scholarly journals Clinical Recovery Timelines following Sport-Related Concussion in Men's and Women's Collegiate Sports

2021 ◽  
Author(s):  
Abigail C. Bretzin ◽  
Carrie Esopenko ◽  
Bernadette A. D'Alonzo ◽  
Douglas J. Wiebe
Keyword(s):  
Sex Differences ◽  
Median Time ◽  
Female Athletes ◽  
Symptom Duration ◽  
Athletic Activity ◽  
Collegiate Sports ◽  
Ivy League ◽  
Big Ten ◽  
Symptom Resolution ◽  
Full Activity

Abstract Context: Past work has identified sex differences in sport-related concussion (SRC) incidence and recovery time; however, few have examined sex differences in specific recovery trajectories: time to symptom resolution, return-to-academics, and return-to-athletic activity across collegiate sports. Objective: To examine sex differences in SRC recovery trajectories across a number of varsity sports with differing levels of contact. Design: Descriptive Epidemiology Study. Setting: College varsity and club sports. Patients or Other Participants: SRCs sustained by student-athletes (N=1,974; 38.7% female) participating in Ivy League sports were tracked from 2013/14-2018/19. Intervention(s): Athletic trainers collected concussive injury and recovery characteristics as part of the Ivy League-Big Ten Epidemiology of Concussion Study's surveillance system. Main Outcome Measure(s): Time to symptom resolution, return-to-academics, and return-to-limited and full athletic activity were collected. Survival analyses determined time from injury to each recovery outcome for males and females by sport. Peto tests compared recovery outcomes between males and female athletes and by sport. Results: The median time to symptom resolution overall was 9 days [IQR:4,18], return-to-academics was 8 days [IQR:3,15], return-to-limited activity was 12 days [IQR:8,23], and return-to-full activity was 16 days [IQR:10,29]. There were significant differences overall between sexes for median time to symptom resolution (males: 8 days [IQR:4,17], females: 9 days [IQR:5,20], p=0.029) and return-to-academics (males: 7 days [IQR:3,14], females: 9 days [IQR:4,17], p<.001), but not return to athletics (limited activity, p=0.107; full activity, p=0.578). Within-sport comparisons found that female lacrosse athletes had longer symptom resolution (p=0.030) and return to academics (p=0.035) compared to males, while male volleyball athletes took longer to return to limited (p=0.020) and full (p=0.049) athletic activity compared to females. Conclusion: There were significant differences in recovery timelines between sexes. Females experienced longer symptom duration and time to return-to-academics compared to male athletes, but females and males presented similar timelines for return-to-athletics.

The Ivy League–Big Ten Epidemiology of Concussion Study: A Report on Methods and First Findings

2019 ◽  
Vol 47 (5) ◽  
pp. 1236-1247 ◽  
Author(s):  
Margot Putukian ◽  
Bernadette A. D’Alonzo ◽  
Carolyn S. Campbell-McGovern ◽  
Douglas J. Wiebe
Keyword(s):  
Student Athletes ◽  
Return To Sport ◽  
Median Number ◽  
University Student ◽  
Ice Hockey ◽  
American Football ◽  
Ivy League ◽  
Big Ten ◽  
Symptom Resolution ◽  
N 93

Background: Little is known about the nature of concussion injury among university student-athletes, including concussion incidence and rates across sports, the mechanisms of injury, the type of activity during competition or practice, and the time to return to academics, return to sport, and symptom resolution. Purpose: To describe methods of the Ivy League–Big Ten Epidemiology of Concussion Study and first epidemiologic findings. Study Design: Descriptive epidemiology study. Methods: A prospective cohort study was conducted with data accrued through a surveillance system that was launched in the 2013-2014 athletic season. Surveillance continues to operate by detecting and collecting sport-related concussion (SRC) cases and non-SRC cases in addition to outcomes among university student-athletes. Results: A total of 1922 cases of SRC (649 women, 1004 men) among athletes from 27 sports, including varsity sports and club rugby, were enrolled during the 5 athletic seasons from 2013-2014 through 2017-2018. American football had the most cases (n = 495, 25.8%), followed by women’s rugby (n = 199, 6.2%), men’s ice hockey (n = 106, 5.5%), men's lacrosse (n = 105, 5.5%), women's soccer (n = 103, 5.4%), wrestling (n = 93, 4.8%), and men's soccer (n = 89, 4.6%), and women's ice hockey (n = 78, 4.1%). The highest overall concussion rates occurred in women’s lacrosse (1.35 concussions per 1000 athletic exposures [AEs]) and football (1.26 per 1000 AEs). Rates of concussion were generally higher during competition than practice and were highest during wrestling competition (4.06 per 1000 AEs) and second highest during football competition (3.68 per 1000 AEs). The median number of concussion symptoms was 7. Time to symptom resolution was longer for athletes with ≥7 symptoms versus <7 ( P < .001) but did not differ across the 4 sports with rules comparable by sex and did not differ significantly between women and men (median, 8 vs 9 days, respectively). Women and men did not differ in days to return to academics, exertion activities, or competition. Conclusion: This multisite collaborative endeavor has produced a robust database yielding novel opportunities to better understand the epidemiology of concussion among university student-athletes participating in a variety of sports. Given the setting and number of cases, these findings add to our understanding of SRC and are the first of many that will be generated over the coming years from this large study that continues in its sixth year.

scholarly journals Sex Differences in Exercise-Induced Bronchoconstriction in Athletes: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 17 (19) ◽  
pp. 7270
Author(s):  
Daniel Enrique Rodriguez Bauza ◽  
Patricia Silveyra
Keyword(s):  
Sex Differences ◽  
Female Athletes ◽  
Meta Analysis ◽  
Sexually Dimorphic ◽  
Atopic Status ◽  
Management Plans ◽  
Disease Experience ◽  
Males And Females ◽  
Male Sex ◽  
Exercise Induced

Exercise-induced bronchoconstriction (EIB) is a common complication of athletes and individuals who exercise regularly. It is estimated that about 90% of patients with underlying asthma (a sexually dimorphic disease) experience EIB; however, sex differences in EIB have not been studied extensively. With the goal of better understanding the prevalence of EIB in males and females, and because atopy has been reported to occur at higher rates in athletes, in this study, we investigated sex differences in EIB and atopy in athletes. A systematic literature review identified 60 studies evaluating EIB and/or atopy in post-pubertal adult athletes (n = 7501). Collectively, these studies reported: (1) a 23% prevalence of EIB in athletes; (2) a higher prevalence of atopy in male vs. female athletes; (3) a higher prevalence of atopy in athletes with EIB; (4) a significantly higher rate of atopic EIB in male vs. female athletes. Our analysis indicates that the physiological changes that occur during exercise may differentially affect male and female athletes, and suggest an interaction between male sex, exercise, and atopic status in the course of EIB. Understanding these sex differences is important to provide personalized management plans to athletes with underlying asthma and/or atopy.

scholarly journals CLINICAL PREDICTORS OF SYMPTOM RESOLUTION FOR CHILDREN AND ADOLESCENTS WITH SPORT-RELATED CONCUSSION

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0000
Author(s):  
David R. Howell ◽  
Morgan N. Potter ◽  
Michael W. Kirkwood ◽  
Pamela E. Wilson ◽  
Aaron Provance ◽  
...  
Keyword(s):  
Sports Medicine ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Outcome Variable ◽  
Symptom Duration ◽  
Symptom Resolution ◽  
Gaze Stability ◽  
Headache Severity ◽  
Romberg Test ◽  
Tandem Gait

Background: Early prognosis of expected recovery duration after a sport-related concussion is a challenging task for sports medicine clinicians, as various pre-morbid, injury characteristic, and functional factors have been identified to help predict recovery. The purpose of this investigation was to determine which variables obtained as a part of a routine concussion clinical evaluation were independently associated with symptom resolution time among pediatric patients evaluated after sport-related concussion by a sports medicine physician. Methods: We conducted an analysis of data collected from a prospective clinical registry of children with concussion. Patients included in the current investigation were seen for care at a pediatric sports medicine concussion clinic between January 1, 2015 to August 31, 2017, were less than 19 years of age, evaluated within 10 days of a sport-related concussion, and followed until they no longer reported symptoms. The primary outcome variable was the number of days from injury until symptom resolution. The predictor variables included those assessed during the initial clinical evaluation. They were obtained via a medical history form (pre-injury history of attention-deficit/hyperactivity disorder, learning disability, anxiety, depression, and migraine or headaches), the Health and Behavior Inventory (HBI) symptom frequency questionnaire, headache severity rating (rated on a scale from 0-10), sleep disturbance questionnaire, and performance on a set of balance, vestibular, and oculomotor function tests (Balance Error Scoring System, Romberg, tandem gait, gaze stability, and near point of convergence). Tests were considered abnormal if patients could not maintain balance or demonstrated exaggerated upper body movement (Romberg/tandem gait tests), if they reported symptom provocation after test administration (gaze stability), or if the near point of convergence was greater than 5 cm from the tip of the nose. To identify the independent factors associated with symptom resolution time, we first constructed univariate Cox proportional models with time to symptom resolution as the outcome and each clinical variable as a separate predictor variable. Predictor variables with a univariate significance level of p < 0.05 were then used to construct a multivariate Cox proportional hazards model where total duration of concussion symptoms remained the outcome variable. Results: We examined data from 351 children and adolescents (mean age= 14.6±2.2 years, 33% female, evaluated 5.6±2.6 days after concussion) who required a median of 11.5 [interquartile range= 7-21] days for symptom resolution. One hundred and sixty-three (46%) of patients reported a prior history of concussion, while other pre-injury health conditions were reported less often (Table 1). The most commonly endorsed symptoms by patients at the initial visit were headaches, difficulty paying attention, difficulty concentrating, and getting distracted easily (Table 2). The most common abnormal vestibular or oculomotor test was symptom provocation brought on by gaze stability testing, while 20% of patients had an abnormal Romberg test, 15% demonstrated abnormal tandem gait, and 15% had abnormal near point of convergence (Table 3). Results from univariate Cox proportional hazards models indicated headache severity, headache frequency, confusion, forgetfulness, attentional difficulties, trouble remembering, getting tired often, getting tired easily, dizziness, and an abnormal Romberg test were associated with a longer symptom duration (Tables 2 and 3). The multivariate Cox proportional hazard model indicated that an abnormal Romberg test was independently associated with a longer symptom duration after adjusting for the effect of all other covariates included in the model (Table 4 and Figure 1). Headache frequency and “being tired easily” were not included in the final model due to collinearity with headache severity and “being tired a lot”, respectively. Conclusions: For adolescent and child patients assessed within 10 days of concussion, an abnormal Romberg test was independently associated with longer symptom duration during recovery. This is in line with other recent studies investigating early predictors of symptom resolution, demonstrating that postural instability appears to provide valuable prognostic information for sports medicine clinicians. [Table: see text]

Identifying Persistent Postconcussion Symptom Risk in a Pediatric Sports Medicine Clinic

2018 ◽  
Vol 46 (13) ◽  
pp. 3254-3261 ◽  
Author(s):  
David R. Howell ◽  
Roger Zemek ◽  
Anna N. Brilliant ◽  
Rebekah C. Mannix ◽  
Christina L. Master ◽  
...  
Keyword(s):  
Risk Score ◽  
Sports Medicine ◽  
Risk Scores ◽  
Secondary Outcome ◽  
Symptom Duration ◽  
Clinical Risk Score ◽  
Symptom Resolution ◽  
Sports Concussion ◽  
Clinical Risk ◽  
Pediatric Sports Medicine

Background: Although most children report symptom resolution within a month of a concussion, some patients experience persistent postconcussion symptoms (PPCS) that continues for more than 1 month. Identifying patients at risk for PPCS soon after an injury can provide useful clinical information. Purpose: To determine if the Predicting Persistent Post-concussive Problems in Pediatrics (5P) clinical risk score, an emergency department (ED)–derived and validated tool, is associated with developing PPCS when obtained in a primary care sports concussion setting. Study Design: Cohort study; Level of evidence, 3. Methods: We conducted a study of patients seen at a pediatric sports medicine concussion clinic between May 1, 2013, and October 1, 2017, who were <19 years of age and evaluated within 10 days of a concussion. The main outcome was PPCS, defined as symptoms lasting >28 days. Nine variables were used to calculate the 5P clinical risk score, and we assessed the association between the 5P clinical risk score and PPCS occurrence. The secondary outcome was total symptom duration. Results: We examined data from 230 children (mean age, 14.8 ± 2.5 years; 50% female; mean time from injury to clinical assessment, 5.6 ± 2.7 days). In univariable analyses, a greater proportion of those who developed PPCS reported feeling slowed down (72% vs 44%, respectively; P < .001), headache (94% vs 72%, respectively; P < .001), sensitivity to noise (71% vs 43%, respectively; P < .001), and fatigue (82% vs 51%, respectively; P < .001) and committed ≥4 errors in tandem stance (33% vs 7%, respectively; P < .001) than those who did not. Higher 5P clinical risk scores were associated with increased odds of developing PPCS (adjusted odds ratio [OR], 1.62 [95% CI, 1.30-2.02]) and longer symptom resolution times (β = 8.40 [95% CI, 3.25-13.50]). Among the individual participants who received a high 5P clinical risk score (9-12), the majority (82%) went on to experience PPCS. The area under the curve for the 5P clinical risk score was 0.75 (95% CI, 0.66-0.84). After adjusting for the effect of covariates, fatigue (adjusted OR, 2.93) and ≥4 errors in tandem stance (adjusted OR, 7.40) were independently associated with PPCS. Conclusion: Our findings extend the potential use for an ED-derived clinical risk score for predicting the PPCS risk into the sports concussion clinic setting. While not all 9 predictor variables of the 5P clinical risk score were independently associated with the PPCS risk in univariable or multivariable analyses, the combination of factors used to calculate the 5P clinical risk score was significantly associated with the odds of developing PPCS. Thus, obtaining clinically pragmatic risk scores soon after a concussion may be useful for early treatments or interventions to mitigate the PPCS risk.

scholarly journals Effect of Athletic Activity on Hormone Levels in High School Female Athletes

2013 ◽  
Vol 1 (4_suppl) ◽  
pp. 2325967113S0011
Author(s):  
Edward M. Wojtys ◽  
Mary L. Jannausch ◽  
Jennifer L. Kreinbrink ◽  
Maryfran R. Sowers
Keyword(s):  
High School ◽  
Female Athletes ◽  
Athletic Activity ◽  
Hormone Levels

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.

Sex Differences in Sports-Related Concussion

2015 ◽  
Author(s):  
Jesse G. Brand ◽  
Heidi R. Rossetti ◽  
Donna K. Broshek
Keyword(s):  
Traumatic Brain Injury ◽  
Sex Differences ◽  
Brain Injury ◽  
Cognitive Outcomes ◽  
Return To Play ◽  
Symptom Reporting ◽  
Future Research ◽  
Female Participation ◽  
Symptom Resolution ◽  
Growing Body

Sex differences in sports-related concussion are the focus of a growing body of literature. This chapter discusses the increasing rates of female participation in sport, briefly addresses sex differences in traumatic brain injury (TBI), as well as physical sex differences and their impact on sports-related concussion. Several discrepancies in sports regulations and playing style between sexes that have been implicated in differing rates of sports-related concussion are also discussed. Variations in symptom reporting between the sexes and sex differences in cognitive outcomes of sports-related concussion are also addressed. Sex differences in symptom resolution and time to return to play are presented. Finally, limitations of this literature are identified and suggestions for future research are provided.

Intraarticular Injuries Associated with Anterior Cruciate Ligament Tear: Findings at Ligament Reconstruction in High School and Recreational Athletes

2003 ◽  
Vol 31 (4) ◽  
pp. 601-605 ◽  
Author(s):  
Dana P. Piasecki ◽  
Kurt P. Spindler ◽  
Todd A. Warren ◽  
Jack T. Andrish ◽  
Richard D. Parker
Keyword(s):  
High School ◽  
Anterior Cruciate Ligament ◽  
Sex Differences ◽  
Ligament Reconstruction ◽  
Female Athletes ◽  
Cruciate Ligament ◽  
Mechanism Of Injury ◽  
Meniscal Tears ◽  
Basketball Players ◽  
Anterior Cruciate

Background Despite research on the increased risk of anterior cruciate ligament tears in female athletes, few studies have addressed sex differences in the incidence of associated intraarticular injuries. Hypothesis When patients are stratified by sport and competition level, no sex differences exist in either the mechanism of injury or pattern of intraarticular injuries observed at anterior cruciate ligament reconstruction. Study Design Prospective cohort study. Methods Two hundred twenty-one athletes undergoing anterior cruciate ligament reconstruction met our inclusion criteria of anterior cruciate ligament tear as a singular event without reinjury or history of prior injury or surgery in either knee. Data were collected on competition level (high school, amateur), sport (basketball, soccer, skiing), mechanism of injury, articular cartilage injuries, and meniscal tears. Data were statistically analyzed by sex with the chi-square test and Student's t-test. Results High school athletes had no significant sex differences in mechanism of injury. Female soccer athletes had fewer medial meniscal tears than did male athletes, and female basketball players had fewer medial femoral condyle injuries. At the amateur level, female basketball players had more contact injuries, an earlier onset of swelling, and fewer lateral meniscal tears than did male players. Conclusion At the high school level, male and female athletes shared a common mechanism of injury, and yet the female athletes had fewer intraarticular injuries in basketball and soccer. If such intraarticular injuries prove to be a significant risk factor for poor long-term outcome, women may enjoy a better prognosis after reconstruction.

The Effects of Sex Differences and Hormonal Contraception on Outcomes after Collegiate Sports-Related Concussion

2018 ◽  
Vol 35 (11) ◽  
pp. 1242-1247 ◽  
Author(s):  
Virginia Gallagher ◽  
Natalie Kramer ◽  
Kristin Abbott ◽  
John Alexander ◽  
Hans Breiter ◽  
...  
Keyword(s):  
Sex Differences ◽  
Hormonal Contraception ◽  
Collegiate Sports

scholarly journals Sex Differences in Reported Concussion Injury Rates and Time Loss From Participation: An Update of the National Collegiate Athletic Association Injury Surveillance Program From 2004–2005 Through 2008–2009

2016 ◽  
Vol 51 (3) ◽  
pp. 189-194 ◽  
Author(s):  
Tracey Covassin ◽  
Ryan Moran ◽  
R. J. Elbin
Keyword(s):  
Sex Differences ◽  
National Collegiate Athletic Association ◽  
Female Athletes ◽  
Epidemiologic Studies ◽  
Injury Surveillance ◽  
Ice Hockey ◽  
Surveillance Program ◽  
Time Loss ◽  
Basketball Players ◽  
Injury Rates

Epidemiologic studies have identified differences in concussion incidence between the sexes. However, few authors to date have updated injury rates (IRs) and time loss between male and female concussed athletes.Context: To examine sex differences in IRs and time loss in concussed National Collegiate Athletic Association (NCAA) athletes.Objective: Descriptive epidemiologic study.Design: National Collegiate Athletic Association athletics.Setting: A total of 1702 concusssed NCAA athletes, consisting of 903 females and 779 males participating in soccer, basketball, ice hockey, lacrosse, softball, or baseball over a 5-year period from 2004–2005 through 2008–2009.Patients or Other Participants: Using the NCAA Injury Surveillance Program, athletic trainers reported concussions, athlete-exposures (AEs), and time loss across 10 NCAA sports. An IR is the number of injuries in a particular category divided by the number of AEs in that category.Main Outcome Measure(s): During the study period, 1702 concussions were reported during 4 170 427 AEs for an overall total of 5.47 per 10 000 AEs. In sex-comparable sports, females had a 1.4 times higher overall concussion IR than males (IRs = 4.84 and 3.46, respectively), with greater rates in women's baseball/softball, basketball, ice hockey, and soccer than men. Female soccer and basketball players also displayed more time loss after concussion compared with male basketball and soccer players.Results: Female athletes sustained a higher rate of concussion and, in all sports except lacrosse, had greater time loss from concussion than male athletes. Additional research is needed on sex differences in time loss after concussions.Conclusions:

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