Effect of sex on symptoms and return to baseline in sport-related concussion

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Sport-related concussions (SRCs) among youth athletes represent a significant public health concern. Prior research suggests that females fare worse symptomatically after an SRC. The authors aimed to assess sex differences in number, severity, and resolution of postconcussive symptoms using reliable change index (RCI) methodology applied to days to return to symptom baseline.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Between 2009 and 2011, 740 youth athletes completed valid neurocognitive and symptom testing before and after an SRC using Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). A total of 122 female and 122 male athletes were matched on number of prior concussions, age, and number of days to first postconcussion test. At baseline and postconcussion, the authors compared each of the individual 22 symptoms on ImPACT to calculate individual symptom severity and aggregate symptom severity, or the Total Symptom Score (TSS). When comparing individual symptoms, the significance level for the comparison of each symptom was set at 0.05/22 = 0.0023. When comparing aggregate symptom severity, or TSS, a single value was compared, requiring an alpha set to 0.05. The number of days to return to baseline TSS was compared using RCI methods set at the 80% confidence interval, equal to a raw score point value of 9.18 on the TSS.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>At baseline, females reported a greater severity for the symptom, “sleeping less than usual,” compared with males (0.88 ± 1.49 vs 0.31 ± 0.86, p &lt; 0.001). However, no other individual symptom severity differences were noted before or after SRC. At baseline, females exhibited a statistically significant greater aggregate symptom severity than males (7.24 ± 10.22 vs 4.10 ± 6.52, p = 0.005). Greater aggregate symptom severity for females was also found postconcussion (21.38 ± 19.02 vs 16.80 ± 17.07, p = 0.049). Females took longer to return to baseline TSS (9.1 ± 7.1 days vs 7.0 ± 5.1 days, p = 0.013).</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The results of this retrospective study indicate that females endorse a greater severity of symptoms at baseline and postconcussion than males without significantly different symptom profiles. Furthermore, after suffering an SRC, females take longer to return to their baseline symptom level.</jats:p></jats:sec>

Symptom Experience and Quality of Life in Children after Sport-Related Head Injuries: A Cross-Sectional Study

“…Young, female athletes reported higher symptom scores and took longer to become symptom free than males following sports-related concussions [26] . Similarly in another study, females were found to report a greater severity of symptoms after concussion and to take longer to return to baseline symptom levels than males while symptom profiles were not significantly different between the sexes [27] .…”

Age at First Exposure to Football Is Associated with Altered Corpus Callosum White Matter Microstructure in Former Professional Football Players

“…For example, the biomechanics and amount of RHI experienced by former NFL players may differ from that of athletes in other high-risk sports, such as soccer and ice hockey. Additionally, developmental trajectories [37][38][39] and outcomes 74 following mTBI differ between males and females; therefore, these results also may not apply to females exposed to RHI during youth. Second, it is not known whether continued exposure to RHI in adolescence and adulthood influences the brain's ability to recover following childhood exposure to RHI.…”

Prevalence and Predictors of Poor Recovery from Mild Traumatic Brain Injury

“…[44][45][46][47][48] Many hypotheses have been put forth to explain the sex difference in elevated and prolonged symptoms. Some have speculated that sex differences in head size or neck musculature may contribute, 49 while others have argued that the findings can be explained by women's and girls' more forthcoming reporting style.…”