of high school football players found that 41 percent of subjects reported not wanting to leave the game as their reason for not reporting a possible concussion, and 66 percent said they did not report their symptoms because they did not think their injury was serious enough to warrant medical attention (McCrea et al., 2004).1 In a 2012 survey of high school football players, a majority indicated that it was “okay” to play with a concussion and said that they would “play through any injury to win a game,” despite being knowledgeable about the symptoms and dangers of concussions (Anderson et al., 2013; see also Coyne, 2013; Kroshus et al., 2013; Register-Mihalik et al., 2013a,c; Torres et al., 2013). In addition, concussion signs and symptoms may develop and evolve over time, particularly within the first hours following injury (Duhaime et al., 2012; McCrory et al., 2013b). The mantra for laypersons faced with a potentially concussed athlete is “when in doubt, sit them out”: If a player has received “a bump, blow, or jolt to the head or body” and exhibits or reports one or more of the signs or symptoms of concussion, the player may have sustained a concussion (CDC, 2012a).

Appropriately trained personnel have a number of tools available for use in the initial assessment of an individual for a possible concussion (see, e.g., Table 3-2; Appendix C). The Standardized Assessment of Concussion (SAC) and the Sport Concussion Assessment Tool (SCAT) 3 or Child SCAT3 were developed for the sideline evaluation of potentially concussed athletes. The Military Acute Concussion Evaluation (MACE) is a screening tool used to assess service members involved in a potentially concussive event. Such tools as well as balance tests (see Table 3-2) may be used either by trained responders as part of an acute sideline or in-field assessment or by health care providers during subsequent clinical evaluation. It is important to note, however, that because of the natural evolution of concussions, not all concussed athletes will be identified at the time of (presumed) injury even when personnel trained in concussion recognition are present (McCrory et al., 2013b). Duhaime and colleagues (2012) found that 50 percent of a sample of collegiate athletes who sustained a diagnosed concussion (with athletic trainers present for all games and practices) did not experience an “immediate or near immediate” onset of symptoms.

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1The reasons for athletes not reporting concussion were not mutually exclusive. The subjects were asked to select all that applied.



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