Concussion Knowledge And Attitude Are Associated With Immediate Vs Delayed Concussion Reporting In Collegiate Athletes

Timely reporting of suspected sports related concussions is critical to reduce the risk of worsening the injury acutely and improving recovery. Concussion education has been emphasized in recent years, but there are limited findings to support if concussion knowledge and attitude improve acute concussion reporting. PURPOSE: The purpose of this study was to identify if baseline concussion knowledge and attitude were different between student-athletes with immediate or delayed concussion reporting. METHODS: We recruited 67 NCAA student-athletes from two institutions (Sex: 36 Female; Age: 19.0 + 1.0 y.o.; Height: 173.7 + 12.8 cm, Weight: 75.5 + 22.3 kg, Concussion History: 0.7 + 1.0) who were diagnosed with sports related concussions. At baseline, all participants completed the reliable and valid RoCKAS questionnaire which has both Knowledge (CKI, score range: 0 - 25) and Attitude (CAI, score range: 15 - 75) indexes. Participants were classified as Immediate (reported within the same event) or Delayed (reported after the event) and all participants completed a graded symptom checklist (GSC, score range 0 - 132) on the day they reported. A binary logistic regression was performed with three predictors (CAI, CKI, GSC) and their two-way interactions while controlling for sex and concussion history. RESULTS: The group outcomes and descriptives were Immediate (CKI: 20.2 + 2.9, CAI 51.9 + 6.8. GSC: 28.2 + 21.2) and Delayed (CKI of 19.8 + 2.5, CAI of 55.8 + 9.1, GSC: 20.9 + 20.3). Amongst the predictors, the CKI (p = 0.028) and CAI (p = 0.010) scores as well as GSC (p = 0.027) were significant. The interactions of CKI * GSC (p = 0.003) and CAI * CKI (p = 0.033) were also significant. Both the CKI (OR: 1.31, 95% CI: 1.01 - 1.70) and GSC (OR: 1.05, 95% CI: 1.00 - 1.09) increased the odds of immediate reporting whereas CAI had lower odds of immediate reporting (OR: 0.89, 95% CI: 0.81 - 0.99). CONCLUSIONS: A higher (better) CKI score and higher acute GSC were significant predictors of immediate reporting; however, surprisingly a higher (better) CAI was associated with a lower reporting. It is unclear why a safer concussion attitude, as reflected in a higher CAI score in the Delayed group, lowered the odds of timely reporting, but may reflect a disconnect between survey responses and actual responses in competitive environments. Supported by: National Institute of Neurological Disorders and Stroke [1R15NS070744, R03NS104371]