Agreement between athlete-recalled and clinically documented concussion histories in former collegiate athletes

Zachary Y Kerr; Jason P Mihalik; Kevin M Guskiewicz; Wayne D Rosamond; Kelly R Evenson; Stephen W Marshall

doi:10.1177/0363546514562180

Agreement between athlete-recalled and clinically documented concussion histories in former collegiate athletes

Am J Sports Med. 2015 Mar;43(3):606-13. doi: 10.1177/0363546514562180. Epub 2015 Jan 5.

Authors

Zachary Y Kerr¹, Jason P Mihalik², Kevin M Guskiewicz³, Wayne D Rosamond⁴, Kelly R Evenson⁴, Stephen W Marshall⁵

Affiliations

¹ Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Matthew A. Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Center for the Study of Retired Athletes, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA zkerr@datalyscenter.org.
² Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Matthew A. Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
³ Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Matthew A. Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Center for the Study of Retired Athletes, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
⁴ Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
⁵ Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Matthew A. Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Center for the Study of Retired Athletes, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

PMID: 25560539
DOI: 10.1177/0363546514562180

Abstract

Background: Athlete-recalled and clinically documented concussion histories have been used in research on former athletes, but both have limitations. Comparisons of these 2 types of concussion histories are needed to improve the accuracy of estimates of concussion history for future research and clinical care.

Purpose: To estimate the agreement between athlete-recalled and clinically documented concussion histories during college and to explore reasons for differences.

Study: Cohort study (diagnosis); Level of evidence, 3.

Methods: Athlete-recalled concussion histories were provided by a convenience sample of 130 former collegiate athletes using an online questionnaire, and they were individually linked to previously collected clinical data that tracked medically diagnosed concussions at the host institution from 1996 to 2012. The intraclass correlation coefficient (ICC2,1) was used to assess agreement between athlete-recalled and clinically documented concussion histories. Descriptive analyses were performed to assess reasons for disagreement.

Results: Agreement between athlete-recalled and clinically documented concussion histories was low (ICC2,1 = 0.21; 95% confidence interval, 0.05-0.37), but it was higher for women (ICC2,1 = 0.65; 95% confidence interval, 0.44-0.79) and for athletes playing more recently (2005-2012; ICC2,1 = 0.39; 95% confidence interval, 0.01-0.67). Of the 53 athletes who self-reported college sports-related concussions, 40% believed that they sustained impacts that should have been diagnosed as concussions but were undetected, and 21% admitted nondisclosure of suspected concussions. Common reasons for nondisclosure included the following: did not think injury was serious enough (91%), did not know it was a concussion (73%), and did not want to leave the game/practice (73%).

Conclusion: Given the low agreement between athlete-recalled and clinically documented concussion histories, methodologic research is needed to improve the quality of tools used to assess concussion histories in former athletes.

Keywords: concurrent validity; concussion; epidemiology; injury; traumatic brain injury.

Publication types

Comparative Study

MeSH terms

Adult
Athletes / psychology
Athletic Injuries / diagnosis*
Brain Concussion / diagnosis*
Cohort Studies
Female
Humans
Medical Records*
Mental Recall
Self Report*
Sex Factors
Truth Disclosure
Universities