In-Season Concussion Symptom Reporting in Male and Female Collegiate Rugby Athletes

Kieffer, Emily; Brolinson, P. Gunnar; Maerlender, Arthur C.; Smith, Eric P.; Rowson, Steven

doi:10.1089/neur.2021.0050

Cited by 3 publications

(2 citation statements)

References 44 publications

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“…The overall differences in reporting by sex are not surprising as generally female athletes will report more symptoms after a concussion. 18,19,41 Clinically, these findings are important as female athletes may over-report at baseline or male athletes may under-report. This stresses the importance of using a change score when determining a concussion diagnosis while using the VOMS regardless of modality.…”

Section: Discussionmentioning

confidence: 99%

Virtual Reality Application for Vestibular/Ocular Motor Screening: Current Clinical Protocol Versus a Novel Prototype

Pavilionis

Adhanom

Moran

et al. 2023

Sports Health: A Multidisciplinary Approach

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Background: Virtual reality (VR) has been explored to improve baseline and postinjury assessments in sport-related concussion (SRC). Some experience symptoms related to VR, unrelated to concussion. This may deter use of vestibular/ocular motor screening (VOMS) using VR. Baseline VR VOMS symptomatology differentiates baseline from overall symptomatology. Hypothesis: There will be no difference between current clinical manual VOMS (MAN), a clinical prototype (PRO), and VR for symptom provocation change score (SPCS) and near point of convergence (NPC) average score in a healthy population and sex differences among the 3 modes of administration. Study Design: Cohort study. Level of Evidence: Level 3. Methods: A total of 688 National Collegiate Athletic Association Division I student-athletes completed VOMS using 3 methods (MAN, N = 111; female athletes, N = 47; male athletes, N = 64; average age, 21 years; PRO, N = 365; female athletes, N = 154; male athletes, N = 211; average age, 21 years; VR, N = 212; female athletes, N = 78; male athletes, N = 134; average age = 20 years) over a 3-year period (2019-2021) during annual baseline testing. Exclusion criteria were as follows: self-reported motion sickness in the past 6 months, existing or previous neurological insult, attention deficit hyperactivity disorder, learning disabilities, or noncorrected vision impairment. Administration of MAN followed the current clinical protocols, PRO used a novel prototype, and VR used an HTC Vive Pro Eye head mounted display. Symptom provocation was compared using Mann-Whitney U tests across each VOMS subtest with total SPCS and NPC average by each method. Results: MAN had significantly ( P < 0.01) more baseline SPCS (MAN = 0.466 ± 1.165, PRO = 0.163 ± 0.644, VR = 0.161 ± 0.933) and significantly ( P < 0.01) and more SPCS (MAN = 0.396 ± 1.081, PRO = 0.128 ± 0.427, VR = 0.48 ± 0.845) when compared with PRO and VR. NPC average measurements for VR (average, 2.99 ± 0.684 cm) were significantly greater than MAN (average, 2.91 ± 3.35 cm; P < 0.01; Cohen’s d = 0.03) and PRO (average, 2.21 ± 1.81 cm; P < 0.01; Cohen’s d = 0.57). For sex differences, female athletes reported greater SPCS with PRO (female athletes, 0.29 ± 0.87; male athletes, 0.06 ± 0.29; P < 0.01) but not in VR or MAN. Conclusion: Using a VR system to administer the VOMS may not elicit additional symptoms, resulting in fewer false positives and is somewhat stable between sexes. Clinical Relevance: VOMS may allow for standardization among administrators and reduce possible false positives.

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Section: Discussionmentioning

confidence: 99%

Virtual Reality Application for Vestibular/Ocular Motor Screening: Current Clinical Protocol Versus a Novel Prototype

Pavilionis

Adhanom

Moran

et al. 2023

Sports Health: A Multidisciplinary Approach

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“…Further investigation has indicated that clinical concussion assessments may be subject to sampling bias, as current assessments have been constructed around studies involving mostly male participants. (Gessel et al, 2007;Granito, 2002;Kieffer et al, 2021;Mihalik et al, 2009;O'Connor et al, 2017;Schatz et al, 2011;Wallace et al, 2017;Zuckerman et al, 2014). Therefore, generalizing head-injury and concussion assessment tools developed in males to the female athlete population is likely to present imprecise results.…”

Section: Introductionmentioning

confidence: 99%

Gender Biases In Sports Concussions: A Differential Item Functioning Analysis into NCAA Female Athlete Symptom Presentation and Validity of the SCAT3 Checklist

Edelstein,

Cushing,

Schmidt

et al. 2024

Preprint

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Background: As a consequence of sports-related concussions, female athletes have been documented as reporting more symptoms than their male counterparts, in addition to incurring longer periods of recovery. However, the role of gender and its potential influence on symptom reporting and recovery outcomes in concussion management has not been completely explored. Study Design: This study investigates potential differential item functioning (DIF) related to gender biases within the SCAT3 symptom severity checklist. The data was obtained from the Federal Interagency of Traumatic Brain Injury Research (FITBIR), which included information from the 2014-2017 NCAA and DoD CARE Consortium. A total of 1,258 NCAA athletes (n=473 females and n=785 males) SCAT3 Symptom Severity sub-scores were analyzed across five time points post-concussion: less than six hours post-injury, 24-48 hours post-injury, asymptomatic, unrestricted return to play, and at 6 months. Results: During the recovery phase, women experienced more headaches, pressure in the head, and fatigue than male athletes. Overall, both male and female athletes had equivalent knowledge of concussions, and there was no significant difference in symptom-reporting ability for most items, including emotional-related symptoms. Only during the unrestricted return to play phase were group-level differences detected, with females being more likely to report more severe symptoms than males. However, upon further analysis, it was discovered females exhibit a relatively high difficulty level reporting symptom severity beyond Mild, therefore the group-level DIF may result from gender biases within the checklist. Conclusion: The present analysis posits that Differential Item Functioning (DIF) in specific symptoms may lead to gender bias. The findings of this study reveal that female athletes tend to exhibit symptomatic behavior upon returning to play, a phenomenon consistent with prior research. However, the possible DIF may provoke biases due to unreliable reporting measures within the SCAT3 symptom severity checklist. Furthermore, explaining why recent literature reports that female athletes do not present as symptomatic upon return to play. Additional research is warranted to determine whether females genuinely experience more symptoms or whether the presence of these potential assessment gender biases obstructs the manifestation of asymptomatic recoveries.

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I won't let you down; why 20% of Men's and Women's Super League players underreported suspected concussions

Tadmor,

Till,

Phillips

et al. 2023

Journal of Science and Medicine in Sport

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In-Season Concussion Symptom Reporting in Male and Female Collegiate Rugby Athletes

Cited by 3 publications

References 44 publications

Virtual Reality Application for Vestibular/Ocular Motor Screening: Current Clinical Protocol Versus a Novel Prototype

Virtual Reality Application for Vestibular/Ocular Motor Screening: Current Clinical Protocol Versus a Novel Prototype

Gender Biases In Sports Concussions: A Differential Item Functioning Analysis into NCAA Female Athlete Symptom Presentation and Validity of the SCAT3 Checklist

I won't let you down; why 20% of Men's and Women's Super League players underreported suspected concussions

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