Context: After a potential concussion mechanism, a cadet is 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.

Objective: The primary purpose of an overall study was to explore determinants that contributed to United States Air Force Academy (USAFA) cadets to disclose a concussion. This manuscript focuses on one of the eight overall themes discovered of unprompted concussion knowledge.

Design: Qualitative study.

Setting: Military academy.

Patients or Other Participants: USAFA cadets (males=23, females=11, age=19.91±1.14 years).

Main Outcome Measure(s): We conducted 34 semi-structured interviews. The transcribed text was analyzed in a five-cycle process. From this process eight overall themes were discovered including unprompted concussion knowledge. Subthemes were also discovered of concussion definition, concussion symptoms, bell-ringer/ding definition, bell-ringer/ding symptoms, and concussion vs. bell-ringer/ding.

Results: Many participants were able to largely accurately describe a concussion. 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%). USAFA cadet participants identified the most common bell-ringer/ding signs and symptoms as dizziness (n=2/34, 5.9%) and headache (n=2/34, 5.9%). Lastly, cadets described how a bell-ringer/ding differs from a concussion, often describing that concussions are more severe than bell-ringers/dings.

Conclusions: Overall, USAFA cadet participants listed common concussion signs and symptoms. However, cadet participants perceived differences between concussion and bell-ringer/ding. While decreasing use of colloquial terms for concussion is recommended, using these terms when examining concussion history may be useful. Concussion educational interventions should continue to focus on describing concussion signs and symptoms using cadets' own words to describe the injury such as “forgetful”, but also differentiating between what may and may not be a concussion, and encourage individuals to seek the care of health care providers to discern concussion symptoms.

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