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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
  1. Christina L Master1,2,3,
  2. Barry P Katz4,
  3. Kristy B Arbogast2,3,
  4. Michael A McCrea5,
  5. Thomas W McAllister6,
  6. Paul F Pasquina7,
  7. Michelle Lapradd4,
  8. Wenxian Zhou4,
  9. Steven P Broglio8
  10. CARE Consortium Investigators
    1. 1Orthopaedics and Sports Medicine, Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
    2. 2Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
    3. 3Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
    4. 4Biostatisics, Indiana University School of Medicine, Indianapolis, Indiana, USA
    5. 5Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
    6. 6Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
    7. 7Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland, USA
    8. 8Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
    1. Correspondence to Dr Christina L Master, Orthopaedics and Sports Medicine, Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104-4399, USA; masterc{at}chop.edu

    Abstract

    Objectives To examine sex differences in sport-related concussion (SRC) across comparable sports.

    Methods Prospective cohort of collegiate athletes enrolled between 2014 and 2017 in the Concussion Assessment, Research and Education Consortium study.

    Results Among 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).

    Conclusion Overall, 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.

    • concussion
    • female
    • gender
    • male
    • sports analysis in different types of sports
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    Footnotes

    • Twitter @drtinamaster

    • Contributors CLM made substantial contributions to the conception of the study, the acquisition and interpretation of data, drafting the work, revising it critically for important intellectual content, providing final approval of the version published and is accountable for all aspects of the work. BK, ML and WZ made substantial contributions to the conception of the study, the analysis and interpretation of data, revising it critically for important intellectual content and providing final approval of the version published. KBA, MAMC, TMA, PFP and SB made substantial contributions to the conception of the study, the acquisition and interpretation of data, revising the manuscript critically for important intellectual content, providing final approval of the version published and are accountable for all aspects of the work. CARE Consortium investigators HJB, MAB, TAB, KC, JC, MWC, SD, JTE, CAE, LF, CG, JG, MNH, AH, JCJ, TWK, LAK, AK, LL, GTMG, JPM, JM, CM, JO, NP, MP, SR, JDS, AJS and SJS made substantial contributions to the acquisition of data, revising it critically for important intellectual content and providing final approval of the version published.

    • Funding This publication was made possible, in part, by support from the Grand Alliance Concussion Assessment, Research and Education (CARE) Consortium, funded by the National Collegiate Athletic Association (NCAA) and the Department of Defense (DoD). The US Army Medical Research Acquisition Activity, Fort Detrick, MD is the awarding and administering acquisition office. This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs through the Psychological Health and Traumatic Brain Injury Program under award number W81XWH-14-2-0151.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

    • Patient consent for publication Not required.

    • Ethics approval This study was approved by the Human Research Protection Office and the Institutional Review Boards at each participating institution.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request.

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