Gender Differences in Concussion Reporting Among High School Athletes

Abstract

Background:An athlete’s lack of concussion knowledge could lead to significant underreporting and injury mismanagement. To provide more effective management strategies of concussions in adolescent athletes, further examination of reporting behaviors is of critical importance.Hypothesis:The hypotheses for this study were as follows: (1) Girls are more likely to report concussion, (2) girls are more likely to report future concussions after an educational intervention, and (3) a difference in rationale for not reporting concussion will be found between sexes.Study Design:Cross-sectional, cohort design.Level of Evidence:Level 3.Methods:Survey answers were collected on 454 high school athletes (212 girls, 242 boys; mean age, 15.7 ± 1.15 years). Individual team meetings lasting approximately 30 minutes were held to collect data and provide an educational lecture. Participants were randomly provided an iClicker to submit a response to questions asked.Results:Girls were more likely to report a concussion (χ2 = 8.32, df = 3, N = 454, P = 0.040) and more likely to report future concussions after educational intervention (χ2 = 8.54, df = 2, N = 454, P = 0.014). There were no differences between sexes regarding rationale for not reporting a concussion (χ2 = 6.42, df = 4, N = 454, P = 0.170).Conclusion:There is concern these athletes still fail to understand the severity and potential sequelae of concussion injury. Both sexes cited that concussion is not a serious enough injury to warrant reporting to a medical professional.Clinical Relevance:High school athletes recover more slowly from concussions compared with college athletes; therefore, educating this population and promoting the importance of being knowledgeable regarding concussion recognition may increase reporting prevalence.

Sex Differences in Common Sports Injuries

“…Confounding accurate measurement of differences in concussion incidence between the sexes is the increased rate of concussion reporting in females. End of season/career athlete reported nondisclosure rates of concussion range from 16%-42.9% in males to 5%-14.9% in females [82][83][84][85][86][87]. These findings are supported by a study demonstrating that the level of gender nonconformity in females influences nondisclosure rates, with female athletes who have higher levels of conforming to traditionally masculine norms reporting a greater level of intent to withhold disclosure of concussion-related symptoms from coaches and medical personnel [85].…”

“…Higher incidence in females [77][78][79][80][81][82][83][84][85][86][87][88][89] Female risk factors include reduced neck girth and strength relative to head size compared to males [88][89][90][91][92][93][94] Females report more symptoms postinjury and have higher rates of postconcussive syndrome [110,111] RED-S ¼ relative energy deficiency in sport; BMI ¼ body mass index; BMD ¼ bone mineral density; BSI ¼ bone stress injury; ACL ¼ anterior cruciate ligament.…”

The impact of patient characteristics on nurse practitioners’ assessment and management of adolescent concussion

“…Although the number of females participating in sports has increased because of the implementation of Title IX in 1972, sports participation rates among males continue to surpass that of females (National Federation of State High School Associations, n.d.; Stevenson, 2007). In sports played by both sexes, girls experience higher concussion rates than boys (Covassin, Moran, & Elbin, 2016;Gessel, Fields, Collins, Dick, & Comstock, 2007;Marar, McIlvain, Fields, & Comstock, 2012), and girls are more likely to report past concussions than boys (Miyashita, Diakogeorgiou, & VanderVegt, 2016). Differences in sports practices and rules may explain some of this differencefor instance, helmets are required for high school lacrosse for males but not females (Xiang, Collins, Liu, McKenzie, & Comstock, 2014).…”

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“…14 Multiple studies show a majority of secondary school student-athletes would continue to play while experiencing concussion symptoms. 6,14,16,17 Another study found the most common reason for not reporting a concussion among secondary school football players was a belief the injury was not serious enough to warrant medical attention. 18 When further examining students-athletes who failed report an injury, it was found that one third did not associate their symptoms with a concussion.…”

“…11 Of interest to us are the multiple studies that provide insight regarding secondary school athletes and concussion education. 2,8,[13][14][15][16][17][18] One such study determined that secondary school athletes with previous formal concussion education are more likely to notify their coaches of concussion symptoms. 15 Secondary school athletes with a previous history of concussion are also more likely to report concussion symptoms.…”