Zachary Y Kerr1,2,3,4, Johna K Register-Mihalik1,2,3,4, Melissa C Kay2,5, J D DeFreese1,2,3, Stephen W Marshall2,3,4,5, Kevin M Guskiewicz1,2,3,4. 1. Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA. 2. Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, North Carolina, USA. 3. Center for the Study of Retired Athletes, University of North Carolina, Chapel Hill, North Carolina, USA. 4. Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina, USA. 5. Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA.
Abstract
BACKGROUND: Despite a focus on the incidence and effects of concussion, nondisclosure of sports-related concussions among retired players from the National Football League (NFL) has yet to be examined. PURPOSE: Examine the prevalence of and factors associated with nondisclosure of sports-related concussions in former NFL athletes. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: A sample of 829 former NFL players completed a general health survey. This historical cohort included players who had played before World War II to 2001. Respondents retrospectively recalled sports-related concussions that they sustained during their professional careers and whether at least one of these sports-related concussions was not reported to medical staff. We computed the prevalence of nondisclosure among those recalling sport-related concussions during their professional careers. Multivariable binomial regression estimated adjusted prevalence ratios (PR) with 95% confidence intervals (CIs) controlling for race/ethnicity, number of years played, primary position played, professional career concussion history, and playing era. Playing era was categorized by whether the majority of a player's career was before or after a 1976 rule change to limit contact ("spearing"). RESULTS: Overall, 417 (50.3%) respondents reported they had sustained a concussion and did not inform medical staff at least once during their professional playing career. Nonwhite respondents had a higher prevalence of nondisclosure than white/non-Hispanic respondents (adjusted PR = 1.19; 95% CI, 1.02-1.38). An interaction between professional career concussion history and playing era was also found ( P = .08). Compared with those in the pre-spearing rule change group with 1 or 2 concussions, all other groups had larger prevalences of nondisclosure (increases ranging from 41% to 153% in multivariable models). Across concussion strata, nondisclosure prevalence was generally higher in the post-spearing rule change group than the pre-spearing rule change group, with the largest differences found among those with 1 or 2 concussions or those with 3 or 4 concussions. CONCLUSION: A large proportion of former NFL players in this historical cohort reported at least one instance of not disclosing sports-related concussions to medical staff. Future research on concussion nondisclosure needs to identify mechanisms to improve football players' intentions to disclose concussion-related symptoms to health care providers and to equip health care providers with more effective strategies for timely identification of concussion.
BACKGROUND: Despite a focus on the incidence and effects of concussion, nondisclosure of sports-related concussions among retired players from the National Football League (NFL) has yet to be examined. PURPOSE: Examine the prevalence of and factors associated with nondisclosure of sports-related concussions in former NFL athletes. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: A sample of 829 former NFL players completed a general health survey. This historical cohort included players who had played before World War II to 2001. Respondents retrospectively recalled sports-related concussions that they sustained during their professional careers and whether at least one of these sports-related concussions was not reported to medical staff. We computed the prevalence of nondisclosure among those recalling sport-related concussions during their professional careers. Multivariable binomial regression estimated adjusted prevalence ratios (PR) with 95% confidence intervals (CIs) controlling for race/ethnicity, number of years played, primary position played, professional career concussion history, and playing era. Playing era was categorized by whether the majority of a player's career was before or after a 1976 rule change to limit contact ("spearing"). RESULTS: Overall, 417 (50.3%) respondents reported they had sustained a concussion and did not inform medical staff at least once during their professional playing career. Nonwhite respondents had a higher prevalence of nondisclosure than white/non-Hispanic respondents (adjusted PR = 1.19; 95% CI, 1.02-1.38). An interaction between professional career concussion history and playing era was also found ( P = .08). Compared with those in the pre-spearing rule change group with 1 or 2 concussions, all other groups had larger prevalences of nondisclosure (increases ranging from 41% to 153% in multivariable models). Across concussion strata, nondisclosure prevalence was generally higher in the post-spearing rule change group than the pre-spearing rule change group, with the largest differences found among those with 1 or 2 concussions or those with 3 or 4 concussions. CONCLUSION: A large proportion of former NFL players in this historical cohort reported at least one instance of not disclosing sports-related concussions to medical staff. Future research on concussion nondisclosure needs to identify mechanisms to improve football players' intentions to disclose concussion-related symptoms to health care providers and to equip health care providers with more effective strategies for timely identification of concussion.
Authors: Adam J Bartsch; Daniel Hedin; Jay Alberts; Edward C Benzel; Jason Cruickshank; Robert S Gray; Kenneth Cameron; Megan N Houston; Tyler Rooks; Gerald McGinty; Erick Kozlowski; Steven Rowson; Joseph C Maroon; Vincent J Miele; J Chris Ashton; Gunter P Siegmund; Alok Shah; Michael McCrea; Brian Stemper Journal: Ann Biomed Eng Date: 2020-10-27 Impact factor: 3.934
Authors: Bhavik H Patel; Kelechi R Okoroha; Toufic R Jildeh; Yining Lu; Alexander J Idarraga; Benedict U Nwachukwu; Sarek A Shen; Brian Forsythe Journal: Orthop J Sports Med Date: 2019-06-27
Authors: Johna Register-Mihalik; Christine E Callahan; Melissa C Kay; Zachary Y Kerr; Madison T Hinson; Laura A Linnan; Heidi Hennink-Kaminski; Paula Gildner; Stephen W Marshall; Megan N Houston; Kenneth L Cameron Journal: J Athl Train Date: 2021-02-22 Impact factor: 2.860
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