Relationship Between Concussion Education and Concussion History on Reporting Behavior in a Simulated Game Experience

This study examines the association between concussion education and concussion history on reporting behavior in a novel simulated game experience. High school football players ( n = 21,213) across 412 high schools located in North Carolina completed demographic questionnaires prior to watching a first-person, 12-min video in which a simulated concussion occurred, followed by a decision prompting respondents to continue to play or to report the concussion. Separate logistic regression models assessed the relationship that prior concussion education and history had with concussion reporting behavior within this simulated-game experience. Overall, 1396 (6.58%) participants chose to stay in the game after the simulated concussion. A majority of participants who chose to stay in the game had no previous concussion education (63.8%) and no history of concussion (82%). Athletes with a previous history of concussion significantly reduced odds of seeking medical attention by 35% (OR = 0.65, 95% CI = 0.57,0.76, p < 0.0001), as compared with not having had a previous concussion, after adjusting for gender. However, athletes who reported previous concussion education had 48% increased odds of seeking medical attention (OR = 1.48, 95% CI = 1.32,1.67, p < 0.0001), after adjusting for gender. Concussion-reporting behavior in a first-person simulated in-game experience is higher among individuals with previous concussion education, and lower among individuals with previous concussion history, in-line with previous literature pertaining to reporting behavior following injuries in real games. The use of simulated game experiences offers promise for evaluating concussion reporting behavior and identifying individuals at risk for underreporting concussion symptoms.