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Background: Concussion underreporting is endemic, and social norms are an established predictor of concussion reporting behavior. However, pluralistic ignorance—a situation in which most individuals in a group hold the belief that their peers' views differ from their own, despite views actually being similar—has not been studied in this context. Aim: To assess whether pluralistic ignorance contributes to concussion underreporting. Method: We surveyed 2,504 military service academy cadets. Each cadet was presented with a survey asking about their willingness to self-report a concussion, their perception of other cadets' willingness to report a concussion, and personal and demographic factors. Results: Most cadets viewed themselves as more willing to report a concussion than others (mean difference = 1.12, 95% CI [1.02, 1.21]), a belief consistent with pluralistic ignorance. Demographic characteristics were associated with holding this belief. For example, female cadets and upper-class cadets were more likely to show this disparity than male or under-class cadets, respectively. Collegiate athletes not only showed similar willingness to report concussion as nonathletes but also perceived other cadets as less likely to report concussions. Meanwhile, future pilots showed less self-report willingness and perceived that others were similarly unwilling to report concussions. Discussion: A majority of this economically and geographically diverse population displays characteristics of pluralistic ignorance: They largely share proconcussion reporting sentiments but incorrectly perceive that others do not. This belief is not held uniformly in all subpopulations, which may inform how these beliefs are developed and maintained. Conclusions: Pluralistic ignorance is an important consideration in concussion education efforts. [ABSTRACT FROM AUTHOR]

Background: There were 18,844 volleyball players in the National Collegiate Athletic Association (NCAA) in the 2014-2015 academic year. Little research has examined sex-based differences among these athletes.Purpose: To examine injury epidemiology in NCAA men's and women's volleyball athletes.Study Design: Descriptive epidemiology study.Level Of Evidence: Level 3.Methods: Injury surveillance data from the 2013-2014 through 2014-2015 academic years were obtained from the NCAA Injury Surveillance Program for 6 men's and 33 women's collegiate volleyball teams. Injury rates per 1000 athlete-exposures (AEs) and injury rate ratios (IRRs) with 95% CIs were calculated. Time-loss (TL) injuries resulted in participation restriction for at least 24 hours, and non-time-loss (NTL) injuries resulted in participation restriction of less than 24 hours.Results: Overall, 83 and 510 injuries were reported in men and women, respectively, leading to injury rates of 4.69 and 7.07 per 1000 AEs. The injury rate was greater in women than men (IRR, 1.51; 95% CI, 1.19-1.90). TL injury rates were 1.75 and 2.62 per 1000 AEs for men and women, respectively. The ankle was the most commonly injured body part among TL injuries (men, 25.8%; women, 24.3%); the knee was the most commonly injured body part among NTL injuries (men, 25.5%; women, 16.3%). Among TL injuries, common diagnoses included sprains (men, 25.8%; women, 31.2%) and concussions (men, 19.4%; women, 14.8%). Most TL concussions were due to ball contact (men, 83.3%; women, 53.6%). Compared with men, women had a greater NTL overuse injury rate (IRR, 3.47; 95% CI, 1.61-7.46). Compared with women, men had a greater TL injury rate associated with ball contact (IRR, 2.24; 95% CI, 1.07-4.68).Conclusion: There are differences in injury patterns and rates between male and female intercollegiate volleyball players. Although a limited-contact sport, a notable number of concussions were sustained, mostly from ball contact.Clinical Relevance: Understanding injury patterns may aid clinicians in injury diagnosis, management, and prevention. [ABSTRACT FROM AUTHOR]

Background. Regulators must act to protect the public when evidence indicates safety problems with medical devices. This requires complex tradeoffs among risks and benefits, which conventional safety surveillance methods do not incorporate. Objective. To combine explicit regulator loss functions with statistical evidence on medical device safety signals to improve decision making. Methods. In the Hospital Cost and Utilization Project National Inpatient Sample, we select pediatric inpatient admissions and identify adverse medical device events (AMDEs). We fit hierarchical Bayesian models to the annual hospital-level AMDE rates, accounting for patient and hospital characteristics. These models produce expected AMDE rates (a safety target), against which we compare the observed rates in a test year to compute a safety signal. We specify a set of loss functions that quantify the costs and benefits of each action as a function of the safety signal. We integrate the loss functions over the posterior distribution of the safety signal to obtain the posterior (Bayes) risk; the preferred action has the smallest Bayes risk. Using simulation and an analysis of AMDE data, we compare our minimum-risk decisions to a conventional Z score approach for classifying safety signals. Results. The 2 rules produced different actions for nearly half of hospitals (45%). In the simulation, decisions that minimize Bayes risk outperform Z score–based decisions, even when the loss functions or hierarchical models are misspecified. Limitations. Our method is sensitive to the choice of loss functions; eliciting quantitative inputs to the loss functions from regulators is challenging. Conclusions. A decision-theoretic approach to acting on safety signals is potentially promising but requires careful specification of loss functions in consultation with subject matter experts. [ABSTRACT FROM AUTHOR]

Concussion underreporting contributes to the substantial public health burden of concussions from sport. Teammates may be able to play an important role in encouraging injury identification and help seeking. This study assessed whether there was an association between beliefs about the consequences of continued play with a concussion and intentions to engage as a proactive bystander in facilitating or encouraging teammate help seeking for a possible concussion. Participants were 328 (male and female) members of 19 U.S. collegiate contact or collision sports teams. Athletes who believed that there were negative health or performance consequences of continued play with a concussion were significantly more likely than their peers to intend to encourage teammate help seeking, but not more likely to alert a coach or medical personnel. Additionally, athletes who believed that their teammates were more supportive of concussion safety were more likely to intend to engage as proactive bystanders in encouraging teammate help seeking. Exploring how to encourage bystander promotion of concussion safety is an important direction for future programming and evaluation research and may provide an opportunity to improve the effectiveness of concussion education. [ABSTRACT FROM AUTHOR]

Background: In recent years, sports leagues and sports medicine experts have developed guidelines for concussion management. The extent to which current clinical practice is consistent with guideline recommendations is unclear. At the collegiate level, there have been few examinations of concussion management practices and the extent to which meaningful differences across divisions of competition exist. Purpose: The purposes of this study were to (1) examine current practices in concussion diagnosis and management at National Collegiate Athletic Association (NCAA) member colleges, (2) explore the extent to which current practices reflect current recommendations for concussion diagnosis and management, and (3) determine whether there are differences in management patterns across divisions of competition. Design: Descriptive epidemiology study. Methods: An electronic questionnaire was sent to sports medicine clinicians at all NCAA member colleges during September and October 2013. Clinicians were asked about baseline assessments, diagnosis and management practices, return-to-play protocols, the perceived prevalence of underdiagnosis, and basic demographic information. Results: Approximately 30% (n = 866) of contacted clinicians, representing nearly 50% (n = 527) of NCAA member colleges, responded to the questionnaire. Preparticipation baseline examinations were administered at the majority of schools (95%), but most (87.5%) administered baseline assessments only to selected high-risk athletes. Computerized neurocognitive testing and balance assessments were most commonly used as preseason baseline and postinjury assessments. Multimodal examination in line with NCAA and other guidance was used only at a minority of institutions. Athletic trainers most commonly administered and interpreted the preseason baseline examination. Most clinicians reported that their institutions’ practices were in line with NCAA guidelines during the first 24 hours of an athlete’s concussion diagnosis, with exact percentages varying across measures. Differences across divisions of competition included shorter return-to-play time at Division I schools than Division III schools (9.13 vs 10.31 days, respectively) and more frequently referring concussed athletes to a physician within 24 hours of diagnosis at Division I schools. Conclusion: Concussion management at many colleges in the United States incorporates elements recommended by current guidelines; however, there is room to improve. Increasing the use of a multimodal baseline and postinjury examination will elevate the concussion care provided to college athletes and better align with best practice guidance. [ABSTRACT FROM AUTHOR]

Concussion education for athletes has the potential to play a role in reducing the health burden of concussions from sport by modifying individual risk-related behaviors. In U.S. collegiate sport, decisions about content and delivery of concussion education are left up to the individual institution. This may result in a high degree of variability in what educational materials athletes receive and is particularly problematic as few concussion education programs have demonstrated efficacy. Health educators can play an important role in working collaboratively with sports medicine clinicians to design and evaluate evidence-based concussion education materials for athletes that meet their learning needs. As a first step in this process, the present study characterizes the content, source, and delivery modalities of concussion currently being provided to U.S. collegiate athletes. It also describes the reported concussion education preferences of a sample of U.S. collegiate athletes. Participants were 789 athletic trainers from 276 schools and 325 athletes from four schools. Results indicated that education is most frequently provided by athletic trainers but that many athletes would also like coaches and physicians to be involved in this process. Athletes also indicated a preference for content provision across a range of topics, including athletic and academic consequences of continued play with a concussion. Implications for the design and delivery of concussion education for athletes are discussed. [ABSTRACT FROM AUTHOR]

Background: Previous studies examining nondisclosure 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. Purpose: To examine the prevalence of, and factors associated with, nondisclosure of recalled concussions in former collegiate athletes. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Former collegiate athletes (N = 797) completed an online questionnaire. Respondents recalled self-identified sports-related concussions (SISRCs) that they sustained while playing sports in high school, college, or professionally, and whether they disclosed these SISRCs to others. Respondents also recalled motivations for nondisclosure. The prevalence of nondisclosure was calculated among those who recalled SISRCs. Multivariate binomial regression estimated adjusted prevalence ratios (PRs) with 95% CIs, controlling for sex, level of contact in sports, and year the athletes began playing collegiate sports. Results: A total of 214 respondents (26.9%) reported sustaining at least 1 SISRC. Of these, 71 (33.2%) reported not disclosing at least 1 SISRC. Former football athletes were most likely to report nondisclosure (68.3% of those recalling SISRCs); female athletes who participated in low/noncontact sports were the least likely to report nondisclosure (11.1% of those recalling SISRC). The prevalence of nondisclosure was higher among men than women 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 were as follows: 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 SISRCs that were not disclosed. Male athletes were less likely to disclose all of their SISRCs than female athletes. [ABSTRACT FROM AUTHOR]

The article presents a study on the school-level compliance with the Concussion Policy and Legislation of the National Collegiate Athletic Association (NCAA) in the U.S. Topics include institutional concussion management, the medically indicated management of the diagnosis and return-to-play (RTP) processes as key components of risk reduction efforts, and the growing body of literature on the enforcement of rules and best-practice guidelines in sports medicine.