Sports Related Concussions: Gender Related Differences

Dr. Scott L. Zuckerman, MD Department of Neurological Surgery Vanderbilt Sports Concussion Interview with:
Dr. Scott L. Zuckerman, MD
Department of Neurological Surgery
Vanderbilt Sports Concussion Center What are the main findings of the study?

Dr. Zuckerman: Our study evaluated 244 athletes who suffered sports-related concussion (SRC), 122 males and 122 females, and assessed for gender differences in number, severity, and resolution of post-concussive symptoms using reliable change index (RCI) methodology applied to days to return to symptom baseline. Both groups were matched on number of prior concussions, age, and days to first post-concussion assessment, which consisted of the 22 symptom Post Concussion Symptom Checklist  from the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) evaluation tool.
Our results showed little significant variation of individual symptoms between genders; however, females experienced more total symptoms at baseline and post-concussion. Moreover, concussed female athletes took an average of 2 days longer to return to their pre-concussion symptom profile compared to concussed male athletes. Were any of the findings unexpected?

Dr. Zuckerman: Yes and no. We were not sure what to expect, as there are well done studies both supporting and refuting gender differences in symptoms after sports-related concussion. It is also fairly well established that females report more symptoms before and after sports-related concussion. In that respect, our findings were not surprising. However, it was interesting to find that females took 2 days longer to return to symptom baseline. Do we know why this is? Not exactly, but we must keep in mind that though aspects of these symptomatic gender differences are statistically significant, inherent gender reporting biases must be taken in context when interpretingthese types of results. What should clinicians and patients take away from your report?

Dr. Zuckerman: It is important to draw conclusions that do not overstate your results. The wrong conclusion to draw from our study is that females take longer to recover from sports concussion and suffer more severe effects than males. That conclusion is simply too grand to claim validly. However, we can say that in our cohort of 244 athletes, it appeared that males and females reported similar types of symptoms after sports-related concussion, though females reported a higher number of symptoms before and after concussion, and took approximately 2 days longer to return to their symptom baseline. What recommendations do you have for future research as a result of this study?

Dr. Zuckerman:  Further research is needed in delineating clinical outcome difference between males and females and what is gender reporting bias. Are females simply more vocal/honest about their symptoms? Are males more stoic? Studies, such as ours, cannot tease this difference out, but this nuance is essential in learning more about the complex process of sports-related concussion.


Effect of sex on symptoms and return to baseline in sport-related concussion

Journal of Neurosurgery: Pediatrics
Jan 2014 / Vol. 13 / No. 1 / Pages 72-81

Jan 2014 / Vol. 13 / No. 1 / Pages 72-81Scott L. Zuckerman, M.D., Rachel P. Apple, M.D., Mitchell J. Odom, B.S., Young M. Lee, B.S.P.H., Gary S. Solomon, Ph.D., and Allen K. Sills, M.D.