Unrecognized and Unreported Concussions Among Community Rugby Players

This study examined the prevalence of intentionally unreported and potentially unrecognized concussions in community rugby players and whether nondisclosure reasons vary by sex, position, or playing history. An online survey was completed by 1037 players (41.0% female; mean age 31.6 ± 11.3 years; 10.1 ± 8.1 years playing) who reported diagnosed, unreported, and unrecognized concussions. Poisson regression models estimated prevalence ratios (PRs), and Fisher's exact tests compared reasons for nondisclosure. The diagnosed, unreported, and unrecognized concussion rates were 66.5%, 32.4%, and 42.2%, respectively. Players with diagnosed concussions had a 7.2-fold higher prevalence of nondisclosure and a 2.3-fold higher prevalence of nonrecognition. A longer playing history was linked to greater nondisclosure (PR: 1.2), and males had a higher prevalence of nonrecognition (PR: 1.4). Position and sex were not associated with nondisclosure; position and playing history did not affect recognition. While nondisclosure reasons were mostly consistent across demographics, players with a history of concussion were more likely to report avoiding removal from games or practices (38.5% vs. 13.6%, p = 0.021). Concussions are common in community rugby, with high rates of underreporting and unawareness, influenced by experience and prior concussions. These findings underscore the need for better education and reporting systems to improve player safety.