Sex Specific Post-concussion Symptom Reporting in Adolescents: A Systematic Review and Meta-analysis
Previous research indicates that concussion symptom presentation is population specific, with differences based upon patients’ sex and age. Awareness of signs and symptoms of concussion in youth and high school sports has improved in recent years. However, it is still widely unknown if sex specific differences emerge in adolescent populations, as the majority of research been performed on collegiate athletes or has combined adolescent and adult concussion patient populations. Identification of sex specific differences in adolescent concussion symptoms, or lack thereof, would aid in concussion diagnosis and management. Therefore, the objective of the current meta-analysis and systematic review was to evaluate the literature and determine if a relationship exists in post-concussion symptom reporting between male and female adolescent athletes. An extensive search of PubMed, SPORT Discs, Web of Knowledge, Cochrane Library, ProQuest and Google Scholar was undertaken. Search terms were based on the individual database. Studies meeting inclusionary criteria underwent quality assessment. A total of three articles met inclusionary criteria and were deemed of high methodological quality. The meta-analysis examined differences in symptoms reported between sexes in 1421 adolescent athletes (770 males, 669 females). A significantly higher percentage of females reported concentration difficulty, drowsiness, visual disturbance, and sensitivity to noise compared to males. Males reported more amnesia and irritability than females. The results of the current meta-analysis indicate differences in the presentation of commonly reported post-concussion symptoms between the male and female adolescents.
KeywordsConcussion symptoms Youth sports Sex differences Gender differences
Thank you to Xan Goodman for her assistance as a reference librarian for this systematic review.
JD conceived of the study, participated in its design and coordination, performed data collection and analysis, and drafted the manuscript; DF participated in the study design, performed the statistical analysis, and interpretation of the data; TG participated in the study design and coordination of the study, and interpretation of the data; KR conceived of the study, participated in its design and coordination, performed data collection and analysis, and drafted the manuscript. All authors read and approved the final manuscript.
Compliance with ethical standards
Conflict of interest
The authors have no conflicts of interest to disclose.
- Berz, K., Divine, J., Foss, K. B., Heyl, R., Ford, K. R., & Myer, G. D. (2013). Sex-specific differences in the severity of symptoms and recovery rate following sports-related concussion in young athletes. The Physician and Sportsmedicine, 41(2), 58–63. https://doi.org/10.3810/psm.2013.05.2015.CrossRefGoogle Scholar
- Broglio, S. P., Cantu, R. C., Gioia, G. A., Guskiewicz, K. M., Kutcher, J., & Palm, M. (2014). National Athletic Trainer’s. National Athletic Trainers’ Association position statement: management of sport concussion. Journal of Athletic Training, 49(2), 245–265. https://doi.org/10.4085/1062-6050-49.1.07. A.CrossRefGoogle Scholar
- Brown, D. A., Elsass, J. A., Miller, A. J., Reed, L. E., & Reneker, J. C. (2015). Differences in symptom reporting between males and females at baseline and after a sports-related concussion: A systematic review and meta-analysis. Sports Medicine, 45(7), 1027–1040. https://doi.org/10.1007/s40279-015-0335-6.CrossRefGoogle Scholar
- Chalabaev, A., Sarrazin, P., Fontayne, P., Boiche, J., & Clement-Guillotin, C. (2013). The influence of sex stereotypes and gender roles on participation and performance in sport and exercise: Review and future directions. Psychology of Sport and Exercise, 14(2), 136–144. https://doi.org/10.1016/j.psychsport.2012.10.005.CrossRefGoogle Scholar
- Covassin, T., Elbin, R. J., Bleecker, A., Lipchik, A., & Kontos, A. P. (2013). Are there differences in neurocognitive function and symptoms between male and female soccer players after concussions? The American Journal of Sports Medicine, 41(12), 2890–2895. https://doi.org/10.1177/0363546513509962.CrossRefGoogle Scholar
- Covassin, T., Elbin, R. J., Harris, W., Parker, T., & Kontos, A. (2012). The role of age and sex in symptoms, neurocognitive performance, and postural stability in athletes after concussion. The American Journal of Sports Medicine, 40(6), 1303–1312. https://doi.org/10.1177/0363546512444554.CrossRefGoogle Scholar
- Covassin, T., Swanik, C. B., & Sachs, M. L. (2003). Sex differences and the incidence of concussions among collegiate athletes. Journal of Athletic Training, 38(3), 238–244.Google Scholar
- Lee, Y. M., Odom, M. J., Zuckerman, S. L., Solomon, G. S., & Sills, A. K. (2013). Does age affect symptom recovery after sports-related concussion? A study of high school and college athletes. Journal of Neurosurgery: Pediatrics, 12(6), 537–544. https://doi.org/10.3171/2013.7.PEDS12572.Google Scholar
- Lincoln, A. E., Caswell, S. V., Almquist, J. L., Dunn, R. E., Norris, J. B., & Hinton, R. Y. (2011). Trends in concussion incidence in high school sports: a prospective 11-year study. The American Journal of Sports Medicine, 39(5), 958–963. https://doi.org/10.1177/0363546510392326.CrossRefGoogle Scholar
- McCrory, P., Meeuwisse, W. H., Aubry, M., Cantu, R. C., Dvorak, J., Echemendia, R. J., Turner, M. (2013). Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport, Zurich, November 2012. Journal of Athletic Training, 48(4), 554–575. https://doi.org/10.4085/1062-6050-48.4.05.CrossRefGoogle Scholar
- Wells, G. A., O’Connell, S. B., Peterson, D., Welch, J., Losos, V., & Tugwell, M. P. (2005). The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Retrieved March 1, 2016, from http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
- Zuckerman, S. L., Lee, Y. M., Odom, M. J., Solomon, G. S., Forbes, J. A., & Sills, A. K. (2012). Recovery from sports-related concussion: Days to return to neurocognitive baseline in adolescents versus young adults. Surgical Neurology International, 3, 130. https://doi.org/10.4103/2152-7806.102945.CrossRefGoogle Scholar
- Zuckerman, S. L., Lee, Y. M., Odom, M. J., Solomon, G. S., & Sills, A. K. (2013). Baseline neurocognitive scores in athletes with attention deficit-spectrum disorders and/or learning disability. Journal of Neurosurgery: Pediatrics, 12(2), 103–109. https://doi.org/10.3171/2013.5.PEDS12524.Google Scholar