Response to acute concussive injury in soccer players: is gender a modifying factor?

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Several studies have suggested a gender difference in response to sports-related concussion (SRC). The Concussion in Sport group did not include gender as a modifying factor in SRC, concluding that the evidence at that point was equivocal. In the present study the authors endeavored to assess acute neurocognitive and symptom responses to an SRC in equivalent cohorts of male and female soccer players. The authors hypothesized that female athletes would experience greater levels of acute symptoms and neurocognitive impairment than males.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Baseline symptom and neurocognitive scores were determined in 40 male and 40 female soccer players by using the Immediate Postconcussion Assessment and Cognitive Testing (ImPACT) scale prior to any SRC. After sustaining an SRC, each athlete completed postconcussion ImPACT tests and was carefully matched on a wide array of biopsychosocial variables. Baseline symptom and neurocognitive test scores were compared, and their acute symptoms and neurocognitive responses to concussive injury were assessed.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Specific a priori hypotheses about differences between males and females at baseline and at postconcussion measurements of verbal and visual memory ImPACT scores were evaluated according to simple main effects of the gender variable and according to baseline-to-postconcussion main effect and interaction of 2 × 2 split-plot ANOVA. Neither the interaction nor the main effects nor the simple main effects for either ImPACT variable were found to be statistically significant. Exploratory ANOVAs applied to the remaining ImPACT variables of visualmotor speed, reaction time, impulse control, and symptom total scores revealed only a single statistically significant baseline-to-postconcussion main effect for the symptom total.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The results failed to replicate prior findings of gender-specific baseline neurocognitive differences in verbal and visual memory. The findings also indicated no differential gender-based acute response to concussion (symptoms or neurocognitive scores) among high school soccer players. The implications of these findings for the inclusion of gender as a modifying factor in this tightly matched cohort are addressed. Potential explanations for the null findings are discussed.</jats:p></jats:sec>

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

“…The results of several recent studies of sex effects on cognition and symptoms in SRC lead to the preliminary conclusion that symptoms rather than neurocognitive scores appear to be the main driver of sex disparities in the sequelae of SRCs. 4,7,12,13,44 The etiology of this disparity is outside the scope of our study; however, male athletes have been shown to minimize or deny symptoms to avoid removal from a game or practice, whereas female athletes show more concern for their future health. [13][14][15]17,24 Embedded social biases may be at the heart of symptom variation.…”

“…Although authors have found disparities in male and female neurocognitive scores at baseline 3,6,15,43 and postconcussion, 4,12,14 a recent study evaluated a homogeneous group of male versus female soccer players and found no differences in neurocognitive deficits after SRC. 44 With respect to symptoms, prior studies have shown different symptom profiles for females and an increased number of symptoms at baseline and postconcussion. Although our study failed to replicate major symptom differences, we did confirm a higher level of symptom endorsement and longer return to baseline in females than in males.…”

Agreement between High School Athletes and Their Parents on Reporting Athletic Events and Concussion Symptoms

“…Findings in the literature on differential reporting of the number, type, or severity of concussion symptoms by sex remain mixed, [13][14][15][16][17][18][19] and there is a paucity of information on whether agreement levels for reporting sports-related events by athletes and key persons is different between female and male players. In terms of the type of activity, football has historically been the main sport in which serious concerns about concussion have been raised.…”

Psychological aspects of sports injuries among male professional soccer players in Croatia

“…Since most sports injuries occur as a result of the interaction of intrinsic and extrinsic risk factors, they both represent a valid scope of research. However, intrinsic risk factors can be almost completely monitored by having an insight into the musculoskeletal potential of a person, his or her functional status as well as all other available anthropological parameters (Venturelli, Schena, Zanolla, & Bishop, 2011;Volpi & Taioli, 2012;Zuckerman, et al, 2012).…”

“…Additional group of intrinsic risk factors are athlete's psychological features such as motivation, aggressiveness, perception of risk situation and willingness to accept risk. Extrinsic risk factors can be associated with a certain sport activity such as type, intensity and frequency of training sessions, warmth, humidity or coldness of weather, special equipment, or type of surface the activity is practised on (van Beijsterveldt, et al, 2011(van Beijsterveldt, et al, , 2012Zuckerman, et al, 2012).…”