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Female athletes suffer more from concussions, prompting clinical reassessment
Female athletes who sustained concussions performed worse than male athletes and reported more symptoms, according to new research from Michigan State University. The study results warrant consideration from clinicians when treating concussions, according to researchers.
Certified athletic trainer Tracey Covassin, PhD, and colleagues examined the age and sex differences in concussion outcomes in a 2-year cohort study that included 296 participants (203 male and 93 female high school and college athletes) aged 14 to 25 years from multiple states who sustained concussions during the 2008-2009 and 2009-2010 academic years. Nearly 2,000 athletes were tested at baseline to obtain the concussion sample, according to the researchers.
A concussion was defined in the study as “a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces,” and met the following criteria:
- Presence of on-field signs (posttraumatic amnesia, loss of consciousness) and symptoms (dizziness, headache) as determined by a sports medicine professional.
- Decrease from baseline levels in at least one post-concussion neurocognitive score determined by reliable change estimates.
- Increase from baseline levels in post-concussion symptoms determined by reliable change estimates.
Before sustaining concussions, the participants — who played a number of different sports, including football, soccer, volleyball, basketball and ice hockey — completed the online version of the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT), a neurocognitive battery that tests memory, visual memory, visual processing speed and reaction time. They also completed the Post-Concussion Symptom Scale (PCSS) at baseline. The ImPACT battery was administered again at 2, 7 and 14 days after sustaining a concussion, and a personal trainer assessed participants’ static and dynamic postural stability using the Balance Error Scoring System (BESS) at 1, 2 and 3 days post-concussion.
Data were analyzed using descriptive and inferential statistics, the researchers wrote.
Results showed that female athletes performed worse than male athletes on visual memory (65.1% vs. 70.1%) and reported more symptoms (14.4 vs. 10.1). High school athletes performed worse than college athletes on verbal (78.8% and 82.7%) and visual memory assessments (65.8% vs. 69.4%), and high school athletes continued to have verbal memory impairment 7 days after sustaining concussions, compared with college athletes, according to researchers. High school male athletes scored worse than college male athletes on the BESS (18.8 vs. 13). However, college females scored worse than high school female athletes on the BESS (21.1 vs. 16.9).
Most concussions occurred playing football (n=121), according to researchers, followed by women’s soccer (n=30).
“The results of the current study suggest that age and sex should be considered when interpreting the results of symptom reports, [neurocognitive testing], and postural instability assessments following concussion,” the researchers wrote.
Disclosure: The National Operating Committee on Standards for Athletic Equipment funded this study.
Perspective
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As a physician treating pediatric and adolescent concussion who practices both general pediatrics and primary care sports medicine, the results of the study by Covassin and colleagues resonate with what I see clinically in the office setting. There has long been the clinical observation that adolescent athletes appear to have a longer recovery time after concussion than the time frame of 5 to 7 days that has been widely reported in the adult and collegiate concussion literature. In addition, gender differences in rates of concussion recovery have also been observed. This article, with girls appearing to have a prolonged recovery time compared with boys, lends additional credence to that clinical observation.
This article is important for practicing clinicians who see pediatric and adolescent concussions because, as with most things, children are simply not “little adults.” Because most of the eye-catching headlines about concussions are about adult professional athletes, there is often the misperception among adolescent athletes and their families that an adult recovery course of a week is the norm for teenagers — when it is very clearly not the case, especially for the female adolescent athletes.
The results of this article indicate that 14 to 21 days is a realistic time frame for recovery for adolescent concussion and further supports physicians caring for these injured athletes by providing further reinforcement that patience is essential and that recovery from adolescent concussion simply can’t be rushed.
