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Unreported Concussion in High School Football Players: Implications for Prevention

McCrea, Michael PhD; Hammeke, Thomas PhD; Olsen, Gary MS; Leo, Peter BS; Guskiewicz, Kevin ATC, PhD

Clinical Journal of Sport Medicine: January 2004 - Volume 14 - Issue 1 - p 13-17
Original Research

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.

From the Neuroscience Center, Waukesha Memorial Hospital (Dr. McCrea and Mr. Leo), Waukesha, WI; Department of Neurology, Medical College of Wisconsin (Drs. McCrea and Hammeke), Milwaukee, WI; Department of Psychology, University of Wisconsin–Milwaukee (Mr. Olsen), Milwaukee, WI; and Departments of Exercise and Sport Science and Orthopedics, University of North Carolina at Chapel Hill (Dr. Guskiewicz), Chapel Hill, NC, USA.

Received for publication March 2003; accepted August 2003.

Supported in part by the Waukesha Memorial Hospital Foundation, National Academy of Neuropsychology, National Federation of State High School Associations, NFL Charities, Green Bay Packer Foundation, Milwaukee Bucks, Herbert H. Kohl Charities, Waukesha Service Club, Michael Emme, and the Medical College of Wisconsin General Clinical Research Center (M01 RR00058).

Reprints: Michael McCrea, PhD, Neuroscience Center, Waukesha Memorial Hospital, 721 American Avenue, Suite 501, Waukesha, WI 53188 (e-mail:

© 2004 Lippincott Williams & Wilkins, Inc.