ORIGINAL ARTICLE COPYRIGHT © 2019 THE CANADIAN JOURNAL OF NEUROLOGICAL SCIENCES INC. Incidence, Awareness, and Reporting of Sport-Related Concussions in Manitoba High Schools Glen L. Bergeron ABSTRACT: Background and Objectives: Federal and provincial governments in Canada are promoting provincial legislation to prevent and manage sport-related concussions (SRCs). The objective of this research was to determine the incidence of concussions in high school sport, the knowledge of the signs, symptoms, and consequences of SRC, and how likely student athletes are to report a concussion. Methods: A cross-sectional survey of athletes (N = 225) from multiple sports in five high schools in one Manitoba school division was conducted. Results: Participants in this study were well aware of the signs, symptoms, and consequences of SRC. Cognitive and emotional symptoms were the least recognized consequences. SRC is prevalent in high schools in both males and females across all sports. Of the 225 respondents, 35.3% reported having sustained an SRC. Less than half (45.5%) reported their concussion. Athletes purposely chose not to report a concussion in games (38.4%) and practices (33.8%). Two major barriers to reporting were feeling embarrassed (3.4/7) and finding it difficult (3.5/7) to report. There was, however, strong agreement (Mean 5.91/7, SD 0.09) when asked if they intend to report a concussion should they experience one in the future. Conclusions: The results suggest that high school athletes would benefit from more SRC education. Coaches and team medical staff must be trained to be vigilant for the mechanism, signs, and symptoms of injury in both game and practice situations. This study will also inform the implementation of pending legislation in Manitoba and perhaps other provinces in Canada. RÉSUMÉ: Fréquence, prise de conscience et signalement des commotions cérébrales liées au sport dans les écoles secondaires du Manitoba. Contexte et objectifs : Au Canada, tant le gouvernement fédéral que les gouvernements des provinces cherchent à encourager l’adoption de lois provinciales visant à prévenir et à prendre en charge les commotions cérébrales liées au sport. L’objectif de cette étude a été de déterminer la fréquence de commotions cérébrales en lien avec la pratique sportive dans les écoles secondaires, de dresser un état des connaissances en lien avec les signes, les symptômes et les conséquences de ce type de traumatisme et de calculer la probabilité que des athlètes étudiants le signalent. Méthodes : Pour ce faire, nous avons effectué un sondage transversal auquel ont participé des athlètes (n = 225) pratiquant plusieurs sports différents. Fait à noter, ces athlètes étaient issus de cinq écoles secondaires du Manitoba faisant partie de la même division. Résultats : Les participants à cette étude étaient bien conscients des signes, des symptômes et des conséquences des commotions cérébrales liées au sport. Les symptômes d’ordre cognitif et émotionnel sont toutefois apparus comme les conséquences les moins mentionnées. Rappelons que les commotions cérébrales liées au sport sont répandues dans tous les sports des écoles secondaires, et ce, peu importe que les athlètes soient des garçons ou des filles. Sur 225 répondants, 35,3 % d’entre eux ont affirmé avoir subi une commotion cérébrale dans le cadre de la pratique d’un sport ; de plus, moins de la moitié (45,5 %) de ces jeunes ont fini par en signaler une. Lors de compétitions, 38,4 % d’entre eux ont délibérément choisi de ne rien signaler ; dans le cas de pratiques, ils ont été 33,8 % à le faire. Deux obstacles importants à un signalement ont émergé de cette étude : éprouver de la gêne (3,4/7) et trouver qu’il est difficile d’en faire un (3,5/7). Nos répondants se sont néanmoins largement rejoints (moyenne : 5,91/7 ; écart-type : 0,09) dans leur intention de signaler une commotion cérébrale s’ils devaient en être victimes dans le futur. Conclusions : Ces résultats suggèrent donc que les athlètes des écoles secondaires pourraient tirer parti de programmes d’éducation ciblant les commotions cérébrales subies dans le cadre d’un sport. Les entraîneurs et le personnel médical des équipes doivent ainsi être formés afind’être à l’affût, tant lors de compétitions que de pratiques, des signes et des symptômes liés à ces traumatismes. Enfin, cette étude entend aussi se pencher sur la mise en œuvre d’une loi en cours de préparation au Manitoba et peut-être aussi sur d’autres lois ailleurs au Canada. Keywords: Concussion, High school, Awareness, Reporting doi:10.1017/cjn.2019.58 Can J Neurol Sci. 2019; 46: 443–450 INTRODUCTION prevalence of concussions1 and considering the importance of Sport-related concussions (SRCs) have been at the forefront this time period with respect to brain development.2 The of sport medical concerns at all levels of sport. Concerns are increasing awareness of chronic traumatic encephalopathy especially focused on children aged 10–19 given their high (CTE) has added to the concern about the long-term From the Department of Kinesiology and Applied Health, The University of Winnipeg, Winnipeg, Canada. RECEIVED FEBRUARY 22, 2019. FINAL REVISIONS SUBMITTED MARCH 27, 2019. DATE OF ACCEPTANCE APRIL 18, 2019. Correspondence to: Glen L. Bergeron, Department of Kinesiology and Applied Health, The University of Winnipeg, Winnipeg, Canada. Email: [email protected] THE CANADIAN JOURNAL OF NEUROLOGICAL SCIENCES 443 Downloaded from https://www.cambridge.org/core. IP address: 170.106.202.226, on 27 Sep 2021 at 11:59:19, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/cjn.2019.58 THE CANADIAN JOURNAL OF NEUROLOGICAL SCIENCES implications on quality of life in later years. Alosco et al.3 29.6% of the 27,466 SR activity injuries reported at the Van- reported on 211 tackle football players who donated their brains couver Children’s Hospital between 1992 and 2005 occurred at and determined that the onset of CTE symptoms increased 2.44 school. In this same timeframe, head injuries represented 11.3% years earlier for every year before the age of 12 that the of all injuries and 20.6% of all admissions to hospital. individual started playing football. Although the signs were deemed to be mild, 3 of 14 (21%) high school football players Unreported Injuries 4 tested positive for CTE at autopsy. As concerning as the prevalence of concussions may be, The Center for Disease Control (CDC) reported 2.8 million concussions are deemed to be underreported.13 As many as traumatic brain injury (TBI)-related US emergency department 50% of concussions go unreported.8,13–15 Most studies are based (ED) visits in 2013. The rate of ED visits for sport-and-recreation on concussions reported to EDs.16 Concussions that may not be (SR)-related injuries more than doubled among children 19 years 1 5 captured in the data include those who report to their family and younger between 2001 and 2012. Zhang et al. reported on physician, athletic therapist, or walk in clinic and so on. Kerr15 insurance-based data that included 8,828,248 patients of which reported that football players were least likely to report a con- 43,884 patients were diagnosed with a concussion between 2007 cussion (68.3%) and males were least likely to report than – and 2014. Youth, aged 15 19 years, had the highest incidence females. Meehan13 suggests that trained observer data are sig- – (16.5/1000 patients), followed by those 10 14 years (10.5/1000 nificantly higher than self-reported data. McGuine17 determined – – patients), 20 24 years (5.2/1000 patients), and 5 9 years (3.5/ that the reporting of concussions increases from schools with 1000 patients). During that 7-year span, there was a 60% increase low- to medium- to high-level access of on-site athletic trainers. in concussions. Only 50% of those athletes with low access to an athletic trainer According to the Canadian Hospitals Injury Reporting and followed a return to play protocol. McCrea15 reported that the Prevention Program (CHIRPP), the prevalence of concussions most common reason for not reporting was lack of awareness of from 2011 to 2016 was 12% of all sport-related injuries. Of those, the seriousness of a concussion (66.4%) followed by fear of being – males 15 19 years incurred the most concussions reportedly in withdrawn from participation (41%) and unable to recognize a rugby (22.7%), ice hockey (20.2%), football (17.4%), and bas- concussion (36.1%). – ketball (10.4%). Conversely, concussions in female athletes 15 Research indicates that concussion education may have an 19 years in this same time period represented 18% of all injuries effect on the reporting rate.18–20 Taylor18 conducted a systematic including ringette (44.37%), ice hockey (36.6%), rugby (27.7%), review of four studies, three of which demonstrated an associa- and basketball (17.7%).6 2 tion between education and increase reporting of concussions. In Harris et al. reported on SR-based head injuries (HI) from a study of Korean athletes, Lee et al.21 reported that, of the 8.9% fi ve hospitals in the Edmonton region from 1995 to 2007. Of the of participants who reported having sustained a concussion, only 63,219 SR-related injuries recorded, 4935 (7.8%) were HI. approximately 50% reported the incident.27 Patients less than 18 years of age sustained 69.8% of all SR Education also affects the athlete’s decision to return to play. head injuries. Kurowski20 reported that there was a significantly lower propor- – In 2016 2017 alone, 46,000 concussions were diagnosed in tion of athletes who continued to play despite having symptoms – Canadian hospital EDs for children aged 5 19.