Concussion Reporting Expectation Screening in the Preparticipation Physical Examination.

Background: Studies of National Collegiate Athletic Association (NCAA) athletes have been concerning for rates of athletes reporting playing while symptomatic with a concussion and of athlete nondisclosure of concussion symptoms.

Purpose/hypothesis: This study's primary aim was to determine whether application of a brief and validated scale for concussion reporting expectation (CR-E) is an effective screening tool for collegiate athletes. It was hypothesized that 20% of athletes would be considered high risk for nondisclosure of concussion symptoms using this screening tool.

Study design: Cross-sectional.

Level of evidence: Level 2B.

Methods: NCAA Division I athletes (n = 358) from 18 teams who presented for preparticipation physical examinations (PPEs) in the 2023 fall season were queried with the CR-E and concussion history questions. The time to complete the CR-E was recorded, and providers recorded whether the screening results warranted additional concussion counseling or education. We report survey responses for all athletes stratified by sex and sport. Power analysis study population was based on NCAA collegiate athletes.

Results: The CR-E required an average of 2 minutes for athletes to complete during their PPE. Of 238 of 358 athletes who completed the CR-E questionnaire, 2 in 3 were determined to benefit from concussion education. Overall, athletes felt "neutral" about their agreement on a Likert scale to report concussion symptoms in 4 scenarios described on the CR-E. Water polo, volleyball, women's soccer, gymnastics, and football represented sports with higher rates of counseling, below average agreement to report concussion symptoms for 4 scenarios queried, and most frequent nonreporting histories.

Conclusion: The CR-E questionnaire represents an impactful screening tool with high utility and feasibility for collegiate athletes.

Clinical relevance: Our study supports a brief screening tool to guide concussion counseling for athletes. Based on our data, there appears to be room for improvement in athlete concussion education overall.