Undiagnosed and undisclosed sports-related concussions in a cohort of former collegiate athletes

Background: Recurrent concussion may result in neuro-dementia.  However, athletes may not disclose sport-related concussion symptoms to others.  Research is needed on factors influencing nondisclosure of concussion symptoms by athletes.

Methods: Former collegiate athletes who played between 1987-2012 (n=797) completed an online self-administered questionnaire about impacts sustained during sport participation that should have been diagnosed by team medical staff as concussions, but were not.  We asked why concussions went undiagnosed and what sources of information influenced respondents’ knowledge of concussions.  

Results: Of the 214 respondents self-reporting sport-related concussions (26.9% of sample), 44.9% stated that they had sustained impacts that should have been diagnosed by medical staff as concussions, but were not.  Common reported factors associated with non-diagnosis were not telling team medical staff (33.2%) and no team medical staff being present (19.2%).  Among those with non-disclosed concussions, common self-reported reasons for non-disclosure included: not wanting to leave the game/practice (78.9%); not wanting to let team down (71.8%); and not knowing it was a concussion (70.4%).  Sources of knowledge that helped respondents realize impacts may have been undiagnosed concussions were continuing education (20.8%); friends (14.6%); and the media (71.9%), particularly ESPN (32.3%). 

Conclusion:  Among those former collegiate athletes self-reporting sport-related concussions, nearly half of former collegiate athletes reported sustaining undiagnosed sport-related concussions.  External influences such as perceived peer expectations and media coverage were influential in former athletes’ concussion reporting.  This information may assist in refining public health campaigns that seek to improve disclosure of symptoms (e.g. CDC’s Heads-Up program).