Sex differences in outcome following sports-related concussion

University of Virginia, Charlottesville, Virginia, United States
Journal of Neurosurgery (Impact Factor: 3.74). 06/2005; 102(5):856-63. DOI: 10.3171/jns.2005.102.5.0856
Source: PubMed

ABSTRACT 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.
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).
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.

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    • "Alternatively, it is conceivable that children with pre-existing learning problems were more likely to have working memory difficulties, and thus be falsely identified as non-credible performers using the CMS Numbers subtest. More generally, as seen in prior research (Broshek et al., 2012; Covassin et al., 2006; Ryan & Warden, 2003), females in our study were more likely than males to present with greater self-and parent-reported post-concussion symptoms, regardless of effort group status (i.e., credible or non-credible). Age was also positively correlated with number of post-concussion symptoms among children in both effort groups, after accounting for baseline symptoms. "
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    ABSTRACT: This retrospective chart review study explored the relationship between suboptimal effort and post-concussion symptoms in pediatric mild traumatic brain injury (mTBI). Participants were 382 clinically referred children and adolescents between 8 and 16 years of age who sustained an mTBI. Suboptimal effort was identified using reliable digit span and age-corrected scaled scores from the Numbers subtest of the Children's Memory Scale (CMS); 20% of the sample were classified as non-credible performers. Chi-square analyses and t-tests were used to examine differences in post-concussion symptoms and neuropsychological test performance between credible and non-credible performers. Linear regression was used to examine whether CMS Numbers performance predicted post-concussion symptoms after controlling for baseline symptoms and other relevant demographic- and injury-related factors. We found that non-credible performers presented with a greater number of post-concussion symptoms as compared with credible performers. Additionally, non-credible performers demonstrated comparatively poorer performance on neuropsychological tests of focused attention and processing speed. These results suggest that children and adolescents with mTBI who fail effort testing might have a greater tendency to exaggerate post-concussion symptoms and cognitive impairment. The clinical implications of these findings are discussed.
    The Clinical Neuropsychologist 03/2014; 28(5). DOI:10.1080/13854046.2014.896415 · 1.72 Impact Factor
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    • "Reports of sex differences in neuropsychological deficits have also revealed mixed findings, with some authors reporting greater impairment for concussed females in some neurocognitive domains (Broshek et al. 2005; Colvin et al. 2009) and others appearing to report no injury-related sex differences in neuropsychological functioning (e.g., sex differences in neuropsychological performance reported by Covassin et al. 2007, 2012 reflected main effects of sex across pre-and post-injury time points and therefore did not appear to be injury related). A large meta-analysis of 3,801 concussed athletes and 5,631 controls found greater post-concussive neuropsychological deficits in females at their first postinjury assessment (1–10 days after injury) after accounting for time since injury, comparison group (personal baseline vs. controls), and age group (Dougan et al. 2013). "
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    ABSTRACT: Concussion is a highly prevalent injury in contact and collision sports that has historically been poorly understood. An influx of sport-concussion research in recent years has led to a dramatic improvement in our understanding of the injury's defining characteristics and natural history of recovery. In this review, we discuss the current state of knowledge regarding the characteristic features of concussion and typical acute course of recovery, with an emphasis on the aspects of functioning most commonly assessed by clinicians and researchers (e.g., symptoms, cognitive deficits, postural stability). While prototypical clinical recovery is becoming better understood, questions remain regarding what factors (e.g., injury severity, demographic variables, history of prior concussions, psychological factors) may explain individual variability in recovery. Although research concerning individual differences in response to concussion is relatively new, and in many cases limited methodologically, we discuss the evidence about several potential moderators of concussion recovery and point out areas for future research. Finally, we describe how increased knowledge about the negative effects of and recovery following concussion has been translated into clinical guidelines for managing concussed athletes.
    Neuropsychology Review 11/2013; 23(4). DOI:10.1007/s11065-013-9240-7 · 4.59 Impact Factor
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    • "As females are generally more proficient than males at reading and interpreting expressional and emotional cues [43], they may also be at greater risk for discrimination against those with minor impairments . The heightened sensitivity that females retain for social relationships may actually contribute to their increased risk for depression, anxiety and loneliness after a TBI [29] [44]. Conversely, mTBI males reared with sham animals demonstrated less impairment in their social play behaviour indicating that the reduced sensitivity to subtle social cues may actually serve as a protective factor for males. "
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