Unreported Concussion in High School Football Players: Implications for Prevention
Abstract
OBJECTIVE: To investigate the frequency of unreported concussion and estimate more accurately the overall rate of concussion in high school football players. DESIGN: Retrospective, confidential survey completed by all subjects at the end of the football season. SETTING AND PARTICIPANTS: A total of 1,532 varsity football players from 20 high schools in the Milwaukee, Wisconsin, area were surveyed. MAIN OUTCOME MEASUREMENTS: The structured survey assessed (1) number of concussions before the current season, (2) number of concussions sustained during the current season, (3) whether concussion during the current season was reported, (4) to whom concussion was reported, and (5) reasons for not reporting concussion. RESULTS: Of respondents, 29.9% reported a previous history of concussion, and 15.3% reported sustaining a concussion during the current football season; of those, 47.3% reported their injury. Concussions were reported most frequently to a certified athletic trainer (76.7% of reported injuries). The most common reasons for concussion not being reported included a player not thinking the injury was serious enough to warrant medical attention (66.4% of unreported injuries), motivation not to be withheld from competition (41.0%), and lack of awareness of probable concussion (36.1%). CONCLUSIONS: These findings reflect a higher prevalence of concussion in high school football players than previously reported in the literature. The ultimate concern associated with unreported concussion is an athlete's increased risk of cumulative or catastrophic effects from recurrent injury. Future prevention initiatives should focus on education to improve athlete awareness of the signs of concussion and potential risks of unreported injury.
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Using the National Patient Register to ascertain TBI cases allowed comprehensive information on all individuals who sought medical treatment, but will have underestimated milder forms of TBI, such as sports-related injuries.
“We used the National Patient Register, as adopted by previous studies [8,15,16], to ascertain TBI cases. This allowed comprehensive information on all individuals who sought medical treatment for their injuries, but will have underestimated milder forms of TBI, for example of the type prevalent in sports-related injuries [53–56].”
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- Authors
- McCrea, M., Hammeke, T., Olsen, G., Leo, P., & Guskiewicz, K.
- Affiliations
- Waukesha Memorial Hospital (US)
- University of North Carolina at Chapel Hill (US)
- Venue
- Clinical Journal of Sport Medicine
- Published
- 2004-01
- Volume
- 14
- Issue
- 1
- Pages
- 13-17
- ISSN
- 1050-642X (ISSN-L)
- OpenAlex
- W2050073457
- Cited by
- 1,220
- References
- 1
- Citations by year
- 2026: 21 · 2025: 36 · 2024: 39 · 2023: 43 · 2022: 39 · 2021: 86 · 2020: 86 · 2019: 88 · 2018: 76 · 2017: 92 · 2016: 93 · 2015: 73 · 2014: 109 · 2013: 83 · 2012: 50
- FWCI
- 10.10
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Journal of Sport Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Center for Research Resources (M01-RR00058, M01RR000058)
- Topics
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports injuries and prevention
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Winter Sports Injuries and Performance
- Keywords
- concussion, high school football, concussion prevalence, concussion reporting, athletic trainers, reasons for not reporting, concussion awareness, concussion prevention
- MeSH terms
- Adolescent, Athletic Injuries, Brain Concussion, Football, Health Promotion, Health Surveys, Humans, Health Knowledge, Attitudes, Practice, Retrospective Studies, Wisconsin, Prevalence
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