INFLUENCE OF DEMOGRAPHIC FACTORS ON CONCUSSION-RELATED DECISION-MAKING BY CERTIFIED ATHLETIC TRAINERS

Melissa K. Kossman1, Zachary Y. Kerr2, Kristen L. Kucera2, J.D. DeFreese2, Meredith A. Petschauer2, Johna K. Register-Mihalik2. 1University of Southern Mississippi, Hattiesburg, MS. 2University of North Carolina at Chapel Hill, Chapel Hill, NC. PURPOSE: This study aimed to identify demographic variables relating to factors influencing concussion-related decision-making (CRDM) by certified athletic trainers (ATC). Understanding these factors will better inform interventions on improving the CRDM abilities of ATCs. METHODS: A cross-sectional study of ATCs (n=1,029; age = 26.0 ± 3.7) completed a validated questionnaire on demographic variables and theory-based (Integrated Behavior Model) factors about CRDM. Multivariable linear regression models (a priori alpha level = 0.05) estimated the effect of each independent variable (scales: knowledge - 25 to 100; attitudes - 14 to 98; perceived behavioral control - 3 to 21; self-efficacy - 2 to 14; intentions - -45 to 45). The predictive factors were: gender (male vs. female), race (non-Caucasian vs. Caucasian), years of experience as an ATC, employment setting (high school vs. college), and sport coverage responsibilities (non-collision vs. collision). Knowledge, attitudes, perceived behavioral control, and self-efficacy were also included as predictors in the model for intentions. RESULTS: Most participants were female (n=724, 70.2%), Caucasian (n=874, 84.7%), and recent graduates (mean = 3.1 ± 1.8 years of experience) and half were employed in high schools (n=519, 50.3%) and responsible for collision sport coverage (n=533, 51.6%). Demographic factors were not significantly related to factors associated with CRDM. However, safer attitudes were associated with better intentions to remove concussed individuals (β = 0.17; p\u3c0.001). CONCLUSION: Intentions to make appropriate concussion-related decisions are a vital step in removing concussed individuals from play. ATCs may have diverse backgrounds and carry diverse professional responsibilities immersed in their own team cultures and experiences; however, these variables, as measured in this study, do not appear to impact their decision-making capabilities regardless of personal and professional background. There does not appear to be a need to develop specific initiatives for different types of ATCs. As such, it is important that educational initiatives focus on creating safer concussion-related attitudes and the need for appropriate decision-making of all ATCs. Supported in part by a NATA Research and Education Foundation Doctoral Grant

Motivations Associated With Nondisclosure of Self-Reported Concussions in Former Collegiate Athletes

BACKGROUND: Previous studies examining non-disclosure among athletes in various settings have found substantial proportions of athletes with undisclosed concussions. Substantial gaps exist in our understanding of the factors influencing athletes’ disclosure of sports-related concussions. HYPOTHESIS/PURPOSE: This cross-sectional study examined prevalence of, and factors associated with, non-disclosure of recalled concussions in former collegiate athletes. STUDY DESIGN: Cross-sectional survey. METHODS: Former collegiate athletes (n=797) completed an online questionnaire. Respondents recalled self-identified sports-related concussions (SISRC) that they sustained while playing sports in high school, college, or professionally, and whether they disclosed these SISRC to others. Respondents also recalled motivations for non-disclosure. We computed the prevalence of non-disclosure among those who recalled SISRC. Multivariate binomial regression estimated adjusted prevalence ratios (PR) with 95% confidence intervals (CI) controlling for sex, level of contact in sport, and year began playing college sports. RESULTS: Two-hundred-and-fourteen (26.9%) respondents reported sustaining at least one SISRC. Of these, 71 (33.2%) reported not disclosing at least one SISRC. Former football athletes were most likely to report non-disclosure (68.3% of those recalling SISRC); female athletes who participated in low/non-contact sports were the least likely to report non-disclosure (11.1% of those recalling SISRC). The prevalence of non-disclosure was higher among males than females in the univariate analysis, (PR=2.88; 95%CI: 1.62, 5.14) multivariate analysis (PR=2.11; 95%CI: 1.13, 3.96), and multivariate analysis excluding former football athletes (PR=2.11; 95%CI: 1.12, 3.94). The most commonly reported motivations included: did not want to leave the game/practice (78.9)%; did not want to let the team down (71.8%); did not know it was a concussion (70.4%); and did not think it was serious enough (70.4%). CONCLUSION: Consistent with previous studies, a substantial proportion of former athletes recalled SISRC that were not disclosed. Males were less likely to disclose all their SISRC than females