College Football Players May Underestimate Their Risks of Concussion or Injury

By Carolyn Crist

January 11, 2021

NEW YORK (Reuters Health) - College football players likely underestimate their risks for injury and concussion, which raises ethical concerns about athletes' informed participation in sports, according to a team of bioethics and sports medicine specialists.

Sports programs should consider whether athletes have received enough information to understand their risks and hold conversations about how much risk is acceptable for an athlete to participate, the team writes in JAMA Network Open.

"Many people justify the risks of sport by asserting that athletes 'know what they are getting themselves into,'" said lead author Dr. Christine Baugh of the Center for Bioethics and Humanities at the University of Colorado Anschutz Medical Campus.

"Whether or to what extent that is true had not been empirically evaluated," she told Reuters Health by email. "It raises questions about whether athletes are making sufficiently informed decisions regarding sports participation."

Dr. Baugh and colleagues surveyed 296 college football players from four teams among the most competitive conferences in the National Collegiate Athletic Association. They asked the athletes to estimate their likelihood of experiencing a concussion or injury during the upcoming season and their concussion and injury history from the previous football season.

The athletes also documented their playing position, role on the team, years of full-contact football participation and year on the team, which the researchers used to estimate their individual risks for concussion or injury.

The research team found that 100 athletes, or 34%, had one or more concussions in the previous season, with 171 concussions in total and about 43 concussions per team.

Only 26 players (9%) thought it was likely they would experience a concussion in the upcoming season, and 174 (60%) thought it was unlikely.

In addition, 197 players had one or more injuries during the previous season, with 483 injuries in total. Fifty-seven players (20%) thought it was likely they would experience an injury in the upcoming season, and 140 (48%) thought it was unlikely.

Under one model, 91% of athletes underestimated their risk of injury and 63% underestimated their risk of concussion. Under a more conservative analysis, 43% underestimated their risk of injury and 42% underestimated their risk of concussion.

"College football players are not uniquely bad at estimating their risks - we're all prone to underestimate the possibility that something bad will happen to us," Dr. Baugh said. "However, they are regularly exposed to situations where potentially severe, long-term, and debilitating outcomes can occur, which means they may be uniquely vulnerable to this very human problem."

The rates of concussion and injuries were also higher in this study than in previously published studies, which raised concerns for the research team. Sports programs should incorporate health risk communication to make sure players know their risks and feel informed enough to participate in football.

In addition, new policies or practices should be put into place to reduce these risks from the outset, the authors write, such as altering high-risk plays, reducing the intensity of contact between players, and providing access to independent athletic-medicine clinicians. Future research could focus on these efforts in the college athletics environment in particular, they write.

"Athletes and young athletes in particular are not always aware of all of the factors in order to weigh the risks and benefits," said Dr. Meredith Kneavel of La Salle University in Philadelphia, Pennsylvania. Dr. Kneavel, who wasn't involved with this study, has researched college athletes' perceptions of reporting concussions.

Players are often influenced by a variety of factors, including uncertainty about their symptoms, changes in the concussion reporting process, and wanting to push through and keep playing. They need a better way to weigh the risks and benefits, she said.

"Education for athletes and coaches about injury rates can ameliorate this but it needs to be done well," she told Reuters Health by email.

SOURCE: JAMA Network Open, online December 29, 2020.