Agreement between High School Athletes and Their Parents on Reporting Athletic Events and Concussion Symptoms

An enhanced understanding of agreement levels between adolescents and parents for reporting athletic events and symptoms can help inform surveillance systems as well as clinical and epidemiological investigations of sports-related concussions. We sought to quantify agreement levels between high school athletes and parents for reporting: (1) number of games; (2) number of practices; (3) occurrence of an injury resulting in any concussion symptoms; and (4) presence of each specific symptom on the date of that injury among high school boys' football and girls' soccer athletes playing in Autumn 2012 in Washington State. There was substantial agreement on reporting the number of athletic events. Agreement levels were greater for games (kappa = 0.82; 95% confidence interval [CI]: 0.79-0.85 in boys' football; kappa = 0.75; 95% CI: 0.72-0.79 in girls' soccer) than for practices (kappa = 0.64; 95% CI: 0.62-0.67 in boys' football; kappa = 0.65; 95% CI: 0.62-0.67 in girls' soccer). There was moderate to substantial agreement on the occurrence of injury resulting in any concussion symptoms; however, agreement on the presence and severity of each symptom varied from poor to almost perfect. Overall, athletes reported greater severity of symptoms than parents did; notably, no difference in mean symptom scores was found when the athlete had a history of concussion. Agreement levels were greater when information was ascertained within 1 week of injury than when it was obtained later than 1 week. Including both athletes' and parents' reports of sports-related events and ascertaining information as soon as possible after injury are important considerations in designing injury surveillance systems.