Sex Differences and Reporting of SCAT-5 Concussion Symptoms in Adolescent Athletes

Abstract

Objective: To elucidate specific symptoms that may differ between adolescent female and male athletes after a sports-related concussion (SRC) and identify symptoms that may require greater clinical attention by medical and athletic staff. Design: Prospective. Setting: This study is part of a larger research project conducted at clinics in the North Texas Concussion Network (ConTex) Registry. Participants: Subjects (N = 491) aged 12 to 18 years who sustained a diagnosed SRC within 30 days of clinic visit. Independent Variables: Sex (female vs male). Covariates included age, race, current mood (anxiety and depression), learning disability/ADHD, and time to clinic. Main Outcome Measures: Twenty-two individual postconcussion symptoms as measured by the Post-Concussion Symptom Scale from the Sport Concussion Assessment Tool-5 (SCAT-5). Results: Girls endorsed higher levels of anxiety and depression symptoms at initial clinic visit. analysis of covariance results revealed that girls had significantly greater symptom severity of headache, dizziness, sensitivity to light, sensitivity to noise, pressure in the head, feeling slowed down, fatigue, and drowsiness than boys. Ordinal logistic regression results also revealed that girls had significantly greater predicted odds of higher symptom severity on these 8 symptoms and in trouble concentrating than boys. Conclusions: Closer examination of specific symptoms with attention to patients' current levels of anxiety and depression symptoms may better inform medical and athletic staff to anticipate and address symptoms that may present greater challenges for adolescent girls than boys.

A Role for the Amygdala in Impairments of Affective Behaviors Following Mild Traumatic Brain Injury

“…Although previous research has found that both sexes exhibit some degree of affective impairment, the consensus of literature states that women experience significantly exacerbated symptoms (Broshek et al, 2005;Sufrinko et al, 2017). Thus, the prevalence of depression, anxiety, and fear is increased in women compared to men (Bunt et al, 2020). Moreover, studies suggest that the severity of behavioral deficits in women depends on their menstrual phase (Bazarian et al, 2010;Stein, 2013;Wunderle et al, 2014).…”

“…Male and female patients (N = 491) ages 12-18 with a diagnosed SRC within 30 days of a clinic visit (Bunt et al, 2020) Memory and concentration using the SCAT-5 scale Depression using GAD-7 Anxiety using PHQ-9…”

“…Depression, anxiety, and fear/post-traumatic stress disorder (PTSD) are affective behavioral impairments that are among the most frequently reported behavioral problems that manifest in the chronic period following mild TBI (Baldassarre et al, 2015;Ellis et al, 2015;Horn et al, 2016;Bunt et al, 2020). The severity of these deficits is known to vary by sex, in that women are more prone to exhibiting affective disorders postinjury (Broshek et al, 2005;Bunt et al, 2020). Interestingly, the heightened response women exhibit following mild TBI is not consistently seen following moderate or severe TBI (Lavoie et al, 2017).…”

“…Interestingly, the heightened response women exhibit following mild TBI is not consistently seen following moderate or severe TBI (Lavoie et al, 2017). Clinical studies used qualitative methods to diagnose the emotional state of an individual in conjunction with brain imaging tasks allowing for the identification of potential brain regions involved in affective disorders (Lange et al, 2016;Chong and Schwedt, 2018;Bunt et al, 2020;Teymoori et al, 2020). In preclinical models, validated behavioral assays have become the mode of quantifying what are usually thought to be subjective, affective states (Can et al, 2011(Can et al, , 2012Calhoon and Tye, 2015;Eagle et al, 2016;Liu et al, 2018).…”

The North Texas Concussion Registry (ConTex)

“…Several manuscript workgroups within the ConTex research team include premorbid risk factors, psychological factors in symptom maintenance, headache, sex differences,31 sleep32 and models for recovery prediction following SRC. A future goal of ConTex is to establish an effective framework for studies aiming to evaluate assessment, surveillance and treatment of concussion as well as the critical evaluation of diagnostic technologies as they are developed to advance the field of concussion research.…”