{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T10:22:20Z","timestamp":1790245340672,"version":"4.1.0"},"reference-count":36,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2025,8,5]],"date-time":"2025-08-05T00:00:00Z","timestamp":1754352000000},"content-version":"vor","delay-in-days":400,"URL":"http:\/\/www.sagepub.com\/licence-information-for-chorus"}],"funder":[{"DOI":"10.13039\/100000005","name":"Department of Defense","doi-asserted-by":"crossref","award":["No. W81XWH-20-2-0044"],"award-info":[{"award-number":["No. W81XWH-20-2-0044"]}],"id":[{"id":"10.13039\/100000005","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Sports Med"],"published-print":{"date-parts":[[2024,7]]},"abstract":"\n Background:<\/jats:title>\n Early medical attention after concussion may minimize symptom duration and burden; however, many concussions are undiagnosed or have a delay in diagnosis after injury. Many concussion symptoms (eg, headache, dizziness) are not visible, meaning that early identification is often contingent on individuals reporting their injury to medical staff. A fundamental understanding of the types and levels of factors that explain when concussions are reported can help identify promising directions for intervention.<\/jats:p>\n <\/jats:sec>\n \n Purpose:<\/jats:title>\n To identify individual and institutional factors that predict immediate (vs delayed) injury reporting.<\/jats:p>\n <\/jats:sec>\n \n Study Design:<\/jats:title>\n Case-control study; Level of evidence, 3.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n This study was a secondary analysis of data from the Concussion Assessment, Research and Education (CARE) Consortium study. The sample included 3213 collegiate athletes and military service academy cadets who were diagnosed with a concussion during the study period. Participants were from 27 civilian institutions and 3 military institutions in the United States. Machine learning techniques were used to build models predicting who would report an injury immediately after a concussive event (measured by an athletic trainer denoting the injury as being reported \u201cimmediately\u201d or \u201cat a delay\u201d), including both individual athlete\/cadet and institutional characteristics.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n In the sample as a whole, combining individual factors enabled prediction of reporting immediacy, with mean accuracies between 55.8% and 62.6%, depending on classifier type and sample subset; adding institutional factors improved reporting prediction accuracies by 1 to 6 percentage points. At the individual level, injury-related altered mental status and loss of consciousness were most predictive of immediate reporting, which may be the result of observable signs leading to the injury report being externally mediated. At the institutional level, important attributes included athletic department annual revenue and ratio of athletes to athletic trainers.<\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n Further study is needed on the pathways through which institutional decisions about resource allocation, including decisions about sports medicine staffing, may contribute to reporting immediacy. More broadly, the relatively low accuracy of the machine learning models tested suggests the importance of continued expansion in how reporting is understood and facilitated.<\/jats:p>\n <\/jats:sec>","DOI":"10.1177\/03635465241259455","type":"journal-article","created":{"date-parts":[[2024,8,5]],"date-time":"2024-08-05T08:50:05Z","timestamp":1722847805000},"page":"2372-2383","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["Optimizing Concussion Care Seeking: Using Machine Learning to Predict Delayed Concussion Reporting"],"prefix":"10.1177","volume":"52","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7484-2601","authenticated-orcid":false,"given":"Emily","family":"Kroshus-Havril","sequence":"first","affiliation":[{"name":"Center for Child Health, Behavior, and Development, Seattle Children\u2019s Research Institute & Department of Pediatrics, University of Washington, Seattle, Washington, USA"},{"name":"Investigation performed at the University of Georgia, Athens, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel D.","family":"Leeds","sequence":"additional","affiliation":[{"name":"Computer and Information Sciences, Fordham University, New York, New York, USA"},{"name":"Investigation performed at the University of Georgia, Athens, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas W.","family":"McAllister","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA"},{"name":"Investigation performed at the University of Georgia, Athens, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1423-1259","authenticated-orcid":false,"given":"Zachary Yukio","family":"Kerr","sequence":"additional","affiliation":[{"name":"Matthew Gfeller Center & Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA"},{"name":"Investigation performed at the University of Georgia, Athens, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristen","family":"Knight","sequence":"additional","affiliation":[{"name":"Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA"},{"name":"Investigation performed at the University of Georgia, Athens, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johna K.","family":"Register-Mihalik","sequence":"additional","affiliation":[{"name":"Matthew Gfeller Center & Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA"},{"name":"Investigation performed at the University of Georgia, Athens, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0785-6640","authenticated-orcid":false,"given":"Robert C.","family":"Lynall","sequence":"additional","affiliation":[{"name":"UGA Concussion Research Laboratory, University of Georgia, Athens, Georgia, USA"},{"name":"Investigation performed at the University of Georgia, Athens, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"D\u2019Lauro","sequence":"additional","affiliation":[{"name":"Department of Behavioral Sciences and Leadership, US Air Force Academy, Colorado Springs, Colorado, USA"},{"name":"Investigation performed at the University of Georgia, Athens, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuet","family":"Ho","sequence":"additional","affiliation":[{"name":"Computer and Information Sciences, Fordham University, New York, New York, USA"},{"name":"Investigation performed at the University of Georgia, Athens, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhibur","family":"Rahman","sequence":"additional","affiliation":[{"name":"Computer and Information Sciences, Fordham University, New York, New York, USA"},{"name":"Investigation performed at the University of Georgia, Athens, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven P.","family":"Broglio","sequence":"additional","affiliation":[{"name":"University of Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA"},{"name":"Investigation performed at the University of Georgia, Athens, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A.","family":"McCrea","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA"},{"name":"Investigation performed at the University of Georgia, Athens, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9363-1391","authenticated-orcid":false,"given":"Julianne D.","family":"Schmidt","sequence":"additional","affiliation":[{"name":"UGA Concussion Research Laboratory, University of Georgia, Athens, Georgia, USA"},{"name":"Investigation performed at the University of Georgia, Athens, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"CARE Consortium Investigators included:","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Port","sequence":"additional","affiliation":[{"name":"School of Optometry, Indiana University, Bloomington, Indiana, USA"},{"name":"Investigation performed at the University of Georgia, Athens, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darren","family":"Campbell","sequence":"additional","affiliation":[{"name":"Intermountain Sports Medicine, Ogden, Utah, USA"},{"name":"Investigation performed at the University of Georgia, Athens, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margot","family":"Putukian","sequence":"additional","affiliation":[{"name":"Athletic Medicine, Princeton University, Princeton, New Jersey, USA"},{"name":"Investigation performed at the University of Georgia, Athens, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara P.D.","family":"Chrisman","sequence":"additional","affiliation":[{"name":"Center for Child Health, Behavior and Development, Seattle Children\u2019s Research Institute, Seattle, Washington, USA"},{"name":"Investigation performed at the University of Georgia, Athens, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth L.","family":"Cameron","sequence":"additional","affiliation":[{"name":"Keller Army Hospital, US Military Academy, West Point, New York, USA; Annapolis, Maryland, USA"},{"name":"Investigation performed at the University of Georgia, Athens, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam James","family":"Susmarski","sequence":"additional","affiliation":[{"name":"Department Head Brigade Orthopaedics and Sports Medicine, US Naval Academy"},{"name":"Investigation performed at the University of Georgia, Athens, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua T.","family":"Goldman","sequence":"additional","affiliation":[{"name":"Departments of Family Medicine & Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA"},{"name":"Investigation performed at the University of Georgia, Athens, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Holly","family":"Benjamin","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine and Pediatrics, University of Chicago, Chicago, Illinois, USA"},{"name":"Investigation performed at the University of Georgia, Athens, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Buckley","sequence":"additional","affiliation":[{"name":"Department of Kinesiology & Applied Physiology, University of Delaware, Newark, Delaware, USA"},{"name":"Investigation performed at the University of Georgia, Athens, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Kaminski","sequence":"additional","affiliation":[{"name":"Department of Kinesiology & Applied Physiology, University of Delaware, Newark, Delaware, USA"},{"name":"Investigation performed at the University of Georgia, Athens, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James R.","family":"Clugston","sequence":"additional","affiliation":[{"name":"Community Health and Family Medicine, University of Florida, Gainesville, Florida, USA"},{"name":"Investigation performed at the University of Georgia, Athens, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis","family":"Feigenbaum","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, Florida, USA"},{"name":"Investigation performed at the University of Georgia, Athens, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James T.","family":"Eckner","sequence":"additional","affiliation":[{"name":"Department of PM&R, University of Michigan, Ann Arbor, Michigan, USA"},{"name":"Investigation performed at the University of Georgia, Athens, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason P.","family":"Mihalik","sequence":"additional","affiliation":[{"name":"Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA"},{"name":"Investigation performed at the University of Georgia, Athens, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Kontos","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA"},{"name":"Investigation performed at the University of Georgia, Athens, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"McDevitt","sequence":"additional","affiliation":[{"name":"Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, Pennsylvania, USA"},{"name":"Investigation performed at the University of Georgia, Athens, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Alison","family":"Brooks","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, University of Wisconsin\u2013Madison, Madison, Wisconsin, USA"},{"name":"Investigation performed at the University of Georgia, Athens, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steve","family":"Rowson","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA"},{"name":"Investigation performed at the University of Georgia, Athens, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Miles","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine, Wake Forest University, Winston-Salem, North Carolina, USA"},{"name":"Investigation performed at the University of Georgia, Athens, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Lintner","sequence":"additional","affiliation":[{"name":"Wake Forest School of Medicine Family Medicine, Winston Salem State University, Winston-Salem, North Carolina, USA"},{"name":"Investigation performed at the University of Georgia, Athens, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise","family":"Kelly","sequence":"additional","affiliation":[{"name":"Department of Exercise Science, California Lutheran University, Thousand Oaks, California, USA"},{"name":"Investigation performed at the University of Georgia, Athens, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Master","sequence":"additional","affiliation":[{"name":"Division of Orthopedics, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"},{"name":"Investigation performed at the University of Georgia, Athens, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,8,5]]},"reference":[{"key":"bibr1-03635465241259455","unstructured":"Abdullah SP. Accessed June 17, 2024. DoD\/NCAA launch mind matters challenge. https:\/\/www.army.mil\/article\/138538\/dodncaa_launch_mind_matters_challenge"},{"key":"bibr2-03635465241259455","doi-asserted-by":"publisher","DOI":"10.1177\/0363546518757984"},{"key":"bibr3-03635465241259455","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-444-63954-7.00007-0"},{"key":"bibr4-03635465241259455","doi-asserted-by":"publisher","DOI":"10.1037\/0003-066X.44.9.1175"},{"key":"bibr5-03635465241259455","doi-asserted-by":"publisher","DOI":"10.1007\/s40279-021-01444-7"},{"key":"bibr6-03635465241259455","doi-asserted-by":"publisher","DOI":"10.4085\/1062-6050-0464.19"},{"key":"bibr7-03635465241259455","doi-asserted-by":"publisher","DOI":"10.4085\/1062-6050-0517.19"},{"key":"bibr8-03635465241259455","doi-asserted-by":"publisher","DOI":"10.4085\/1062-6050-362-19"},{"key":"bibr9-03635465241259455","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2018.5643"},{"key":"bibr10-03635465241259455","doi-asserted-by":"publisher","DOI":"10.1007\/s40279-021-01541-7"},{"key":"bibr11-03635465241259455","doi-asserted-by":"publisher","DOI":"10.1007\/s40279-017-0707-1"},{"key":"bibr12-03635465241259455","doi-asserted-by":"publisher","DOI":"10.4324\/9781351200516-5"},{"key":"bibr13-03635465241259455","doi-asserted-by":"publisher","DOI":"10.1136\/injuryprev-2014-041479"},{"key":"bibr14-03635465241259455","doi-asserted-by":"publisher","DOI":"10.1080\/07448481.2021.1944166"},{"key":"bibr15-03635465241259455","unstructured":"College Board. Concordance tables: SAT Suite of Assessments. Published May 15, 2015. Accessed June 17, 2024 https:\/\/collegereadiness.collegeboard.org\/educators\/higher-ed\/scoring\/concordance"},{"issue":"2","key":"bibr16-03635465241259455","first-page":"1","volume":"16","author":"Ferdinand Pennock K","year":"2020","journal-title":"Int Rev Sport Exerc Psychol"},{"key":"bibr17-03635465241259455","doi-asserted-by":"publisher","DOI":"10.2307\/258594"},{"key":"bibr18-03635465241259455","doi-asserted-by":"publisher","DOI":"10.1007\/s11682-015-9399-z"},{"key":"bibr19-03635465241259455","doi-asserted-by":"publisher","DOI":"10.1016\/S0191-8869(01)00032-0"},{"key":"bibr20-03635465241259455","doi-asserted-by":"publisher","DOI":"10.1177\/1090198117715669"},{"key":"bibr21-03635465241259455","doi-asserted-by":"publisher","DOI":"10.1097\/JSM.0000000000000137"},{"key":"bibr22-03635465241259455","doi-asserted-by":"publisher","DOI":"10.1177\/1090198114543011"},{"key":"bibr23-03635465241259455","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2020-102185"},{"key":"bibr24-03635465241259455","doi-asserted-by":"publisher","DOI":"10.1177\/1090198119859414"},{"key":"bibr25-03635465241259455","doi-asserted-by":"publisher","DOI":"10.1097\/JSM.0000000000000409"},{"key":"bibr26-03635465241259455","doi-asserted-by":"publisher","DOI":"10.1038\/44565"},{"key":"bibr27-03635465241259455","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0000000000003004"},{"key":"bibr28-03635465241259455","first-page":"2825","volume":"12","author":"Pedregosa F","year":"2011","journal-title":"J Mach Learn Res"},{"key":"bibr29-03635465241259455","doi-asserted-by":"publisher","DOI":"10.5120\/ijca2017915495"},{"key":"bibr30-03635465241259455","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2008-0080"},{"key":"bibr31-03635465241259455","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.159.9.997"},{"key":"bibr32-03635465241259455","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2019.6637"},{"key":"bibr33-03635465241259455","volume-title":"Introduction to Data Mining","author":"Tan PN","year":"2005"},{"key":"bibr34-03635465241259455","unstructured":"US Department of Education. Accessed June 17, 2024. Equity in athletics. https:\/\/ope.ed.gov\/athletics\/#\/"},{"key":"bibr35-03635465241259455","unstructured":"US Postal Service. What are the USPS abbreviations for US States and Territories? Accessed on June 17, 2024. https:\/\/faq.usps.com\/s\/article\/What-are-the-USPS-abbreviations-for-U-S-states-and-territories"},{"key":"bibr36-03635465241259455","doi-asserted-by":"publisher","DOI":"10.1177\/0363546515610537"}],"container-title":["The American Journal of Sports Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/03635465241259455","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/03635465241259455","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/03635465241259455","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/03635465241259455","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T09:48:04Z","timestamp":1777369684000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/03635465241259455"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7]]},"references-count":36,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2024,7]]}},"alternative-id":["10.1177\/03635465241259455"],"URL":"https:\/\/doi.org\/10.1177\/03635465241259455","relation":{},"ISSN":["0363-5465","1552-3365"],"issn-type":[{"value":"0363-5465","type":"print"},{"value":"1552-3365","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7]]}}}