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Concussions in Sports: Does Gender Matter?

Active area of research, but remains murky, with general trends but few definitive answers

A factor in concussion management?

The Consensus Statement on Concussion in Sport issued by the 4th International Conference on Concussion in Sport [12] held in Zurich in November 2012 "accepted that gender may be a risk factor for injury and/or influence injury severity" but did not list female gender as a possible modifier in the management of concussions because there was no "unanimous agreement that the current published research evidence is conclusive."   

The 2012 study in the American Journal of Sports Medicine,[4] however, recommended that gender be considered by clinicians when interpreting the results of symptom reports, neurocognitive testing, and postural instability assessments (e.g. BESS) following concussion.

The authors of the 2012 Vanderbilt study [8] cautioned against interpreting their results as indicating that there is no gender-based difference in acute response (symptoms or neurocognitive scores) to concussive injury in high school athletes, or that gender should always be considered a modifying factor in managing a concussion.  Instead, they were supported the interim position taken by the Zurich consensus statement [12] that gender may be a risk factor for injury and/or influence injury severity.

1. Gessel LM. Fields SK. Collins CL. Dick RW. Comstock RD. Concussions among United States high school and collegiate athletes. J. Athl Train. 2007; 42(4): 495-503.

2. Frommer L, Gurka K, Cross K, Ingersoll C, Comstock R.D., Saliba S. Sex Differences in Concussion Symptoms of High School Athletes. J. Ath. Train, 2011; 46(1):000-000.

3. Colvin AC, Mullen J, Lovell MR, West RV, Collins MW, Groh M. The Role of Concussion History and Gender in Recovery from Soccer-Related Concussion.  Am. J. Sports Med. 2009; 37(9): 1699-1704.

4. Covassin T, Elbin R, Harris W, Parker T, Kontos A. The Role of Age and Sex in Symptoms, Neurocognitive Performance, and Postural Stability in Athletes After Concussion. Am. J. Sports Med. 2012;20(10); published on April 26, 2012 at doi:10.117703654651244454

5. Broshek D et. al. Sex differences in outcome following sports-related concussion. J Neurosurg. 2005;102(5):856-863.

7. Covassin T, Schatz P, Swanik C. Sex differences in neuropsychological function and post-concussion symptoms of concussed collegiate athletes.  Neurosurgery 2007:61:345-351.

8. Zuckerman SL, Solomon GS, Forbes JA, Haase RF, Sills AK, Lovell MR.  Response to acute concussive injury in soccer players: is gender a modifying factor?  J Neurosurg: Pediatrics 2012; DOI:10.3171/2012.8.PEDS12139 (published online ahead of print October 2, 2012)(accessed October 15, 2012). 

9. Covassin T, Swanik CB, Sachs M, Kendrick Z, Schatz P, Zillmer E, et. al. Sex differences in basesline neuropsychological function and concussion symptoms of concussed collegiate athletes.  Br J Sports Med 2006;40:923-927. 

10. Broshek DK, Kaushik T, Freeman JR, Erlanger D, Webbe F, Barth JT. Sex differences in outcome follwoing sports-related concussion.  J Neurosurg 2005;102:856-863.

11.  Weiss E, Kemmler G, Deisenhammer E, Fleischhacker W, Delazer M. Sex differences in cognitive functions.  Pers Individ Dif 2003;35:863-875.

12.  McCrory P, et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012.  Br J Sports Med 2013; 47:250-258.

13.  Giza CC, Hovda DA, The Neurometabolic Cascade of Concussion. J. Ath Train 2001;36(3):228-235.

14. Tierney R, Sitler M, Swanik C, et al. Gender differences in head-neck segment dynamic stabilization during head acceleration. Med Sci Sports Exerc 2005;37:272-279. 

15.  Makdissi M, Davis G, Jordan B, Patricios J, Purcell L, Putakian M.  Revisiting the modifiers: how should the evaluation and management of acute concussions differ in specific groups? Br J Sports Med 2013;47:314-320.

16. Cantu R, Hyman M. Concussion and Our Kids (Houghton Mifflin Harcourt 2012)

17. Register-Mihalik JK, Guskiewicz KM, Valovich McLeod TC, Linnan LA, Meuller FO, Marshall SW.  Knowledge, Attitude, and Concussion-Reporting Behaviors Among High School Athletes: A Preliminary Study.  J Ath Tr. 2013;48(3):000-000. DOI:10.4085/1062-6050-48.3.20 (published online ahead of print)

18. McCrea M, Hammeke T, Olsen G, Leo P, Guskiewicz K. Unreported concussion in high school football players: implications for prevention. Clin J Sport Med. 2004;14(1):13-17.

19. Echlin PS, Tator CH, Cusimano MD, et al. A prospective study of physician-observed concussions during junior ice hockey: implications for incidence rates.  Neurosurgery Focus. 2010;29(5):E4.

20. Delaney JS, Lacroix VJ, Leclerc S, Johnston KM. Concuission among university football and soccer players.  Clin J Sport Med 2002;12(6):331-338.

21. Ferguson RW. Safe Kids Worldwide Analysis of CPSC NEISS data, 2013.

22, Ferguson RW. Safe Kids Worldwide Analysis of CPSC NEISS data, 2013, cited in Ferguson RW, Green A, Hansen LM. Game Changers: Stats, Stories and What Communities Are Doing to Protect Young Athletes.  Washington, DC: Safe Kids Worldwide, August 2013.

Updated to include a video of Dr. Covassin's SmartTeam Talk on December 15, 2014