%0 Journal Article
%T Concussion Nondisclosure During Professional Career Among a Cohort of Former National Football League Athletes
%A J.D. DeFreese
%A Johna K. Register-Mihalik
%A Kevin M. Guskiewicz
%A Melissa C. Kay
%A Stephen W. Marshall
%A Zachary Y. Kerr
%J The American Journal of Sports Medicine
%@ 1552-3365
%D 2018
%R 10.1177/0363546517728264
%X Despite a focus on the incidence and effects of concussion, nondisclosure of sports-related concussions among retired players from the National Football League (NFL) has yet to be examined. Examine the prevalence of and factors associated with nondisclosure of sports-related concussions in former NFL athletes. Cross-sectional study; Level of evidence, 3. A sample of 829 former NFL players completed a general health survey. This historical cohort included players who had played before World War II to 2001. Respondents retrospectively recalled sports-related concussions that they sustained during their professional careers and whether at least one of these sports-related concussions was not reported to medical staff. We computed the prevalence of nondisclosure among those recalling sport-related concussions during their professional careers. Multivariable binomial regression estimated adjusted prevalence ratios (PR) with 95% confidence intervals (CIs) controlling for race/ethnicity, number of years played, primary position played, professional career concussion history, and playing era. Playing era was categorized by whether the majority of a player¡¯s career was before or after a 1976 rule change to limit contact (¡°spearing¡±). Overall, 417 (50.3%) respondents reported they had sustained a concussion and did not inform medical staff at least once during their professional playing career. Nonwhite respondents had a higher prevalence of nondisclosure than white/non-Hispanic respondents (adjusted PR = 1.19; 95% CI, 1.02-1.38). An interaction between professional career concussion history and playing era was also found (P = .08). Compared with those in the pre¨Cspearing rule change group with 1 or 2 concussions, all other groups had larger prevalences of nondisclosure (increases ranging from 41% to 153% in multivariable models). Across concussion strata, nondisclosure prevalence was generally higher in the post¨Cspearing rule change group than the pre¨Cspearing rule change group, with the largest differences found among those with 1 or 2 concussions or those with 3 or 4 concussions. A large proportion of former NFL players in this historical cohort reported at least one instance of not disclosing sports-related concussions to medical staff. Future research on concussion nondisclosure needs to identify mechanisms to improve football players¡¯ intentions to disclose concussion-related symptoms to health care providers and to equip health care providers with more effective strategies for timely identification of concussion
%K epidemiology
%K sport
%K underreporting
%K traumatic brain injury
%U https://journals.sagepub.com/doi/full/10.1177/0363546517728264