Sex Specific Post-concussion Symptom Reporting in Adolescents: A Systematic Review and Meta-analysis

  • Jessica Dunn
  • Du Feng
  • Tedd J. Girouard
  • Kara N. RadzakEmail author
Systematic Review


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.


Concussion symptoms Youth sports Sex differences Gender differences 



Thank you to Xan Goodman for her assistance as a reference librarian for this systematic review.

Authors’ Contributions

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.


  1. 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. Scholar
  2. Blume, H. K. (2018). Posttraumatic headache in pediatrics: an update and review. Current Opinion in Pediatrics. Scholar
  3. 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. A.CrossRefGoogle Scholar
  4. Broshek, D. K., Kaushik, T., Freeman, J. R., Erlanger, D., Webbe, F., & Barth, J. T. (2005). Sex differences in outcome following sports-related concussion. Journal of Neurosurgery, 102(5), 856–863. Scholar
  5. 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. Scholar
  6. 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. Scholar
  7. Chrisman, S. P., Rivara, F. P., Schiff, M. A., Zhou, C., & Comstock, R. D. (2013). Risk factors for concussive symptoms 1 week or longer in high school athletes. Brain Injury, 27(1), 1–9. Scholar
  8. Comstock, R. D., Currie, D. W., Pierpoint, L. A., Grubenhoff, J. A., & Fields, S. K. (2015). An evidence-based discussion of heading the ball and concussions in high school soccer. JAMA Pediatrics, 169(9), 830–837. Scholar
  9. 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. Scholar
  10. 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. Scholar
  11. 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
  12. Field, M., Collins, M. W., Lovell, M. R., & Maroon, J. (2003). Does age play a role in recovery from sports-related concussion? A comparison of high school and collegiate athletes. The Journal of pediatrics, 142(5), 546–553. Scholar
  13. Frommer, L. J., Gurka, K. K., Cross, K. M., Ingersoll, C. D., Comstock, R. D., & Saliba, S. A. (2011). Sex differences in concussion symptoms of high school athletes. J Journal of Athletic Training, 46(1), 76–84. Scholar
  14. Grady, M. F. (2010). Concussion in the adolescent athlete. Current Problems in Pediatric and Adolescent Health, 40(7), 154–169. Scholar
  15. Henry, L. C., Elbin, R. J., Collins, M. W., Marchetti, G., & Kontos, A. P. (2016). Examining recovery trajectories after sport-related concussion with a multimodal clinical assessment approach. Neurosurgery, 78(2), 232–241. Scholar
  16. Higgins, J. P. T., Green, S., & Cochrane Collaboration (2008). Cochrane handbook for systematic reviews of interventions. Chichester: Wiley-Blackwell.CrossRefGoogle Scholar
  17. Kroshus, E., Baugh, C. M., Stein, C. J., Austin, S. B., & Calzo, J. P. (2017). Concussion reporting, sex, and conformity to traditional gender norms in young adults. Journal of Adolescence, 54, 110–119. Scholar
  18. 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. Scholar
  19. 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. Scholar
  20. Marar, M., McIlvain, N. M., Fields, S. K., & Comstock, R. D. (2012). Epidemiology of concussions among United States high school athletes in 20 sports. The American Journal of Sports Medicine, 40(4), 747–755. Scholar
  21. 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. Scholar
  22. Meehan, W. P. III, d’Hemecourt, P., & Comstock, R. D. (2010). High school concussions in the 2008–2009 academic year: mechanism, symptoms, and management. The American Journal of Sports Medicine, 38(12), 2405–2409. Scholar
  23. Moher, D., Shamseer, L., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., Group, P.-P. (2015). Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic Review, 4, 1. Scholar
  24. Powell, J. W., & Barber-Foss, K. D. (1999). Traumatic brain injury in high school athletes. JAMA, 282(10), 958–963.CrossRefGoogle Scholar
  25. Preiss-Farzanegan, S. J., Chapman, B., Wong, T. M., Wu, J., & Bazarian, J. J. (2009). The relationship between gender and postconcussion symptoms after sport-related mild traumatic brain injury. Pm r, 1(3), 245–253. Scholar
  26. Reddy, C. C., Collins, M. W., & Gioia, G. A. (2008). Adolescent sports concussion. Physical Medicine and Rehabilitation Clinics of North America, 19(2), 247–269. (Viii).CrossRefGoogle Scholar
  27. Sady, M. D., Vaughan, C. G., & Gioia, G. A. (2014). Psychometric characteristics of the postconcussion symptom inventory in children and adolescents. Archives of Clinical Neuropsychology, 29(4), 348–363. Scholar
  28. Stang, A. (2010). Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. European Journal of Epidemiology, 25(9), 603–605. Scholar
  29. 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
  30. Williams, R. M., Puetz, T. W., Giza, C. C., & Broglio, S. P. (2015). Concussion recovery time among high school and collegiate athletes: a systematic review and meta-analysis. Sports Medicine, 45(6), 893–903. Scholar
  31. Zuckerman, S. L., Apple, R. P., Odom, M. J., Lee, Y. M., Solomon, G. S., & Sills, A. K. (2014). Effect of sex on symptoms and return to baseline in sport-related concussion. Journal of Neurosurgery: Pediatrics, 13(1), 72–81. Scholar
  32. 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. Scholar
  33. 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. Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Jessica Dunn
    • 1
    • 2
  • Du Feng
    • 1
  • Tedd J. Girouard
    • 1
  • Kara N. Radzak
    • 1
    Email author
  1. 1.University of NevadaLas Vegas, Las VegasUSA
  2. 2.Northwest Orthopedics and Sports MedicineChicagoUSA

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