Sex differences in outcome following sports-related concussion

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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.

Article Information

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.

© AANS, except where prohibited by US copyright law.

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Figures

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    Bar graph demonstrating mean RCI scores on CRIs together with 95% CIs on follow up. Shaded bars represent men; white bars represent women. * p < 0.05.

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    Bar graph depicting self-reported symptoms on follow up according to patient sex. Shaded bars, males; white bars, females. * p < 0.05.

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    Bar graph exhibiting the mean number of symptoms reported on follow up according to patient sex together with 95% CIs. Shaded bars, males; white bars, females; p < 0.05.

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    Bar graph exhibiting mean RCI scores on CRIs together with 95% CIs on follow up. *Scores in females (white bars) were lower than those in males without helmets (light gray bars), p < 0.01; scores in females were lower than those in males with helmets (dark gray bars), p < 0.15. **Scores in females were lower than those in males without helmets, p < 0.15; scores in females were lower than those in males with helmets, p < 0.05. ***Speeds in females were lower than those in males without helmets, p < 0.05.

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    Bar graph demonstrating the mean number of symptoms as well as CIs reported on follow up by males with helmets (dark gray bars), males without helmets (light gray bars), and females (white bars). Females had more symptoms than males without helmets, p = 0.01; females had more symptoms than males with helmets, p = 0.05.

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