Objectives: Quantify concussion under-reporting and factors associated with concussion reporting in rugby league players.
Design: Cross-sectional online anonymised survey.
Setting: Rugby league in Europe.
Participants: 422 elite men’s and women’s players registered with the governing body.
Interventions: Independent variables: age, playing history, international experience and playing position.
Outcome Measures: Dependent variables: concussion history, prevalence and reasons of under-reporting concussion, concussion knowledge and long-term implications of concussion.
Results: 19.5% did not report concussion-related symptoms to medical staff during the 2020 and 2021 seasons. The most common reasons for under-reporting concussion were ‘didn’t want to be ruled out of a match’ (34.5%) and ‘didn’t want to let down team’ (24.3%). Symptoms of concussion were correctly identified on 73.5 ± 0.2% of occasions. At the start of their senior rugby league career versus now, 65.2% and 88.6% of players had an appropriate level of knowledge about concussion and the potential long-term implications. 56.7% of players were concerned about the potential long-term implications from concussion, and 11.3% of players would encourage their/family members children to not play rugby league.
Conclusion: More players in this study tried to hide concussion symptoms than previously reported in a similar cohort. The main reasons for not reporting concussion appear linked to the players perceptions of what is beneficial for the team, suggesting both performance and medical staff should encourage the reporting of concussion symptoms. This is an individual modifiable risk-factor and should be a priority for rugby league players and all stakeholders for supporting long-term concussion management.
ORCID: 
CORE (COnnecting REpositories)
CORE (COnnecting REpositories)