Sex Differences in Concussion Symptoms of High School Athletes

Here is a brief overview of the article out of the newest Journal of Athletic Training. I suggest you take a chance to read the entire article. It’s free to NATA members!

Frommer LJ, Gurka KK, Cross KM, Ingersoll CD, Comstock RD, Saliba SA. Journal of Athletic Training. Sex Differences in Concussion Symptoms of High School Athletes. 2011; 46(1):76-84.

An estimated 1.6-3.8 million sport-related concussions are reported each year with about 21% of those being high school athletes. The occurrence of injury in female athletes has continued to rise with the increase in sports participation and females have a higher incidence rate than males of sport-related concussions.

Research has shown that females may respond to concussions differently than males. Females tended to fare worse than male counterparts leading to longer hospitalizations, longer disability, and higher mortality rates. Females also require greater monitoring and more aggressive treatment due to symptoms not aligning with Glascow Coma Scale.

Hormones are believed to be a factor in the response to head trauma. Females tended to be more cognitively impaired after a sport-related concussion.

Males tended to report amnesia and confusion as a primary symptom more often than females. Females reported drowsiness and sensitivity to noise more often than males.

Males often returned to play 7-9 days post-injury while females had a greater percentage returning 3-6 days after a concussion.

This data is representative of what is actually taking place in the high school setting rather than in a research lab.

The outcomes of this study show there is little difference in severity of concussions between the two sexes, but it appears they present with different types of symptoms. Males reported more cognitive symptoms while females reported more neurobehavioral and somatic symptoms.

6 thoughts on “Sex Differences in Concussion Symptoms of High School Athletes

  1. athletic training consultants January 28, 2011 / 13:11

    I have a hard time believing that adolescent athletes RTP 7-9 days after sports related concussion and they were completely sx free in 3 days. Most sx’s do not clear in adolescents until 7-10 days. If the Zurich protocol is followed to a T then the average RTP would be around 27 days if that athlete was completely sx free and they completed neurocognitive testing with each rehab stage with no returning sx’s. This study seems to be flawed in many ways. If you really want to see if these athlete really healed pull all their academic records Pre, during and post injury and then see if they returned to homeostasis.

  2. Michael Hopper January 28, 2011 / 15:20

    I was reading through this article and tried to pull out some highlights. Some of those lit me up as well.. I couldn’t believe the RTP with some of it. Now, I do believe this study was conducted prior to the newest Zurich Statement so it’s using some older research.

    I find it hard to believe that the average RTP for a concussion should be nearly 4 weeks. I think it will definitely be hard to advocate for that in the absence of symptoms. If there are signs and symptoms present, I think it’s easy to hold an athlete out. If the signs and symptoms allow it though, RTP would be much earlier.

    • athletic training consultants January 28, 2011 / 20:15

      My point is quite clear, when there is neurocognitive testing the research clearly states that average RTP is 27 days when following the Zurich rehabilitation protocol. I manage 30-35 MBTI’s each year that is 5% of my athletic population and the average return to play is 27.5 days. If an athletic trainer does not have access to neurocognitive testing and is clearly relying on SCATII and subjective sx reporting then I can see RTP being less. That being said each of these cases should be responded to on a case by case basis and we should not just rely on neurocognitive testing as the final determinate but a tool to help us better our understanding of this injury and help us when making judgements with our athletes.

  3. Michael Hopper January 29, 2011 / 00:02

    Agree with you.. each case has to be evaluated on an individual basis. I don’t have a lot of experience with IMPact testing or anything of that sort. I have used the SCAT 2 forms, but I’m not sold on that either.

    Right or wrong, this research concluded that their participants RTP was within 10 days. That’s what this particular research says. There could be other research out there that did not find that to be the case. As a clinician, we have to look at each thing individually and decide what is best.

    My point is at this time, it’s difficult for us to tell an athlete who is asymptomatic that s/he should sit out nearly 4 weeks. It’s not like an ACL tear where there is likely instability and an inability to cut, etc. Or a muscle strain where there is weakness. While athletes may not like it, they can see the deficiencies. With a concussion, those deficiencies are much more difficult to see and realistically judge.

    That said, 3 days RTP is nuts. Especially at the high school level, there is no reasonable explanation for allowing an athlete to RTP after a concussion that quickly. We know the brain does not heal that fast. And most RTP protocols that I’ve seen require 72 hours asymptomatic before even beginning the progression back. I expect an athlete with a concussion to miss a minimum of 6-7 days. MINIMUM.

    • Andrew Rizza January 29, 2011 / 12:17

      My point exactly you are relying on a subjective finding with your athletes. Every athlete that I have had the pleasure of working with from secondary school to professional would lie, cheat and steal to get back onto a playing field. Symptoms take anywhere from 24 hrs in some athletes to weeks if not months to subside. I have seen more of my fare share of concussion over the years and the best tool we have to help make the right clinical assessment with our athletes is ImPact testing. I have had athletes that are symptom free for weeks with the first two stages of rehab and when we get to stage three and are increasing there exertion levels they either have returning symptoms or we see a reliable index change within their ImPact test. We also find that when athletes require increased demand with academics such as high stakes testing or demanding analytics they once again become symptomatic. This is why I stress that the ImPact test is a very crucial part of the evaluative process. It take all the guess work out of the timing of RTP. Academics is a large focus with our kids so return to normalcy is key as I would think most all people would want. I have had a student that was top of his class going to Stanford and deferred a year due to symptoms that kept re-occurring for over 1 yr. So as I have stated previously this is always a case by case basis, Ive had kids be full cleared of symptoms and RTP in 2 week and some that have taken a year. If you look at most of the current research that is out they are pointing towards the reliability of using SCATII and ImPact for safe RTP.

      Just curious what are you using to assess your athletes if you are not using ImPact of SCAT II


  4. Michael Hopper January 29, 2011 / 13:01

    At this point, we’re using the SCAT 2 forms. That’s what I have the most experience with (and that is limited). We used IMPACT in college, but I don’t have much personal experience with it because as a student we weren’t involved with the administration.

    While I use the SCAT 2 forms, the jury is still out with regards to what any of it means. It specifically states that on the form. And so it is a useful tool, but it’s only a tool. The clinician must be able to use that tool as a part of the evaluation and not expect it to be THE evaluation.

    I was on the IMPACT website earlier today and saw they offer a free webinar to learn more about the program. I am going to try to go through that soon to learn more about it..

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