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BLOG: An undiagnosed concussion is an untreated concussion

Jeffrey J. Milroy

by Jeffrey J. Milroy, MPH, DrPH

Although there are four million sport-related concussions reported annually, these likely represent only half the concussions that actually occur.

Estimates suggest that in some student athlete populations, up to 80% of suspected sports-related concussions (SRCs) go unreported (Torres et al., Williamson et al., Baugh et al.). This is important, not only from the public health perspective of understanding the incidence of concussion, but also because it means that many individuals with SRCs are going untreated, putting young athletes at risk of a second injury and longer recovery time.

Unlike a broken bone or torn ligament, a concussion is often not apparent on imaging and must be diagnosed largely by the athlete’s symptoms. That makes it essential that athletes disclose (rather than hide) symptoms.

Willingness to disclose

At the Institute to Promote Athlete Health and Wellness, my colleagues and I have been studying a variety of factors that influence athletes’ willingness to disclose. We have previously reported that collegiate athletes who have a trusting, open relationship with a coach are more likely to say they would disclose symptoms to that coach. Currently, we are exploring the role that coaches and parents play in symptom disclosure at the recreational sports level.

Parents can be advocates for disclosure and appropriate concussion care for their kids, but on the other hand, they may also be a barrier to disclosure. Parents who are fearful of jeopardizing the athlete’s status on the team or eligibility for a college scholarship, for example, may pressure their son or daughter not to report. This is a very overt type of pressure they may place on their child athlete. Less obvious but potentially just as impactful, parents may directly or indirectly convey a “play through the pain” attitude, intending to encourage persistence and physical toughness.

Disclosure is just the first step. Ideally, if the potentially concussive event wasn’t observed, we want whoever the athlete talks to — whether that is a coach, parent or doctor — to respond by following appropriate concussion protocols, including removal from play if necessary.

To that end, my team and I are investigating the use of digital media interventions such as very short videos that could be shared via text, an app or social media to educate athletes, parents and coaches about concussion, the benefits of disclosure and the potential consequences of ignoring symptoms.