Sport level and sex differences in sport-related concussion among Japanese collegiate athletes: Epidemiology, knowledge, reporting behaviors, and reported symptoms

Abstract

This study investigated the incidence of sport-related concussion (SRC) in sports, effect of athlete knowledge on reporting behavior differences between collegiate and non-collegiate athletes, and differences in SRC symptoms between sexes and level of participation. In this cross-sectional survey, 1 344 Japanese collegiate and non-collegiate athletes from a single institute were analyzed. Using a web-based survey, demographics, general SRC, knowledge of SRC, the most recent SRC reporting behaviors, and symptom presentation were examined. The prevalence of SRC during the academic year 2016-2017 was 2.68 (95% confidence interval [CI]: 1.88-3.69) across all sports. The prevalence of SRC was 33.3 (95% CI: 17.96-51.83) in rugby union and 8.33 (95% CI: 1.03-27.00) in women's soccer. The prevalence of SRC in males (3.47 [95% CI: 2.38-4.86] was 3.65 times higher than that in females (0.95 [95% CI: 0.26-2.41]). In total, the mean total score of knowledge was 5.30 (4.2) across 25 questions; dizziness was the most well-known symptom (867/1 344, 64.5%), followed by headache (59.3%). Being more emotional (44/1 345, 3.3%) was the least frequently known symptom. Level of participation did not affect scores (5.16 [3.96] vs. 5.52 [4.54]; p ​= ​0.131). All 87 disclosing participants experienced drowsiness and irritability and felt more emotional. In terms of sex and participant level, no significant differences were found in any symptoms. This study found very low rates of concussion education in Japan. Dissemination of concussion education is essential in the future to recognize concussion earlier and prevent severe concussive injury.

Keywords

Disclosure / Knowledge / Attitudes / Prevalence / Brain injury

References

[[1]] P McCrory, W Meeuwisse, J Dvořák, et al.. Consensus statement on concussion in sport-the 5^th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med, 51 (11) ( 2017), pp. 838-847, DOI: 10.1136/bjsports-2017-097699

[[2]] A Chandran, AJ Boltz, SN Morris, et al.. Epidemiology of concussions in national collegiate athletic association (NCAA) sports: 2014/15-2018/19. Am J Sports Med, 50 (2) ( 2022), pp. 526-536, DOI: 10.1177/03635465211060340

[[3]] ZY Kerr, SL Zuckerman, EB Wasserman, T Covassin, A Djoko, TP Dompier. Concussion symptoms and return to play time in youth, high school, and college american football athletes. JAMA Pediatr, 170 (7) ( 2016), pp. 647-653, DOI: 10.1001/jamapediatrics.2016.0073

[[4]] AJ Gardner, GL Iverson, WH Williams, S Baker, P. Stanwell. A systematic review and meta-analysis of concussion in rugby union. Sports Med, 44 (12) ( 2014), pp. 1717-1731, DOI: 10.1007/s40279-014-0233-3

[[5]] C McNeel, GM Clark, CB Davies, BP Major, JAG Lum. Concussion incidence and time-loss in australian football: a systematic review. J Sci Med Sport, 23 (2) ( 2020), pp. 125-133, DOI: 10.1016/j.jsams.2019.10.010

[[6]] A Gardner, GL Iverson, CR Levi, et al.. A systematic review of concussion in rugby league. Br J Sports Med, 49 (8) ( 2015), pp. 495-498, DOI: 10.1136/bjsports-2013-093102

[[7]] P McCrory, N Feddermann-Demont, J Dvořák, et al.. What is the definition of sports-related concussion: a systematic review. Br J Sports Med, 51 (11) ( 2017), pp. 877-887, DOI: 10.1136/bjsports-2016-097393

[[8]] The Japanese Association for the Surgery of Trauma.Japan Trauma Data Bank Report 2019.2014-2018. June 2022

[[9]] Japan Sport Council Survey and research on accidents during physical education activities under school management, trends and prevention of accidents: trends in head and neck trauma in physical education activities and points to consider in accident prevention. June 2022

[[10]] LJ Frommer, KK Gurka, KM Cross, CD Ingersoll, RD Comstock, SA. Saliba. Sex differences in concussion symptoms of high school athletes. J Athl Train, 46 (1) ( 2011), pp. 76-84, DOI: 10.4085/1062-6050-46.1.76

[[11]] EB Wasserman, ZY Kerr,SL Zuckerman, T. Covassin. Epidemiology of sports-related concussions in National Collegiate Athletic Association athletes from 2009-2010 to 2013-2014: symptom prevalence, symptom resolution time, and return-to-play time. Am J Sports Med, 44 (1) ( 2016), pp. 226-233, DOI: 10.1177/0363546515610537

[[12]] A Chandran, AJ Boltz, BL Brett, et al.. Patterns and predictors of concussion symptom presentations in NCAA athletes. Res Sports Med ( 2022), pp. 1-15, DOI: 10.1080/15438627.2022.2105218

[[13]] SL Zuckerman, AM Yengo-Kahn, TA Buckley, GS Solomon, AK Sills, ZY Kerr.Predictors of postconcussion syndrome in collegiate student-athletes. Neurosurg Focus, 40 (4) ( 2016), p. E13, DOI: 10.3171/2016.1.FOCUS15593

[[14]] DM Torres, KM Galetta, HW Phillips, et al.. Sports-related concussion: anonymous survey of a collegiate cohort. Neurol Clin Pract, 3 (4) ( 2013), pp. 279-287, DOI: 10.1212/CPJ.0b013e3182a1ba22

[[15]] J Cournoyer, BL. Tripp. Concussion knowledge in high school football players. J Athl Train, 49 (5) ( 2014), pp. 654-658, DOI: 10.4085/1062-6050-49.3.34

[[16]] E Beidler, AC Bretzin, C Hanock, T. Covassin. Sport-related concussion: knowledge and reporting behaviors among collegiate club-sport athletes. J Athl Train, 53 (9) ( 2018), pp. 866-872, DOI: 10.4085/1062-6050-266-17

[[17]] F De Stefano, B Fiani, TA. Mayo. Foundational “survival guide” overview of sports-related head injuries. Cureus, 12 (11) ( 2020), Article e11636, DOI: 10.7759/cureus.11636

[[18]] M Anderson, KM Petit, J Wallace, T Covassin, E. Beidler. Factors associated with concussion nondisclosure in collegiate student-athletes. J Athl Train, 56 (2) ( 2021), pp. 157-163, DOI: 10.4085/1062-6050-0102.20

[[19]] S O’Connor, D Geaney, E. Beidler. Non-disclosure in Irish collegiate student-athletes: do concussion history, knowledge, pressure to play and gender impact concussion reporting?. Phys Sportsmed, 48 (2) ( 2020), pp. 186-193, DOI: 10.1080/00913847.2019.1671141

[[20]] RJ Echemendia, W Meeuwisse, P McCrory, et al.. The sport concussion assessment tool 5th edition (SCAT5): background and rationale. Br J Sports Med, 51 (11) ( 2017), pp. 848-850, DOI: 10.1136/bjsports-2017-097506

[[21]] J Wallace, T Covassin, S Nogle, D Gould, J. Kovan. Knowledge of concussion and reporting behaviors in high school athletes with or without access to an athletic trainer. J Athl Train, 52 (3) ( 2017), pp. 228-235, DOI: 10.4085/1062-6050-52.1.07

[[22]] JK Register-Mihalik, KM Guskiewicz, TC McLeod, LA Linnan, FO Mueller, SW Marshall. Knowledge, attitude, and concussion-reporting behaviors among high school athletes: a preliminary study. J Athl Train, 48 (5) ( 2013), pp. 645-653, DOI: 10.4085/1062-6050-48.3.20

[[23]] S Tanaka, K Tsukigase, T Hara, et al.. Effect of real-time visual feedback device “Quality Cardiopulmonary Resuscitation (QCPR) Classroom” with a metronome sound on layperson CPR training in Japan: a cluster randomized control trial. BMJ Open, 9 (6) ( 2019), Article e026140, DOI: 10.1136/bmjopen-2018-026140

[[24]] TL Miyashita, WM Timpson, MA Frye, GW Gloeckner. The impact of an educational intervention on college athletes’ knowledge of concussions. Clin J Sport Med, 23 (5) ( 2013), pp. 349-353, DOI: 10.1097/JSM.0b013e318289c321

[[25]] 25. The Japan Sport Council Accident prevention efforts of each athletic organization [In Japanese].

[[26]] KL O’Connor, MM Baker, SL Dalton, TP Dompier, SP Broglio, ZY Kerr.Epidemiology of sport-related concussions in high school athletes: national athletic treatment, injury and outcomes network (NATION), 2011-2012 through 2013-2014. J Athl Train, 52 (3) ( 2017), pp. 175-185, DOI: 10.4085/1062-6050-52.1.15

[[27]] S Nagahiro, Y. Mizobuchi. Current topics in sports-related head injuries: a review. Neuro Med Chir (Tokyo), 54 (11) ( 2014), pp. 878-886, DOI: 10.2176/nmc.ra.2014-0224

[[28]] DH Daneshvar, CJ Nowinski, AC McKee, RC Cantu. The epidemiology of sport-related concussion. Clin Sports Med, 30 (1) ( 2011), pp. 1-vii, DOI: 10.1016/j.csm.2010.08.006

[[29]] SL Zuckerman, ZY Kerr, A Yengo-Kahn, E Wasserman, T Covassin, GS Solomon.Epidemiology of sports-related concussion in NCAA athletes from 2009-2010 to 2013-2014: incidence, recurrence, and mechanisms [published correction appears in Am J sports med. 2016;

44( 1): NP5]. Am J Sports Med, 43 (11) ( 2015), pp. 2654-2662, DOI: 10.1177/0363546515599634

[[30]] TC Valovich McLeod, C Schwartz, RC Bay. Sport-related concussion misunderstandings among youth coaches. Clin J Sport Med, 17 (2) ( 2007), pp. 140-142, DOI: 10.1097/JSM.0b013e31803212ae

[[31]] J Breck, A Bohr, S Poddar, MB McQueen, T. Casault. Characteristics and incidence of concussion among a US collegiate undergraduate population. JAMA Netw Open, 2 (12) ( 2019), Article e1917626, DOI: 10.1001/jamanetworkopen.2019.17626

[[32]] CM Baugh, E Kroshus, DH Daneshvar, RA Stern. Perceived coach support and concussion symptom-reporting: differences between freshmen and non-freshmen college football players. J Law Med Ethics, 42 (3) ( 2014), pp. 314-322, DOI: 10.1111/jlme.12148

[[33]] ZY Kerr, JK Register-Mihalik, E Kroshus, CM Baugh, SW Marshall. Motivations associated with nondisclosure of self-reported concussions in former collegiate athletes. Am J Sports Med, 44 (1) ( 2016), pp. 220-225, DOI: 10.1177/0363546515612082

[[34]] AC Bretzin, AJ Zynda, DJ Wiebe, T. Covassin. Time to authorized clearance from sport-related concussion: the influence of health care provider and medical facility. J Athl Train, 56 (8) ( 2021), pp. 869-878, DOI: 10.4085/JAT0159-20

[[35]] H Ochiai, T. Abe. Clinical features and early detection of sport-related concussion. Acute Med Surg, 6 (1) ( 2019), pp. 49-53, DOI: 10.1002/ams2.376

[[36]] M McCrea, K Guskiewicz, C Randolph, et al.. Effects of a symptom-free waiting period on clinical outcome and risk of reinjury after sport-related concussion. Neurosurgery, 65 (5) ( 2009), pp. 876-883, DOI: 10.1227/01.NEU.0000350155.89800.00

[[37]] C Cancelliere, CA Hincapié, Keightley, et al.. Systematic review of prognosis and return to play after sport concussion: results of the international collaboration on mild traumatic brain injury prognosis. Arch Phys Med Rehabil, 95 (3 Suppl) ( 2014), pp. S210-S229, DOI: 10.1016/j. apmr.2013.06.035

[[38]] WP Meehan 3rd, P d’Hemecourt, RD Comstock. High school concussions in the 2008-2009 academic year: mechanism, symptoms, and management. Am J Sports Med, 38 (12) ( 2010), pp. 2405-2409, DOI: 10.1177/0363546510376737