Sex differences in outcome following sports-related concussion

Donna K. Broshek Ph.D.1, Tanya Kaushik Psy.D.1, Jason R. Freeman Ph.D.1, David Erlanger Ph.D.1, Frank Webbe Ph.D.1, and Jeffrey T. Barth Ph.D.1
View More View Less
  • 1 Department of Psychiatric Medicine, University of Virginia Health System, Charlottesville, Virginia; HeadMinder, Inc., New York; Department of Psychiatry, Albert Einstein College of Medicine, New York, New York; and Department of Psychology, Florida Institute of Technology, Melbourne, Florida
Page Range:
856–863
Volume/Issue:
Volume 102: Issue 5
DOI link:
https://doi.org/10.3171/jns.2005.102.5.0856
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Click here for subscription options

  • Purchase Now

    USD  $45.00

  • JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

    USD  $515.00

  • JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

    USD  $612.00
Print or Print + Online Sign in

Object. Females comprise an increasing percentage of the athlete population across all age groups, and analysis of recent literature reveals that they sustain more concussions in collegiate sports. Results of human and animal studies indicate that females may have poorer outcomes after traumatic brain injury; however, no return-to-play guideline takes sex or other individual differences into account. In the present study the authors evaluated the influence of patient sex on objective neurocognitive performance and subjective reporting of symptoms following sports-related concussion.

Methods. According to preseason baseline neurocognitive computerized testing in 2340 male and female high school and collegiate athletes, individuals who sustained sports-related concussions (155 persons) were reevaluated using an alternate form of the cognitive test. Sex differences in the magnitude of cognitive change from baseline levels and the subjective experience of symptoms were analyzed. To account for the possible protective effects of helmets, comparisons were performed among females, males with helmets, and males without helmets; none of the female athletes wore helmets.

Female athletes had significantly greater declines in simple and complex reaction times relative to preseason baseline levels, and they reported more postconcussion symptoms compared with males. As a group, females were cognitively impaired approximately 1.7 times more frequently than males following concussions. Furthermore, females experienced more objective and subjective adverse effects from concussion even after adjusting for the use of helmets by some groups of male athletes (for example, in football).

Conclusions. Return-to-play decisions and concussion management must be objective and made on an individual basis, including consideration of factors such as patient sex rather than relying on a one-size-fits-all guideline.

Volume 102: Issue 5 (May 2005)

in Journal of Neurosurgery
Cover Journal of Neurosurgery

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Click here for subscription options

  • JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

    USD  $515.00

  • JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

    USD  $612.00
Print or Print + Online

Contributor Notes

Address reprint requests to: Donna K. Broshek, Ph.D., Neuropsychology Laboratory, Box 800203, University of Virginia School of Medicine, Charlottesville, Virginia 22908—0203. email: broshek@virginia.edu.
  • 1.

    Andreason PJ, , Zametkin AJ, , Guo AC, , Baldwin P, & Cohen RM: Gender-related differences in regional cerebral glucose metabolism in normal volunteers. Psychiatry Res 51:175–183, 1994 Andreason PJ, Zametkin AJ, Guo AC, Baldwin P, Cohen RM: Gender-related differences in regional cerebral glucose metabolism in normal volunteers. Psychiatry Res 51:175–183, 1994

    • Search Google Scholar
    • Export Citation
  • 2.

    Barth JT, , Alves WM, & Ryan TV, et al: Mild head injury in sports: Neuropsychological sequelae and recovery of function, in Levin HS, , Eisenberg HM, & Benton AL (eds): Mild Head Injury. New York: Oxford Press, 1989, pp 257–275 Barth JT, Alves WM, Ryan TV, et al: Mild head injury in sports: Neuropsychological sequelae and recovery of function, in Levin HS, Eisenberg HM, Benton AL (eds): Mild Head Injury. New York: Oxford Press, 1989, pp 257–275

    • Search Google Scholar
    • Export Citation
  • 3.

    Barth JT, , Freeman JR, & Broshek DK: Mild head injury, in Ramachandran VS (ed): Encyclopedia of the Human Brain. San Diego: Academic Press, 2002, Vol 3, pp 81–92 Barth JT, Freeman JR, Broshek DK: Mild head injury, in Ramachandran VS (ed): Encyclopedia of the Human Brain. San Diego: Academic Press, 2002, Vol 3 , pp 81–92

    • Search Google Scholar
    • Export Citation
  • 4.

    Bazarian JJ, , Wong T, , Harris M, , Leahey N, , Mookerjee S, & Dombovy M: Epidemiology and predictors of post-concussive syndrome after minor head injury in an emergency population. Brain Inj 13:173–189, 1999 Bazarian JJ, Wong T, Harris M, Leahey N, Mookerjee S, Dombovy M: Epidemiology and predictors of post-concussive syndrome after minor head injury in an emergency population. Brain Inj 13:173–189, 1999

    • Search Google Scholar
    • Export Citation
  • 5.

    Bounds TA, , Schopp L, , Johnstone B, , Unger C, & Goldman H: Gender differences in a sample of vocational rehabilitation clients with TBI. NeuroRehabilitation 18:189–196, 2003 Bounds TA, Schopp L, Johnstone B, Unger C, Goldman H: Gender differences in a sample of vocational rehabilitation clients with TBI. NeuroRehabilitation 18:189–196, 2003

    • Search Google Scholar
    • Export Citation
  • 6.

    Brooks J: Gender issues in brain injury, in Lovell MR, , Echemendia R, & Barth JT, et al (eds): Traumatic Brain Injury in Sports. Lisse, The Netherlands: Swets & Zeitlinger, 2004, pp 443–466 Brooks J: Gender issues in brain injury, in Lovell MR, Echemendia R, Barth JT, et al (eds): Traumatic Brain Injury in Sports. Lisse, The Netherlands: Swets & Zeitlinger, 2004, pp 443–466

    • Search Google Scholar
    • Export Citation
  • 7.

    Cantu RC: Guidelines for return to contact sports after a cerebral concussion. Phys Sportsmed 14:75–83, 1986 Cantu RC: Guidelines for return to contact sports after a cerebral concussion. Phys Sportsmed 14:75–83, 1986

    • Search Google Scholar
    • Export Citation
  • 8.

    Cantu RC: Posttraumatic retrograde and anterograde amnesia: pathophysiology and implications in grading and safe return to play. J Athl Train 36:244–248, 2001 Cantu RC: Posttraumatic retrograde and anterograde amnesia: pathophysiology and implications in grading and safe return to play. J Athl Train 36:244–248, 2001

    • Search Google Scholar
    • Export Citation
  • 9.

    Centers for Disease Control and Prevention: Traumatic Brain Injury (TBI): Risks & Groups at Risk. (http://www.cdc.gov/node.do/id/0900f3ec8000dbdc/aspectId/C60308) [Accessed 23 February 2005] Centers for Disease Control and Prevention: Traumatic Brain Injury (TBI): Risks & Groups at Risk. (http://www.cdc.gov/node.do/id/0900f3ec8000dbdc/aspectId/C60308) [Accessed 23 February 2005]

    • Search Google Scholar
    • Export Citation
  • 10.

    Collins MW, , Iverson GL, , Lovell MR, , McKeag DB, , Norwig J, & Maroon J: On-field predictors of neuropsychological and symptom deficit following sports-related concussion. Clin J Sport Med 13:222–229, 2003 Collins MW, Iverson GL, Lovell MR, McKeag DB, Norwig J, Maroon J: On-field predictors of neuropsychological and symptom deficit following sports-related concussion. Clin J Sport Med 13:222–229, 2003

    • Search Google Scholar
    • Export Citation
  • 11.

    Covassin T, , Swanik CB, & Sachs ML: Sex differences and the incidence of concussions among collegiate athletes. J Athl Train 38:238–244, 2003 Covassin T, Swanik CB, Sachs ML: Sex differences and the incidence of concussions among collegiate athletes. J Athl Train 38:238–244, 2003

    • Search Google Scholar
    • Export Citation
  • 12.

    de Courten-Myers GM: The human cerebral cortex: gender differences in structure and function. J Neuropathol Exp Neurol 58:217–226, 1999 de Courten-Myers GM: The human cerebral cortex: gender differences in structure and function. J Neuropathol Exp Neurol 58:217–226, 1999

    • Search Google Scholar
    • Export Citation
  • 13.

    Donders J, & Hoffman NM: Gender differences in learning and memory after pediatric traumatic brain injury. Neuropsychology 16:491–499, 2002 Donders J, Hoffman NM: Gender differences in learning and memory after pediatric traumatic brain injury. Neuropsychology 16:491–499, 2002

    • Search Google Scholar
    • Export Citation
  • 14.

    Donders J, & Woodward HR: Gender as a moderator of memory after traumatic brain injury in children. J Head Trauma Rehabil 18:106–115, 2003 Donders J, Woodward HR: Gender as a moderator of memory after traumatic brain injury in children. J Head Trauma Rehabil 18:106–115, 2003

    • Search Google Scholar
    • Export Citation
  • 15.

    Echemendia RJ, & Julian LJ: Mild traumatic brain injury in sports: neuropsychology's contribution to a developing field. Neuropsychol Rev 11:69–88, 2001 Echemendia RJ, Julian LJ: Mild traumatic brain injury in sports: neuropsychology's contribution to a developing field. Neuropsychol Rev 11:69–88, 2001

    • Search Google Scholar
    • Export Citation
  • 16.

    Emerson CS, , Headrick JP, & Vink R: Estrogen improves biochemical and neurologic outcome following traumatic brain injury in male rats, but not in females. Brain Res 608:95–100, 1993 Emerson CS, Headrick JP, Vink R: Estrogen improves biochemical and neurologic outcome following traumatic brain injury in male rats, but not in females. Brain Res 608:95–100, 1993

    • Search Google Scholar
    • Export Citation
  • 17.

    Erlanger D, , Feldman D, , Kutner K, , Kaushik T, , Kroger H, & Festa J, et al: Development and validation of a web-based neuropsychological test protocol for sports-related return-to-play decisionmaking. Arch Clin Neuropsychol 18:293–316, 2003 Erlanger D, Feldman D, Kutner K, Kaushik T, Kroger H, Festa J, et al: Development and validation of a web-based neuropsychological test protocol for sports-related return-to-play decisionmaking. Arch Clin Neuropsychol 18:293–316, 2003

    • Search Google Scholar
    • Export Citation
  • 18.

    Erlanger D, , Kaushik T, , Cantu R, , Barth JT, , Broshek DK, & Freeman JR, et al: Symptom-based assessment of the severity of a concussion. J Neurosurg 98:477–484, 2003 Erlanger D, Kaushik T, Cantu R, Barth JT, Broshek DK, Freeman JR, et al: Symptom-based assessment of the severity of a concussion. J Neurosurg 98:477–484, 2003

    • Search Google Scholar
    • Export Citation
  • 19.

    Esposito G, , Van Horn JD, , Weinberger DR, & Berman KF: Gender differences in cerebral blood flow as a function of cognitive state with PET. J Nucl Med 37:559–564, 1996 Esposito G, Van Horn JD, Weinberger DR, Berman KF: Gender differences in cerebral blood flow as a function of cognitive state with PET. J Nucl Med 37:559–564, 1996

    • Search Google Scholar
    • Export Citation
  • 20.

    Farace E, & Alves WM: Do women fare worse: a metaanalysis of gender differences in traumatic brain injury outcome. J Neurosurg 93:539–545, 2000 Farace E, Alves WM: Do women fare worse: a metaanalysis of gender differences in traumatic brain injury outcome. J Neurosurg 93:539–545, 2000

    • Search Google Scholar
    • Export Citation
  • 21.

    Fenton G, , McClelland R, , Montgomery A, , MacFlynn G, & Rutherford W: The postconcussional syndrome: social antecedents and psychological sequelae. Br J Psychiatry 162:493–497, 1993 Fenton G, McClelland R, Montgomery A, MacFlynn G, Rutherford W: The postconcussional syndrome: social antecedents and psychological sequelae. Br J Psychiatry 162:493–497, 1993

    • Search Google Scholar
    • Export Citation
  • 22.

    Giza CC, & Hovda DA: The pathophysiology of traumatic brain injury, in Lovell MR, , Barth JT, & Collins MW (eds): Traumatic Brain Injury in Sports. Lisse, The Netherlands: Swets & Zeitlinger, 2004, pp 45–70 Giza CC, Hovda DA: The pathophysiology of traumatic brain injury, in Lovell MR, Barth JT, Collins MW (eds): Traumatic Brain Injury in Sports. Lisse, The Netherlands: Swets & Zeitlinger, 2004, pp 45–70

    • Search Google Scholar
    • Export Citation
  • 23.

    Grosswasser Z, , Cohen M, & Karen O: Female TBI patients recover better than males. Brain Inj 12:805–808, 1998 Grosswasser Z, Cohen M, Karen O: Female TBI patients recover better than males. Brain Inj 12:805–808, 1998

    • Search Google Scholar
    • Export Citation
  • 24.

    Gunstad J, & Suhr JA: Cognitive factors in Postconcussion Syndrome symptom report. Arch Clin Neuropsychol 19:391–405, 2004 Gunstad J, Suhr JA: Cognitive factors in Postconcussion Syndrome symptom report. Arch Clin Neuropsychol 19:391–405, 2004

    • Search Google Scholar
    • Export Citation
  • 25.

    Kozniewska E, , Roberts TPL, , Vexler ZS, , Oseka M, , Kucharczyk J, & Arieff AI: Hormonal dependence of the effects of metabolic encephalopathy on cerebral perfusion and oxygen utilization in the rat. Circ Res 76:551–558, 1995 Kozniewska E, Roberts TPL, Vexler ZS, Oseka M, Kucharczyk J, Arieff AI: Hormonal dependence of the effects of metabolic encephalopathy on cerebral perfusion and oxygen utilization in the rat. Circ Res 76:551–558, 1995

    • Search Google Scholar
    • Export Citation
  • 26.

    Kraus JF, , Peek-Asa C, & McArthur D: The independent effect of gender on outcomes following traumatic brain injury: a preliminary investigation. Neurosurg Focus 8 (1):E5, 2000 Kraus JF, Peek-Asa C, McArthur D: The independent effect of gender on outcomes following traumatic brain injury: a preliminary investigation. Neurosurg Focus 8(1):E5, 2000

    • Search Google Scholar
    • Export Citation
  • 27.

    Kupina NC, , Detloff MR, , Bobrowski WF, , Snyder BJ, & Hall ED: Cytoskeletal protein degradation and neurodegeneration evolves differently in males and females following experimental head injury. Exp Neurol 180:55–73, 2003 Kupina NC, Detloff MR, Bobrowski WF, Snyder BJ, Hall ED: Cytoskeletal protein degradation and neurodegeneration evolves differently in males and females following experimental head injury. Exp Neurol 180:55–73, 2003

    • Search Google Scholar
    • Export Citation
  • 28.

    Lovell MR, , Iverson GL, , Collins MW, , McKeag D, & Maroon JC: Does loss of consciousness predict neuropsychological decrements after concussion? Clin J Sport Med 9:193–198, 1999 Lovell MR, Iverson GL, Collins MW, McKeag D, Maroon JC: Does loss of consciousness predict neuropsychological decrements after concussion? Clin J Sport Med 9:193–198, 1999

    • Search Google Scholar
    • Export Citation
  • 29.

    McCrea M, , Kelly J, & Randolph C: The Standardized Assessment of Concussion (SAC): Manual for Administration and Scoring. Alexandria, VA: The Brain Injury Association, 1997 McCrea M, Kelly J, Randolph C: The Standardized Assessment of Concussion (SAC): Manual for Administration and Scoring. Alexandria, VA: The Brain Injury Association, 1997

    • Search Google Scholar
    • Export Citation
  • 30.

    Mueller FO: Catastrophic head injuries in high school and collegiate sports. J Athl Train 36:312–315, 2001 Mueller FO: Catastrophic head injuries in high school and collegiate sports. J Athl Train 36:312–315, 2001

    • Search Google Scholar
    • Export Citation
  • 31.

    Report of the Quality Standards Subcommittee: practice parameter: the management of concussion in sports (summary statement). Neurology 48:581–585, 1997 Report of the Quality Standards Subcommittee: practice parameter: the management of concussion in sports (summary statement). Neurology 48:581–585, 1997

    • Search Google Scholar
    • Export Citation
  • 32.

    Rimel RW, , Giordani B, , Barth JT, , Boll TJ, & Jane JA: Disability caused by minor head injury. Neurosurgery 9:221–228, 1981 Rimel RW, Giordani B, Barth JT, Boll TJ, Jane JA: Disability caused by minor head injury. Neurosurgery 9:221–228, 1981

    • Search Google Scholar
    • Export Citation
  • 33.

    Rohling ML, , Meyers JE, & Millis SR: Neuropsychological impairment following traumatic brain injury: a dose-response analysis. Clin Neuropsychol 17:289–302, 2003 Rohling ML, Meyers JE, Millis SR: Neuropsychological impairment following traumatic brain injury: a dose-response analysis. Clin Neuropsychol 17:289–302, 2003

    • Search Google Scholar
    • Export Citation
  • 34.

    Roof RL, & Hall ED: Gender differences in acute CNS trauma and stroke: neuroprotective effects of estrogen and progesterone. J Neurotrauma 17:367–388, 2000 Roof RL, Hall ED: Gender differences in acute CNS trauma and stroke: neuroprotective effects of estrogen and progesterone. J Neurotrauma 17:367–388, 2000

    • Search Google Scholar
    • Export Citation
  • 35.

    Rutherford WH, , Merrett JD, & McDonald JR: Symptoms at one year following concussion from minor head injuries. Injury 10:225–230, 1979 Rutherford WH, Merrett JD, McDonald JR: Symptoms at one year following concussion from minor head injuries. Injury 10:225–230, 1979

    • Search Google Scholar
    • Export Citation
  • 36.

    Ryan JP, , Atkinson TM, & Dunham KT: Sports-related and gender differences on neuropsychological measures of frontal lobe functioning. Clin J Sport Med 14:18–24, 2004 Ryan JP, Atkinson TM, Dunham KT: Sports-related and gender differences on neuropsychological measures of frontal lobe functioning. Clin J Sport Med 14:18–24, 2004

    • Search Google Scholar
    • Export Citation
  • 37.

    United States Department of Education: Title IX: 25 years of progress. (http://www.ed.gov/pubs/TitleIX/index.html#toc) [Accessed 24 February 2005] United States Department of Education: Title IX: 25 years of progress. (http://www.ed.gov/pubs/TitleIX/index.html#toc) [Accessed 24 February 2005]

    • Search Google Scholar
    • Export Citation
  • 38.

    Vriezen ER, & Pigott S: Gender differences in executive function following pediatric brain injury, in International Neuropsychological Society Conference, Baltimore, MD, 2004, 32nd Annual Meeting Program & Abstracts. Columbus, OH: International Neuropsychological Society, p 50 (Abstract)Vriezen ER, Pigott S: Gender differences in executive function following pediatric brain injury, in International Neuropsychological Society Conference, Baltimore, MD, 2004, 32nd Annual Meeting Program & Abstracts. Columbus, OH: International Neuropsychological Society, p 50 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 39.

    Waber DP, & Mullenix PJ: Acute lymphoblastic leukemia, in Yeates KO, , Ris MD, & Taylor HG (eds): Pediatric Neuropsychology: Research, Theory, and Practice. New York: Guilford Press, 2000, pp 300–319 Waber DP, Mullenix PJ: Acute lymphoblastic leukemia, in Yeates KO, Ris MD, Taylor HG (eds): Pediatric Neuropsychology: Research, Theory, and Practice. New York: Guilford Press, 2000, pp 300–319

    • Search Google Scholar
    • Export Citation
  • 40.

    Webbe FM: Cerebral concussion: definition, physiology, and severity, in Echemendia RJ (ed): Sports Neuropsychology: A Clinical Primer. New York: Guilford Press (In press)Webbe FM: Cerebral concussion: definition, physiology, and severity, in Echemendia RJ (ed): Sports Neuropsychology: A Clinical Primer. New York: Guilford Press (In press)

    • Search Google Scholar
    • Export Citation
  • 41.

    Webbe FM, & Barth JT: Short-term and long-term outcome of athletic closed head injuries. Clin Sports Med 22:577–592, 2003 Webbe FM, Barth JT: Short-term and long-term outcome of athletic closed head injuries. Clin Sports Med 22:577–592, 2003

    • Search Google Scholar
    • Export Citation
  • 42.

    Women's Sports Foundation: Title IX: Overview of Current Developments. (http://www.womenssportsfoundation.org/cgi-bin/iowa/about/media/press.html?record=68). [Accessed 24 February 2005] Women's Sports Foundation: Title IX: Overview of Current Developments. (http://www.womenssportsfoundation.org/cgi-bin/iowa/about/media/press.html?record=68). [Accessed 24 February 2005]

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 4869 1539 159
Full Text Views 897 130 13
PDF Downloads 397 122 9
EPUB Downloads 0 0 0