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Differences in Symptom Reporting Between Males and Females at Baseline and After a Sports-Related Concussion: A Systematic Review and Meta-Analysis

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Abstract

Background

Concussion literature and treatment guidelines are inconclusive regarding the role of sex in symptom reporting at baseline and post-concussion. Although empirical evidence is lacking, it is generally regarded that females have a more severe symptomatic presentation than males at all time-points on the concussion spectrum.

Objectives

Our objective was to determine whether differences exist between males and females at baseline (pre-season/before concussion) or post-concussion for self-reported (1) prevalence of individual symptoms and (2) total symptom scores in high school and college athletes.

Design

Systematic review and meta-analysis of observational cohort studies; level of evidence, 1.

Methods

A computerized search of the PubMed, SPORTDiscus, CINAHL, and Scopus databases was performed. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines were followed. Criteria for inclusion were (1) self-report of symptoms at any time within the concussion spectrum, including baseline and after concussion, (2) study sample included high school and/or collegiate athletes aged 12–26 years, (3) concussions occurred during participation in sport, and (4) symptom reporting was separated by sex. The Quality Assessment Tool for Cohort Studies, Q-Coh, was utilized for quality assessment.

Results

Twenty-one studies met the criteria for inclusion: seventeen had good quality and four, acceptable quality. At baseline, females had significantly higher odds than males of reporting the individual symptoms of vision/hearing problems, headache/migraine, difficulty concentrating, energy/sleep disturbances, and emotional disturbances. Post-concussion, only one symptom demonstrated significant differences between males and females, with females demonstrating lower odds of reporting confusion than males. Statistically, at baseline and post-concussion, females had significantly higher total symptom scores on the Post-Concussion Scale (PCS) and the Sport Concussion Assessment Tool 2 (SCAT2), but when the standard mean difference was interpreted after back-transformation, these results were clinically insignificant.

Conclusions

The symptomatic presentation of males and females, most notably the prevalence of specific symptoms, is very divergent. Females had higher total symptom scores at baseline and post-concussion, however, clinically this cannot be interpreted as a meaningful difference. It is possible that these differences can be explained by normal hormonal changes associated with the menstrual cycle. The implications of these findings are that symptomatic presentation during an individual female’s menstrual cycle needs to be taken into consideration post-concussion when making return-to-play decisions, as returning to a completely asymptomatic level may not be a reasonable expectation.

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References

  1. 2013–2014 High school athletics participation survey. National Federation of State High School Associations; 2014.

  2. Student-athletes. 2014. Available from: http://www.ncaa.org/student-athletes. Accessed 10 Nov 2014.

  3. Langlois JA, Rutland-Brown W, Wald MM. The epidemiology and impact of traumatic brain injury. J Head Trauma Rehabil. 2006;21(5):375–8.

    Article  PubMed  Google Scholar 

  4. McCrory P. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Br J Sports Med. 2013;47:250–8.

    Article  PubMed  Google Scholar 

  5. Harmon KG, Drezner JA, Gammons M. American Medical Society for Sports Medicine position statement: concussion in sport. Br J Sports Med. 2013;47:15–26.

    Article  PubMed  Google Scholar 

  6. Broshek DK, Kaushik T, Freeman JR, et al. Sex differences in outcome following sports-related concussion. J Neurosurg. 2005;102(5):856–63.

    Article  PubMed  Google Scholar 

  7. Colvin AC, Mullen J, Lovell MR. The role of concussion history and gender in recovery from soccer-related concussion. Am J Sports Med. 2009;37:1699–704.

    Article  PubMed  Google Scholar 

  8. Covassin T, Swanik CB, Sachs ML, et al. Sex differences in baseline neuropsychological function and concussion symptoms of collegiate athletes. Br J Sports Med. 2006;40:923–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Covassin T, Swanik CB, Sachs ML. Sex differences and the incidence of concussions among collegiate athletes. J Athletic Training. 2003;38:238–44.

    Google Scholar 

  10. Lidvall HF, Linderoth B, Norlin B. Causes of the post-concussional syndrome. Acta Neurol Scand Suppl. 1974;56:3–144.

    CAS  PubMed  Google Scholar 

  11. Preiss-Farzanegan SJ, Chapman B, Wong TM, et al. The relationship between gender and postconcussion symptoms after sport-related mild traumatic brain injury. PM R. 2009;1:245–53.

    Article  PubMed  Google Scholar 

  12. Rutherford WH. Sequelae of concussion caused by minor head injuries. Lancet. 1977;1:1–4.

    Article  CAS  PubMed  Google Scholar 

  13. Dick RW. Is there a gender difference in concussion incidence and outcomes? Br J Sports Med. 2009;43(Suppl 1):i46–50.

    Article  PubMed  Google Scholar 

  14. Kutcher JS, Eckner JT. At-risk populations in sports-related concussion. Curr Sports Med Rep. 2010;9:16–20.

    Article  PubMed  Google Scholar 

  15. Stroup DF, Berlin JA, Olkin I. Meta-analysis of observational studies in epidemiology: a proposal for reporting. JAMA. 2000;283(15):2008–12.

    Article  CAS  PubMed  Google Scholar 

  16. Huedo-Medina T, Sanchez-Meca J, Martin-Martinez F. Assessing heterogeneity in meta-analysis: Q statistic or I 2 index? The Center for Health, Intervention, and Prevention (CHIP): Digital Commons; 2006.

  17. Higgins J, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58.

    Article  PubMed  Google Scholar 

  18. McClure DJ, Zuckerman SL, Kutscher SJ. Baseline neurocognitive testing in sports-related concussions. Am J Sports Med. 2013;42(2):472–8.

    Article  PubMed  Google Scholar 

  19. Valovich McLeod TC, Bay RC, Lam KC, et al. Representative baseline values on the sport concussion assessment tool 2 (SCAT2) in adolescent athletes vary by gender, grade, and concussion history. Am J Sports Med. 2012;40(4):927–33.

    Article  PubMed  Google Scholar 

  20. Immediate Post-Concussion Assessment Testing (ImPACT) Test: technical manual. Online version 2007 to 2012: ImPACT Applications, Inc.; 2012.

  21. Jarde A, Losilla JM, Vives J. Q-Coh: a tool to screen the methodological quality of cohort studies in systematic reviews and meta-analyses. Int J Clin Health Psychol. 2013;13(2):138–46.

    Article  Google Scholar 

  22. Covassin T, Schatz P, Swanik CB. Sex differences in neuropsychological function and post-concussion symptoms of concussed collegiate athletes. J Neurosurg. 2007;61:345–51.

    Article  Google Scholar 

  23. Covassin T, Elbin RJ, Harris W, et al. The role of age and sex in symptoms, neurocognitive performance, and postural stability in athletes after concussion. Am J Sports Med. 2012;40(6):1303–12.

    Article  PubMed  Google Scholar 

  24. Covassin T, Elbin RJ, Bleeker A, et al. Are there differences in neurocognitive function and symptoms between male and female soccer players after concussion? Am J Sports Med. 2013;41(12):2890–5.

    Article  PubMed  Google Scholar 

  25. Covassin T, Elbin RJ, Larson E, et al. Sex and age differences in depression and baseline sport-related concussion neurocognitive performance and symptoms. Clin J Sports Med. 2012;22(2):98–104.

    Article  Google Scholar 

  26. Majerske CM, Mihalik JP, Ren D, et al. Concussion in sports: postconcussive activity levels, symptoms, and neurocognitive performance. J Athl Train. 2008;43(3):265–74.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Zuckerman S, Solomon GS, Forbes JA, et al. Response to acute concussive injury in soccer players: is gender a modifying factor? J Neurosurg Pediatr. 2012;10(6):504–10.

    Article  PubMed  Google Scholar 

  28. Brooks BL, Mrazik M, Barlow KM, et al. Absence of differences between males and female adolescents with prior sport concussion. J Head Trauma Rehabil. 2014;29(3):257–64.

    Article  PubMed  Google Scholar 

  29. Schneider KJ, Emery CA, Kang J, et al. Examining sport concussion assessment tool ratings for male and female youth hockey players with and without a history of concussion. Br J Sports Med. 2010;44:1112–7.

    Article  PubMed  Google Scholar 

  30. Mihalik JP, Register-Mihalik J, Kerr ZY, et al. Recovery of posttraumatic migraine characteristics in patients after mild traumatic brain injury. Am J Sports Med. 2013;41(7):1490–6.

    Article  PubMed  Google Scholar 

  31. Jinguji TM, Bompadre V, Harmon KG, et al. Sport Concussion Assessment Tool-2: baseline values for high school athletes. Br J Sports Med. 2012;46(5):365–70.

    Article  PubMed  Google Scholar 

  32. Schatz P, Neidzwski K, Moser RS, et al. Relationship between subjective test feedback provided by high-school athletes during computer-based assessment of baseline cognitive functioning and self-reported symptoms. Arch Clin Neuropsychol. 2010;25(4):285–92.

    Article  PubMed  Google Scholar 

  33. Kontos AP, Dolese A, Elbin RJ. Relationship of soccer heading to computerized neurocognitive performance and symptoms among female and male youth soccer players. Brain Inj. 2011;25(12):1234–41.

    Article  PubMed  Google Scholar 

  34. Shehata N, Wiley JP, Richea S, et al. Sport Concussion Assessment Tool: baseline values for varsity collision sport athletes. Br J Sports Med. 2009;43(10):730–4.

    Article  CAS  PubMed  Google Scholar 

  35. Kontos AP, Elbin RJ, Schatz P, et al. A revised factor structure for the Post-Concussion Symptom Scale: baseline and postconcussion factors. Am J Sports Med. 2012;40(10):2375–84.

    Article  PubMed  Google Scholar 

  36. Leach CA, Bay RC, Valovich McLeod TC. Baseline self-report symptoms and health-related quality of life in high school athletes: influence of sex and prior concussion history. Athletic Train Sports. Health Care. 2012;5(3):115–22.

    Google Scholar 

  37. Lovell MR, Iverson GL, Collins MW, et al. Measurement of symptoms following sports-related concussion: reliability and normative data for the post-concussion scale. Appl Neuropsychol. 2006;13(3):166–74.

    Article  PubMed  Google Scholar 

  38. Frommer LJ, Gurka KK, Cross KM, et al. Sex differences in concussion symptoms of high school athletes. J Athl Train. 2011;46(1):76–84.

    Article  PubMed Central  PubMed  Google Scholar 

  39. Castile L, Collins CL, McIlvain NM, et al. The epidemiology of new versus recurrent sports concussions among high school athletes, 2005-2010. Br J Sports Med. 2012;46:603–10.

    Article  PubMed  Google Scholar 

  40. Schmelzer K, Ditzen B, Weisec C. Clinical profiles of premenstrual experiences among women having premenstrual syndrome (PMS): affective changes predominate and relate to social and occupational functioning. Health Care Women Int. 2014;00:1–20.

    Article  Google Scholar 

  41. Freeman EW, Halberstadt SM, Rickels K. Core symptoms that discriminate premenstrual syndrome. J Women Health. 2011;20(1):29–35.

    Article  Google Scholar 

  42. Ishii C, Kazuko Nishino L, Herrerias de Campos CA. Vestibular characterization in the menstrual cycle. Braz J Otorhinolaryngol. 2009;75(3):375–80.

    Article  PubMed  Google Scholar 

  43. Caras ML. Estrogenic modulation of auditory processing: a vertebrate comparison. Front Neuroendocrinol. 2013;34(4):285–99.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  44. Bazarian JJ, Blyth B, Mookerjee S, et al. Sex differences in outcome after mild traumatic brain injury. J Neurotrauma. 2010;27:527–39.

    Article  PubMed Central  PubMed  Google Scholar 

  45. Wunderle K, Hoeger KM, Wasserman S, et al. Menstrual phase as a predictor of outcome after mild traumatic brain injury in women. J Head Trauma Rehabil. 2013;29(5):E1–8.

    Article  Google Scholar 

  46. Berz K, Divine J, Foss KB, et al. Sex-specific differences in the severity of symptoms and recovery rate following sports-related concussion in young athletes. Phys Sportsmed. 2013;41(2):58–63.

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors of this paper would like to thank Jonathan Ford for his contributions in the identification of potential journal articles to be included in this review, and librarian, Shirley Lewis, for her assistance in the database search.

Compliance with ethical standards

None of the authors of this manuscript have a financial conflict of interest associated with this work. No funding was received in association with this project.

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Authors and Affiliations

  1. Division of Health Sciences, Physical Therapy Program, Walsh University, 2020 E Maple Street, North Canton, OH, 44720, USA

    Dana A. Brown, Julie A. Elsass, Ashley J. Miller, Lauren E. Reed & Jennifer C. Reneker

  2. Department of Biostatistics, Epidemiology and Environmental Health Sciences, College of Public Health, Kent State University, Kent, OH, USA

    Jennifer C. Reneker

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  1. Dana A. Brown
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Correspondence to Jennifer C. Reneker.

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Brown, D.A., Elsass, J.A., Miller, A.J. et al. Differences in Symptom Reporting Between Males and Females at Baseline and After a Sports-Related Concussion: A Systematic Review and Meta-Analysis. Sports Med 45, 1027–1040 (2015). https://doi.org/10.1007/s40279-015-0335-6

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  • DOI: https://doi.org/10.1007/s40279-015-0335-6

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