussion injuries sustained during the 2014 season, and frequency of reporting concussions. Additional information included age, grade point average, position, perceived importance to the team, intentions to play sport beyond high school, and position at time of injury. All high schools in Ohio and 27 high schools in the greater Boston area of Massachusetts were invited to participate. 


A total of 692 athletes from 38% of invited high schools participated, 103 (14.9%) of which sustained a concussion during the 2014 season.  Just over half (56.4%) of participants who sustained a concussion reported it, mostly to athletic trainers (71.2%) and coaches (52.5%) The proportion of first stringers who reported a concussion this season (49.3%) was lower than non-first stringers (73.3%), (OR=0.35, 95%CI 0.14. 0.90 p=0.029).  Of the players who did not report his or her concussion, the most common reasons for not reporting were “didn’t want to be pulled from competition” (47.7%) and “feeling it wasn’t a serious injury” (56.9%).  As with prior studies, the proportion of players with a prior concussion history who sustained a concussion during the current season (29.4%) was higher than those with no prior concussion history (10.8%), (OR=3.46, 95%CI 2.19, 5.47 p<0.001).


The reporting of concussions among high school football players remains problematic despite increased awareness, education and legislation. Athletic trainers and coaches play an integral role in the reporting of concussions in this population, and awareness and education initiatives may best be focused on educating them to identify additional risk factors for athletes susceptible for concussion and non-reporting.