Differences in concussion knowledge and attitudes among American community rugby members

Objectives To assess and determine if concussion knowledge and attitudes differ among American community rugby members: Coaches, Sports Medicine Staff (SM; ranging from first aid trained personnel to sports-medicine trained physicians), Administrators (Admins), Players, and Referees/Referee Coaches (Refs). Methods Participants completed an online survey of the Rosenbaum Concussion Knowledge and Attitude Survey-Student Version to calculate two indices: Concussion Knowledge Index (CKI: Range 0–25) and Concussion Attitude Index (CAI: Range 15–75), with higher scores indicating greater knowledge and safer attitudes towards concussion. Krushkal-Wallis tests compared CAI and CKI scores across all five roles, with pairwise comparisons using Dunn's procedure and a Bonferroni correction ( α = 0.005). Results 702 participants (30.0 + 10.4 years, 75.1% Male) represented five groups: Coaches: n = 115; SM: n = 23; Admin: n = 18; Players: n = 472, and Refs: n = 74. Post hoc analyses revealed statistically significant differences in median CKI and CAI between Refs (22.0; 65.5) and SM (13.0; 51.0) and Players (12.0; 50.0) [ p < 0.003 for all comparisons]. Refs also had significantly higher CKI than coaches (18.0) [ p < 0.001]. Admins (22.0) had significantly higher CKI than players and SM ( p < 0.002). Lastly, players had significantly lower CAI than Coaches (61.0) and Admins (65.5) [ p < 0.001]. Conclusions Concussion knowledge and attitudes vary significantly by role in American community rugby. Referees and administrators demonstrated the highest knowledge and safest attitudes, while players exhibited the lowest, raising concerns about self-reporting behaviors. Targeted education initiatives are needed to improve player awareness and safety.