Sex differences in outcome following sports-related concussion

2005 ◽  
Vol 102 (5) ◽  
pp. 856-863 ◽  
Author(s):  
Donna K. Broshek ◽  
Tanya Kaushik ◽  
Jason R. Freeman ◽  
David Erlanger ◽  
Frank Webbe ◽  
...  
Keyword(s):  
Sex Differences ◽  
Subjective Experience ◽  
Female Athletes ◽  
Collegiate Athletes ◽  
Cognitive Change ◽  
Return To Play ◽  
Cognitive Test ◽  
Content Type ◽  
Baseline Levels ◽  
Fine Print

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.

Posttraumatic migraine characteristics in athletes following sports-related concussion

2005 ◽  
Vol 102 (5) ◽  
pp. 850-855 ◽  
Author(s):  
Jason P. Mihalik ◽  
Jamie E. Stump ◽  
Michael W. Collins ◽  
Mark R. Lovell ◽  
Melvin Field ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Visual Memory ◽  
Collegiate Athletes ◽  
Return To Play ◽  
Motor Speed ◽  
Neurocognitive Deficits ◽  
Neurocognitive Dysfunction ◽  
Content Type ◽  
Symptom Status ◽  
Fine Print

Object. The object of this study was to compare symptom status and neurocognitive functioning in athletes with no headache (non-HA group), athletes complaining of headache (HA group), and athletes with characteristics of posttraumatic migraine (PTM group). Methods. Neurocognitive tests were undertaken by 261 high-school and collegiate athletes with a mean age of 16.36 ± 2.6 years. Athletes were separated into three groups: the PTM group (74 athletes with a mean age of 16.39 ± 3.06 years), the HA group (124 athletes with a mean age of 16.44 ± 2.51 years), and the non-HA group (63 patients with a mean age of 16.14 ± 2.18 years). Neurocognitive summary scores (outcome measures) for verbal and visual memory, visual motor speed, reaction time, and total symptom scores were collected using ImPACT, a computer software program designed to assess sports-related concussion. Significant differences existed among the three groups for all outcome measures. The PTM group demonstrated significantly greater neurocognitive deficits when compared with the HA and non-HA groups. The PTM group also exhibited the greatest amount of departure from baseline scores. Conclusions. The differences among these groups can be used as a basis to argue that PTM characteristics triggered by sports-related concussion are related to increased neurocognitive dysfunction following mild traumatic brain injury. Thus, athletes suffering a concussion accompanied by PTM should be examined in a setting that includes symptom status and neurocognitive testing to address their recovery more fully. Given the increased impairments observed in the PTM group, in this population clinicians should exercise increased caution in decisions about treatment and when the athlete should be allowed to return to play.

scholarly journals Sex Differences in Time to Return-to-Play Progression After Sport-Related Concussion

2016 ◽  
Vol 9 (1) ◽  
pp. 41-44 ◽  
Author(s):  
Sarah Stone ◽  
Bobby Lee ◽  
J. Craig Garrison ◽  
Damond Blueitt ◽  
Kalyssa Creed
Keyword(s):  
Sex Differences ◽  
Sport Participation ◽  
Clinical Decision Making ◽  
Female Athletes ◽  
Collegiate Athletes ◽  
Sports Participation ◽  
American Football ◽  
Return To Play ◽  
Male Athletes ◽  
History Of

Background: Recently, female sports participation has increased, and there is a tendency for women to experience more symptoms and variable presentation after sport-related concussion (SRC). The purpose of this study was to determine whether sex differences exist in time to begin a return-to-play (RTP) progression after an initial SRC. Hypothesis: After initial SRC, female athletes (11-20 years old) would take longer to begin an RTP progression compared with age-matched male athletes. Study Design: Retrospective cohort study. Level of Evidence: Level 3. Methods: A total of 579 participants (365 males [mean age, 15.0 ± 1.7 years], 214 females [mean age, 15.2 ± 1.5 years]), including middle school, high school, and collegiate athletes who participated in various sports and experienced an initial SRC were included and underwent retrospective chart review. The following information was collected: sex, age at injury, sport, history of prior concussion, date of injury, and date of initiation of RTP progression. Participants with a history of more than 1 concussion or injury sustained from non–sport-related activity were excluded. Results: Despite American football having the greatest percentage (49.2%) of sport participation, female athletes took significantly longer to start an RTP progression after an initial SRC (29.1 ± 26.3 days) compared with age-matched male athletes (22.7 ± 18.3 days; P = 0.002). Conclusion: On average, female athletes took approximately 6 days longer to begin an RTP progression compared with age-matched male athletes. This suggests that sex differences exist between athletes, aged 11 to 20 years, with regard to initiation of an RTP progression after SRC. Clinical Relevance: Female athletes may take longer to recover after an SRC, and therefore, may take longer to return to sport. Sex should be considered as part of the clinical decision-making process when determining plan of care for this population.

Symptom-based assessment of the severity of a concussion

2003 ◽  
Vol 98 (3) ◽  
pp. 477-484 ◽  
Author(s):  
David Erlanger ◽  
Tanya Kaushik ◽  
Robert Cantu ◽  
Jeffrey T. Barth ◽  
Donna K. Broshek ◽  
...  
Keyword(s):  
Empirical Support ◽  
Return To Play ◽  
Neurocognitive Testing ◽  
Duration Of Symptoms ◽  
Content Type ◽  
Memory Problems ◽  
Management Protocol ◽  
History Of ◽  
Fine Print

Object. Current grading systems of concussion and return-to-play guidelines have little empirical support. The authors therefore examined the relationships of the characteristics and symptoms of concussion and the history of concussion to three indicators of concussion severity—number of immediate symptoms, number of symptoms at the initial follow-up examination, and duration of symptoms—to establish an empirical basis for grading concussions. Methods. Forty-seven athletes who sustained concussions were administered alternate forms of an Internet-based neurocognitive test until their performances were within normal limits relative to baseline levels. Assessments of observer-reported and self-reported symptoms at the sideline of the playing field on the day of injury, and at follow-up examinations were also obtained as part of a comprehensive concussion management protocol. Although loss of consciousness (LOC) was a useful indicator of the initial severity of the injury, it did not correlate with other indices of concussion severity, including duration of symptoms. Athletes reporting memory problems at follow-up examinations had significantly more symptoms in general, longer durations of those symptoms, and significant decreases in scores on neurocognitive tests administered approximately 48 hours postinjury. This decline of scores on neurocognitive testing was significantly associated with an increased duration of symptoms. A history of concussion was unrelated to the number and duration of symptoms. Conclusions. This paper represents the first documentation of empirically derived indicators of the clinical course of postconcussion symptom resolution. Self-reported memory problems apparent 24 hours postconcussion were robust indicators of the severity of sports-related concussion and should be a primary consideration in determining an athlete's readiness to return to competition. A decline on neurocognitive testing was the only objective measure significantly related to the duration of symptoms. Neither a brief LOC nor a history of concussion was a useful predictor of the duration of postconcussion symptoms.

scholarly journals Return to play following a sports concussion: The “added value” of post-exertion assessment

Neurology ◽  
2018 ◽  
Vol 91 (23 Supplement 1) ◽  
pp. S7.3-S8
Author(s):  
Veronik Sicard ◽  
Jean-Christophe Lortie ◽  
Robert Davis Moore ◽  
Dave Ellemberg
Keyword(s):  
Statistical Significance ◽  
Collegiate Athletes ◽  
Physical Exertion ◽  
Added Value ◽  
Return To Play ◽  
Cognitive Test ◽  
Average Score ◽  
Maximal Heart Rate ◽  
Post Exercise ◽  
Full Contact

Decision of return to play (RTP) after a concussion is critical given the potential consequences of premature RTP. Athletes should not be cleared for full contact activity until they demonstrate normal cognitive functioning on both rest and post-exertion assessments. Accordingly, this study aimed to examine post-exertion cognitive performance in asymptomatic collegiate athletes who were cleared to return-to-play. Twenty-two recently concussed athletes who completed step 4 of Zurich's RTP protocol and 39 teammate controls participated in the study. They completed a Switch task before and after an acute bout of moderate cardiovascular exercise (80%–85% maximal predicted maximal heart rate for 20-minute) on an ergocycle. Based on their performance on both conditions (Rest, Post-exertion), concussed athletes were categorized into the Pass or Fail group. Specifically, they were placed in the Fail group if their performance was 2 SD lower than the control group's average score. A χ2 test was used to test for equality of proportions between conditions. Although, the proportion of athletes categorized in the Fail group was higher in post-exercise (31.82%) relative to rest (22.73%), it did not reach statistical significance (χ2 = 0.20, p = 0.66). Irrespective of condition, 45% of concussed athletes were categorized in the Fail group. Of these, 10% failed on both conditions, 13% failed on rest only, and 22% failed on post-exercise. The current study suggests that 1 out of 2 athletes who successfully completed the RTP protocol exhibited diminished cognitive functions compared to controls. The use of a sensitive cognitive test, combined with physical exertion, can prevent premature RTP in identifying athletes would have otherwise received medical clearance.

Differences in sport-related concussion for female and male athletes in comparable collegiate sports: a study from the NCAA-DoD Concussion Assessment, Research and Education (CARE) Consortium

2020 ◽  
pp. bjsports-2020-103316
Author(s):  
Christina L Master ◽  
Barry P Katz ◽  
Kristy B Arbogast ◽  
Michael A McCrea ◽  
Thomas W McAllister ◽  
...  
Keyword(s):  
Sex Differences ◽  
Collegiate Athletes ◽  
Return To Play ◽  
Extrinsic Factors ◽  
Contact Sports ◽  
Recovery Times ◽  
Division Ii ◽  
Concussion Recovery ◽  
Research And Education ◽  
Assessment Research

ObjectivesTo examine sex differences in sport-related concussion (SRC) across comparable sports.MethodsProspective cohort of collegiate athletes enrolled between 2014 and 2017 in the Concussion Assessment, Research and Education Consortium study.ResultsAmong 1071 concussions (females=615; 57.4%), there was no difference in recovery (median days to full return to play) (females=13.5 (IQR 9.0, 23.1) vs males=11.8 (IQR 8.1, 19.0), p=0.96). In subgroup analyses, female recovery was longer in contact (females=12.7 days (IQR 8.8, 21.4) vs males=11.0 days (IQR 7.9, 16.2), p=0.0021), while male recovery was longer in limited contact sports (males=16.9 days (IQR 9.7, 101.7) vs females=13.8 days (IQR 9.1, 22.0), p<0.0001). There was no overall difference in recovery among Division I schools (females=13.7 (IQR 9.0, 23.1) vs males=12.2 (IQR 8.2 19.7), p=0.5), but females had longer recovery at the Division II/III levels (females=13.0 (IQR 9.2, 22.7) vs males=10.6 (IQR 8.1, 13.9), p=0.0048).ConclusionOverall, no difference in recovery between sexes across comparable women’s and men’s sports in this collegiate cohort was found. However, females in contact and males in limited contact sports experienced longer recovery times, while females had longer recovery times at the Division II/III level. These disparate outcomes indicate that, while intrinsic biological sex differences in concussion recovery may exist, important, modifiable extrinsic factors may play a role in concussion outcomes.

scholarly journals The Influence of Hormonal Contraceptives on Cognitive Recovery in Concussed Collegiate Athletes: Data from the NCAA-DoD CARE Consortium

Neurology ◽  
2019 ◽  
Vol 93 (14 Supplement 1) ◽  
pp. S14.3-S15
Author(s):  
Jacob Kay ◽  
Andrew Lapointe ◽  
Thomas McAllister ◽  
Michael McCrea ◽  
Steven Broglio ◽  
...  
Keyword(s):  
Verbal Memory ◽  
Female Athletes ◽  
Clinical Symptoms ◽  
Collegiate Athletes ◽  
Neurological Status ◽  
Return To Play ◽  
Hormonal Contraceptives ◽  
Cognitive Efficiency ◽  
Concussion Recovery ◽  
The Impact

ObjectiveTo longitudinally examine the relation between hormonal contraceptives and concussion recovery. We hypothesized that female athletes using hormonal contraceptives would exhibit faster recovery times and smaller post-injury alterations in neurological status, cognition, and clinical symptoms than female athletes not using hormonal contraceptives.BackgroundResearch indicates sex may moderate concussion outcomes, with some females experiencing protracted recovery relative to males. It is hypothesized that fluctuations of sex hormones lead to poorer outcomes in these females. Thus, female athletes taking hormonal contraceptives may exhibit better recovery than their un-medicated counterparts, as their hormone levels are artificially stabilized.Design/MethodsData from the NCAA-DOD Grand Alliance: Concussion Assessment, Research, and Education (CARE) Consortium were used to evaluate female athletes who were (n = 50) and were not (n = 50) taking hormonal contraceptives. Baseline assessments were completed prior to athletes’ sport season. Athletes were re-assessed 24–48 hours post-concussion, and again at the unrestricted return-to-play. Length of recovery was defined as days between injury and the unrestricted return-to-play. Neurological status was measured using the Standardized Assessment of Concussion (SAC). Cognitive function and clinical symptoms were measured using the ImPACT test. Participants were matched on age, sex, body mass index, sport, and concussion history.ResultsNo group differences in length of recovery were observed (p > 0.05). Across all timepoints, analyses revealed main effects of group for concentration (SAC; p = 0.04), verbal memory (ImPACT; p = 0.03), and cognitive efficiency (ImPACT; p = 0.01). No differences in change scores (relative to baseline) were observed between groups.ConclusionsThe current results suggest that hormonal contraceptives do not influence concussion recovery. However, irrespective of injury status, our findings indicate that females on hormonal contraceptives may exhibit better concentration, working memory, and cognitive efficiency.

Neurocognitive efficiency following left temporal lobectomy: standard versus limited resection

1993 ◽  
Vol 79 (1) ◽  
pp. 76-83 ◽  
Author(s):  
Ronald L. Wolf ◽  
Robert J. Ivnik ◽  
Kathryn A. Hirschorn ◽  
Frank W. Sharbrough ◽  
Gregory D. Cascino ◽  
...  
Keyword(s):  
Extent Of Resection ◽  
Cognitive Change ◽  
Cognitive Outcome ◽  
Temporal Lobectomy ◽  
Seizure Onset ◽  
Content Type ◽  
Lateral Cortex ◽  
Intractable Seizures ◽  
Temporal Structures ◽  
Fine Print

✓ Decreased memory and learning efficiency may follow left temporal lobectomy. Debate exists as to whether the acquired deficit is related to the size of the surgical resection. This study addresses this question by comparing changes in cognitive performance to the extent of resection of both mesial temporal structures and lateral cortex. The authors retrospectively reviewed 47 right-handed patients who underwent left temporal lobectomy for medically intractable seizures. To examine the effects of the extent of mesial resection, the patients were divided into two groups: those with resection at the anterior 1 to 2 cm of mesial structures versus those with resection greater than 2 cm. To examine the effects of the extent of lateral cortical resection, patients were again divided into two groups: those with lateral cortex resections of 4 cm or less versus those with resections greater than 4 cm. Statistical analyses showed no difference in cognitive outcome between the groups defined by the extent of mesial resection. Likewise, no difference in cognitive outcome was seen between the groups defined by the extent of lateral cortical resection. Associated data analyses did, however, reveal a negative correlation of cognitive change with patient age at seizure onset. These results showed that the neurocognitive consequences of extended mesial resections were similar to those of limited mesial resections, and that the neurocognitive consequences of extended lateral cortical resections were similar to those of limited lateral cortical resections. The risk of cognitive impairment depends more on age at seizure onset than on the extent of mesial or lateral resection.

Recovery from mild concussion in high school athletes

2003 ◽  
Vol 98 (2) ◽  
pp. 296-301 ◽  
Author(s):  
Mark R. Lovell ◽  
Michael W. Collins ◽  
Grant L. Iverson ◽  
Melvin Field ◽  
Joseph C. Maroon ◽  
...  
Keyword(s):  
High School ◽  
Mental Status ◽  
Test Performance ◽  
Neuropsychological Test ◽  
Return To Play ◽  
Control Group ◽  
High School Athletes ◽  
Post Injury ◽  
Content Type ◽  
Fine Print

Object. A computerized neuropsychological test battery was conducted to evaluate memory dysfunction and self-reporting of symptoms in a group of high school athletes who had suffered concussion. Methods. Neuropsychological performance prior to and following concussion was compared with the test performance of an age-matched control group. Potentially important diagnostic markers of concussion severity are discussed and linked to recovery within the 1st week of injury. Conclusions. High school athletes who had suffered mild concussion demonstrated significant declines in memory processes relative to a noninjured control group. Statistically significant differences between preseason and postinjury memory test results were still evident in the concussion group at 4 and 7 days postinjury. Self-reported neurological symptoms such as headache, dizziness, and nausea resolved by Day 4. Duration of on-field mental status changes such as retrograde amnesia and posttraumatic confusion was related to the presence of memory impairment at 36 hours and 4 and 7 days post-injury and was also related to slower resolution of self-reported symptoms. The results of this study suggest that caution should be exercised in returning high school athletes to the playing field following concussion. On-field mental status changes appear to have prognostic utility and should be taken into account when making return-to-play decisions following concussion. Athletes who exhibit on-field mental status changes for more than 5 minutes have longer-lasting postconcussion symptoms and memory decline.

SEX DIFFERENCES IN NEUROPSYCHOLOGICAL FUNCTION AND POST-CONCUSSION SYMPTOMS OF CONCUSSED COLLEGIATE ATHLETES

Neurosurgery ◽  
2007 ◽  
Vol 61 (2) ◽  
pp. 345-351 ◽  
Author(s):  
Tracey Covassin ◽  
Philip Schatz ◽  
C. Buz Swanik
Keyword(s):  
Sex Differences ◽  
Visual Memory ◽  
Female Athletes ◽  
Multivariate Analyses ◽  
Neuropsychological Test ◽  
Collegiate Athletes ◽  
Reliable Change ◽  
Main Effect ◽  
Composite Scores ◽  
The Impact

Abstract OBJECTIVE Our purpose was to determine whether sex differences exist with respect to post-concussion symptoms and neurocognitive function in concussed collegiate athletes. METHODS A prospective dependent-sample cohort design was used to compare baseline and post-concussion neuropsychological test scores and endorsed symptoms as functions of serial post-concussion assessment with respect to time and sex. The Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) battery was administered to a multicenter analysis group of 79 concussed athletes. This computerized neuropsychological test was given to the athletes during the preseason and, on average, 2 and 8 days postinjury. RESULTS Multivariate analyses revealed no significant between-group differences on baseline test performance with respect to sex on any of the ImPACT composite scores or on the total symptom score. Multivariate analyses of post-concussion data revealed a significant main effect of time on ImPACT scores, but no main effect of sex was identified, and no time-by-sex interaction existed. Post hoc analysis revealed that concussed female athletes performed significantly worse than concussed male athletes on visual memory tasks (P = 0.001), and analysis of endorsed post-concussion symptoms revealed that concussed men were significantly more likely than concussed women to report post-concussion symptoms of vomiting (P = 0.001) and sadness (P = 0.017). Athletes' scores were examined individually using the reliable-change methodology. At 2 days post-injury, 58% of concussed athletes had one or more reliable incidents of performance decline or increases in symptom reporting. At 8 days post-concussion, 30% of concussed athletes were still showing one or more reliable change from preseason values. CONCLUSIONS College athletes exhibit differences on visual memory composite scores and symptoms post-concussion as a function of sex. These data support the importance of evaluating neuropsychological status and post-concussion symptoms in concussed athletes. In addition, these data illustrate the importance of analyzing an individual athlete's recovery pattern, because individual differences in recovery trajectories may be overshadowed by global norm-group comparisons.

scholarly journals Male Sex Predicts Higher Depression Scores Among Healthy Collegiate Athletes

Neurology ◽  
2019 ◽  
Vol 93 (14 Supplement 1) ◽  
pp. S10.2-S10
Author(s):  
Jessie Oldham ◽  
Francis Wang ◽  
Brant Berkstresser ◽  
Corey Lanois ◽  
William Meehan ◽  
...  
Keyword(s):  
Mental Health ◽  
Female Athletes ◽  
Depression Scale ◽  
Collegiate Athletes ◽  
Return To Play ◽  
Anxiety And Depression ◽  
Male And Female ◽  
Concussion History ◽  
Male Sex ◽  
Independent Association

ObjectiveTo 1) investigate differences in baseline scores on the Hospital Anxiety and Depression Scale (HADS) between male and female athletes and 2) examine the influence of concussion history on baseline HADS scores.BackgroundAlthough post-concussion differences between sexes have been documented, whether male and female athletes differ in reporting mental health outcomes and how concussion history may influence scores remains to be fully investigated. Since athletes may experience anxiety and depression after a concussion, screening prior to the beginning of an athletic season (baseline) may identify those who are prone to post-concussion mental health disturbances.Design/MethodsOne hundred fifty-two collegiate athletes (86 males, 66 females) completed a HADS assessment during baseline testing. Each participant also reported the number of diagnosed concussions he or she previously sustained. We used independent samples t-tests to compare baseline HADS scores between male and female athletes, and a multiple linear regression to examine the relationship between baseline HADS scores, sex, and concussion history.ResultsFemale athletes reported significantly lower HADS depression scores at baseline compared to males (Females: 0.92 ± 1.49, Males: 1.77 ± 2.22, F = 2.78, p = 0.01). There were no significant sex differences in HADS anxiety scores (Females: 4.53 ± 2.80, Males: 4.51 ± 2.84, F = 0.02, p = 0.97), but both sexes had higher anxiety outcomes than depression. There was an independent association between higher HADS depression scores and male sex (β = −0.84, p = 0.01; 95% CI = −1.47, −0.21), but not concussion history (β = −0.09, p = 0.66, 95% CI = −0.51, 0.33). Neither sex nor concussion history were significantly associated with HADS anxiety scores.ConclusionsFemale athletes reported lower levels of depression at baseline than males. Concussion history did not appear to influence anxiety or depression baseline scores. Psychological measures could be evaluated, both at baseline and prior to post-concussion return to play, to help identify those who may need more focused monitoring of mental health.

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