Page 90 - JSOM Fall 2020

Improving Concussion Education

Consensus From the NCAA-Department of
Defense Mind Matters Research & Education Grand Challenge

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Emily Kroshus *; Kenneth L. Cameron ; J. Douglas Coatsworth ; Christopher D’Lauro ;
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Eungjae Kim ; Katherine M. Lee ; Johna Register-Mihalik ; Jeffery J. Milroy ; E. Paul Roetert ;
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Julianne D. Schmidt ; Ross D. Silverman ; Dee Warmath ; Heidi A. Wayment ; Brian Hainline 14
This article is being simultaneously COPUBLISHED with the British Journal of Sports Medicine (BJSM).
What Is Already Known? What Are the New Findings?
• Concussion education is increasingly mandated for par- • Key additions to the content of concussion education
ticipants in activities with elevated risk of concussion, should include short-term benefits of early symptom dis-
with the goal of ensuring concussions are disclosed to closure and the potential dilemma individuals face when
medical personnel for appropriate evaluation and care. deciding to disclose a concussion.
• There are no data to indicate that existing approaches to • Improving concussion disclosure requires more than
concussion education are associated with lasting changes improving the content of concussion education. This in-
in concussion disclosure behavior. cludes attending to how concussion education is dissem-
inated and ensuring that team/unit and organizational
processes positively reinforce rather than undermine
concussion education messaging.

ABSTRACT
Early disclosure of possible concussive symptoms has the po- (1) content of concussion education for athletes and MSA
tential to improve concussion-related clinical outcomes. The cadets, (2) dissemination and implementation of concussion
objective of the present consensus process was to provide education for athletes and military service academy cadets, (3)
useful and feasible recommendations for collegiate athletic other stakeholder concussion education, (4) team and unit-
departments and military service academy leaders about how level processes, and (5) organizational processes. Collectively,
to increase concussion symptom disclosure in their setting. these recommendations provide a path forward for athletics
Consensus was obtained using a modified Delphi process. departments and military service academies in terms of the be-
Participants in the consensus process were grant awardees havioral health supports and institutional processes that are
from the National Collegiate Athletic Association and Depart- needed to increase early and honest disclosure of concussion
ment of Defense Mind Matters Research & Education Grand symptoms and ultimately to improve clinical care outcomes.
Challenge and a multidisciplinary group of stakeholders from
collegiate athletics and military service academies. The pro- Keywords: concussion; athletics departments; military ser-
cess included a combination of in-person meetings and anon- vice academies; clinical care outcomes
ymous online voting on iteratively modified recommendations
for approaches to improve concussion symptom disclosure.
Recommendations were rated in terms of their utility and fea-
sibility in collegiate athletic and MSA settings with a priori Introduction
thresholds for retaining, discarding, and revising statements. Early and honest disclosure of possible concussive symptoms
A total of 17 recommendations met thresholds for utility and may improve concussion-related clinical outcomes. Emerging
feasibility and are grouped for discussion in five domains: data suggest that earlier evaluation for concussion is associated

*Correspondence to ekroshus@uw.edu
1 Dr Kroshus is affiliated with the University of Washington, Department of Pediatrics and the Seattle Children’s Research Institute, Center for
Child Health, Behavior and Development. Dr Cameron is affiliated with the United States, Military Academy, Keller Army Community Hos-
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pital. Dr Coatsworth is affiliated with Colorado State University, Human Development and Family Studies. Dr D’Lauro is affiliated with the
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United States Air Force Academy, Department of Behavioral Sciences and Leadership. Mr Kim is affiliated with Emory University. Ms Lee is
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affiliated with Health Readiness and Policy Oversight, Health Affairs, Department of Defense. Dr Register-Mihalik is affiliated with University
of North Carolina at Chapel Hill, Department of Exercise and Sport Science. Dr Milroy is affiliated with the University of North Carolina at
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Greensboro, Department of Public Health Education. Dr Roetert is affiliated with the National Collegiate Athletic Association. Dr Schmidt
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is affiliated with University of Georgia, Department of Kinesiology. Mr Silverman is affiliated with Indiana University, Richard M. Fairbanks
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School of Public Health. Dr Warmath is affiliated with the University of Georgia, College of Family and Consumer Sciences. Dr Wayment
is affiliated with Northern Arizona University, Department of Psychological Sciences. Dr Hainline is affiliated with the National Collegiate
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Athletic Association.
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