Are Sex Differences in Collegiate and High School Sports-Related Concussion Reflected in the Guidelines? A Scoping Review

Abstract

Background: Sport-related concussion (SRC) is a common sport injury. Females are participating in sports at increasing rates, and there is growing awareness that female athletes may be more vulnerable to SRC. Objectives: We aimed to identify sex differences in epidemiology, clinical manifestation and assessment of SRC and examine how these relate to the 6th International Conference on Concussion in Sport (ICCS). Methods: We conducted a scoping review of the Medline database and identified 58 studies examining the effects of sex on SRC in collegiate and high school athletes that were written in English and published in a peer-reviewed journal between March 2012 and March 2022. Results: We found that female athletes suffer higher rates of concussion in sex-comparable sports, in particular soccer. Female athletes experience more somatic symptoms—headache/migraine/sleep disturbance—and may take longer to recover from concussion. Sex differences were also identified regarding some aspects of sideline concussion assessment with the Sport Concussion Assessment Tool. Conclusions: Females are at greater risk and experience SRC differently than males; this is mostly likely due to a combination of biomechanical factors, differences in neck musculature and hormonal and social factors. Sex differences are not widely addressed by the 6th ICSS, which informs many sports’ concussion protocols.

Sport-related concussion in soccer –a scoping review of available guidelines and a call for action to FIFA & soccer governing bodies

“…Additionally, the discrepancies in guidelines could further contribute to existing lack of clarity in the management of SRCs in female athletes and put them at higher risk of developing poorer outcomes. Further discussion is required on this topic by soccer governing associations to determine whether a specific protocol needs to be developed for female athletes ( Musko and Demetriades, 2023 ).…”

“…There have been studies done looking at trends in clinical practice with regards to standardisation of clinical practice with guidelines to increase the efficiency of managing patients and improving their outcomes ( Schoenbaum and Sundwall, 1995 ). However, there are also studies suggesting that some degree of variation and customisation from guidelines is beneficial when taking into the account the individuality of each patient and their clinical presentation ( Musko and Demetriades, 2023 ; Woolf et al, 1999 ; Van Haitsma et al, 2020 ).…”

Sex-Biased Expression and Response of microRNAs in Neurological Diseases and Neurotrauma

“…Numerous studies suggest a sexual dimorphism in TBI responses (see details in review by Gupte et al, 2019). Men are three-times more likely than women to die from TBI, and women often have worse symptom burdens and take longer time to recovery [ 31 , 32 , 33 , 34 , 35 , 36 , 37 ]. Multiple factors impact the outcome measurement of a TBI.…”

“…Some studies have reported no difference in miRNA expression profiles between males and females [ 158 ]. Nevertheless, it is encouraging that gender/sex has now been integrated as a biological variable in many recent TBI-related miRNA clinical studies [ 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 148 , 149 , 150 , 151 , 152 ].…”

“…According to the Centers for Disease Control and Prevention (CDC), men are two-times more likely to be hospitalized and three-times more to die due to TBI, yet women were more vulnerable than men to show persisting TBI-related cognitive and somatic symptoms [ 31 , 32 , 33 , 34 ]. Moreover, a longer time to symptom resolution was reported in high school and collegiate female athletes [ 35 , 36 , 37 , 38 ].…”