United States Air Force Academy Cadets' Unprompted Knowledge of Concussions and "Bell Ringers" or "Dings": Perceived Differences and Similarities.

Context: After a possible concussion mechanism, cadets are unlikely to have a list of concussion signs and symptoms at their disposal. As such, unprompted concussion knowledge may be an essential factor in personal recognition of injury.

Objective: To explore determinants that contributed to United States Air Force Academy (USAFA) cadets' disclosure of a concussion. This research focused on 1 of 8 overall discovered themes of unprompted concussion knowledge.

Design: Qualitative study.

Setting: Military academy.

Patients Or Other Participants: Cadets at the USAFA (males = 23, females = 11, age = 19.91 ± 1.14 years).

Main Outcome Measure(s): We conducted 34 semistructured interviews. The transcribed text was analyzed in a 5-cycle process. From this process, 8 overall themes emerged, including unprompted concussion knowledge. Subthemes were concussion definition, concussion symptoms, "bell-ringer" or "ding" definition, "bell-ringer" or "ding" symptoms, and concussion versus "bell ringer" or "ding."

Results: Many participants were able to describe a concussion fairly accurately. The most commonly listed concussion signs and symptoms were dizziness (n = 22/34, 64.7%); "can't remember"/"memory loss"/"forgetful" (n = 19/34, 55.9%); and headache (n = 16/34, 47.1%). The cadet participants characterized the most common bell-ringer or ding signs and symptoms as dizziness (n = 2/34, 5.9%) and headache (n = 2/34, 5.9%). Cadets also described how a bell ringer or ding differs from a concussion, often commenting that concussions were more severe than bell ringers or dings.

Conclusions: Overall, USAFA cadet participants listed common concussion signs and symptoms. However, they perceived differences between a concussion and a bell ringer or ding. Although decreasing the use of colloquial terms for concussion is recommended, use of these terms when examining a concussion history may be helpful. Concussion-education interventions should continue to focus on describing concussion signs and symptoms using cadets' own words to describe the injury (eg, "forgetful") but differentiating between what may and may not be a concussion and encouraging individuals to consult health care providers regarding possible concussion symptoms.