Background: Failure of high school football players to report or to under report symptoms of concussion has been found to be highly prevalent in prior research and represents a significant obstacle to providing adequate healthcare to this population. Reduced speed of information processing, poor attention, and impaired executive functioning are common cognitive sequelae that exist following a concussive injury. These can lead to significant negative secondary impact upon educational and social attainment for the adolescent patient. More importantly, returning to play prior to complete resolution of concussion symptoms can lead to catastrophic consequences as demonstrated by second impact syndrome. The majority of return to play decisions is based solely upon the athlete's self-report of symptoms. Recent research has shown that the three most common reasons for athletes underreporting their symptoms were: desire not to be withheld from competition, athlete not thinking their injury was serious enough to warrant medical attention, and the athlete's lack of awareness that a concussion had occurred. There has been a significant focus on educating high school football players on the symptoms and consequences of a concussive injury. The Center for Disease Control's (CDC) "Head's Up": Concussions in High School Sports is one type of educational packet designed to address these issues, however, there is no research aimed at determining the efficacy of these programs in reducing the incidence of symptom underreporting. Objective: To determine if a pre-season viewing of the "Heads Up": Concussion in High School Sports video, by a group of Freshman, JV, and Varsity football players, will have an impact upon the anticipated reporting of concussion symptoms for the upcoming season. Study Design: This study utilized a survey administered to high school footballs players to assess the likelihood of reporting of concussion symptoms. The survey was administered both prior to and after showing the "Heads Up": Concussion in High School Sports video. Methods: 91 Freshman, JV, and Varsity level football players from five high schools in northwest Oregon participated in this study. Results: A 14.9% increase was revealed from mean total pre-education scores (M = 6.7) to mean total post-education scores (M = 7.7). Statistically significant improvements in likelihood of reporting from pre- to post-education were revealed in scenarios SIb and S4b. Motivation not to be withheld from competition was a major barrier contributing to players' failure to report their own concussion symptoms. During preeducation testing, the five most common signs or symptoms that participants would likely or definitely report on were: vision problems (85%), dizziness/balance problems (84%), nausea/vomiting (77%), pressure in head (68%), and hearing problems/ringing (66%). The five least common signs or symptom that participants would likely or definitely report on were: sadness (12%), nervousness/anxious (13%), more emotional than usual (13%), irritability (15%), and sleeping more than usual (17%). The greatest percentage of change between pre- and posteducation in participants responding not at all or not likely to report were seen in the following signs or symptoms: more emotional than usual (25%), nervousness/anxious (20%), irritability (19%), sadness (18%), and drowsiness (17%). Conclusion: The findings of this study suggest that a 10-minute concussion education video does increase the likelihood of reporting potential signs and symptoms of concussion in high school football players. In addition, education not only increases general symptom awareness, but significantly improves knowledge of lesser known signs and symptoms of concussion.
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