Objective To determine the rate of under-reporting of concussion and its symptoms in elite rugby league players in Australia. Methods The study was conducted in the preseason of the 2020 National Rugby League (NRL) competition. A total of 151 male, NRL club contracted rugby league players across three professional clubs participated. The participants completed a voluntary, anonymous survey exploring player demographics, concussion data, under-reporting instances and reasons for under-reporting over the 2018 and 2019 rugby league seasons. Results 17.2% of surveyed players reported sustaining a likely concussion over the past 2 years and not reporting to medical staff. 22% of NRL first grade players admitted to not reporting at least one concussion during the 2018 and 2019 seasons. The most common reason not to report was the player `not wanting to be ruled out of the game or training session` (57.7%), followed by `not wanting to let down the coaches or teammates` (23.1%). 85.4% of surveyed players reported having concussion education by their club in the previous two seasons. Conclusions 17.2 % of elite rugby league players in Australia chose not to report likely concussive episodes and concussion-related symptoms during the 2018 and 2019 seasons. Clinicians need to be aware of under-reporting in athletes when assessing players following head injuries. The findings highlight the need for development of validated, objective testing for concussion following sports-associated head injury.
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