College Football Players Less Likely to Report Concussions and Other Injuries with Increased Injury Accumulation.

Athletes sometimes choose not to report suspected concussions, risking delays in treatment and health consequences. How and why do athletes make these reporting decisions? Using original survey data from a cohort of college football players, we evaluate two assumptions of the current literature on injury reporting: first, that the probability of reporting a concussion or injury is constant over time; second, that athletes make reasoned deliberative decisions about whether to report their concussion or other injury. We find that athletes are much less likely to report a concussion to a medical professional than they are to report another injury (47% vs. 80%), but no association between reporting and a measure of athletes' ability to switch from fast, reactive thinking to reasoned, deliberative thinking. The likelihood of reporting decreases as the number of injuries and concussions increases, and no athlete reported more than four concussions. Sports medicine clinicians sometimes use four concussions as a time to discuss possibly curtailing sports participation, which may influence athletes' subsequent reporting behavior. Sports medicine clinicians may want to consider athlete injury history as a risk factor for concussion and injury under-reporting.