Female Collegiate Athletes' Concussion Characteristics and Recovery Patterns: A Report from the NCAA-DoD CARE Consortium

Landon B Lempke; Jaclyn B Caccese; Reid A Syrydiuk; Thomas A Buckley; Sara P D Chrisman; James R Clugston; James T Eckner; Elsa Ermer; Carrie Esopenko; Divya Jain; Louise A Kelly; Allyssa K Memmini; Anne E Mozel; Margot Putukian; Adam Susmarski; Paul F Pasquina; Michael A McCrea; Thomas W McAllister; Steven P Broglio; Christina L Master; CARE Consortium Investigators

doi:10.1007/s10439-023-03367-y

Female Collegiate Athletes' Concussion Characteristics and Recovery Patterns: A Report from the NCAA-DoD CARE Consortium

Ann Biomed Eng. 2023 Sep 26. doi: 10.1007/s10439-023-03367-y. Online ahead of print.

Authors

Landon B Lempke^{1

2

3}, Jaclyn B Caccese⁴, Reid A Syrydiuk⁵, Thomas A Buckley⁶, Sara P D Chrisman⁷, James R Clugston⁸, James T Eckner⁹, Elsa Ermer^{10

11}, Carrie Esopenko¹², Divya Jain¹², Louise A Kelly¹³, Allyssa K Memmini¹⁴, Anne E Mozel¹⁵, Margot Putukian¹⁶, Adam Susmarski¹⁷, Paul F Pasquina¹¹, Michael A McCrea¹⁸, Thomas W McAllister¹⁹, Steven P Broglio⁵, Christina L Master^{15

20}; CARE Consortium Investigators

Affiliations

¹ Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA. llempke@umich.edu.
² Exercise and Sport Science Initiative, University of Michigan, Ann Arbor, MI, USA. llempke@umich.edu.
³ , 830 North University Avenue, Suite 4000, Ann Arbor, MI, 48109, USA. llempke@umich.edu.
⁴ School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA.
⁵ Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA.
⁶ Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA.
⁷ Division of Adolescent Medicine, University of Washington, Seattle, WA, USA.
⁸ Departments of Community Health Family Medicine and Neurology, University of Florida, Gainesville, FL, USA.
⁹ Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI, USA.
¹⁰ Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.
¹¹ Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
¹² Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
¹³ Department of Exercise Science, California Lutheran University, Thousand Oaks, CA, USA.
¹⁴ Department of Health, Exercise & Sports Sciences, University of New Mexico, Albuquerque, NM, USA.
¹⁵ Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
¹⁶ Major League Soccer, Princeton, NJ, USA.
¹⁷ Department of Orthopedics and Sports Medicine, United States Naval Academy, Annapolis, MD, USA.
¹⁸ Center for Neurotrauma Research, Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA.
¹⁹ Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA.
²⁰ Orthopaedics and Sports Medicine, Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.

PMID: 37751028
DOI: 10.1007/s10439-023-03367-y

Abstract

Concussion has been described in the United States (US) collegiate student-athlete population, but female-specific findings are often underrepresented and underreported. Our study aimed to describe female collegiate student-athletes' initial injury characteristics and return to activity outcomes following concussion. Female collegiate student-athletes (n = 1393) from 30-US institutions experienced a concussion and completed standardized, multimodal concussion assessments from pre-injury through unrestricted return to play (uRTP) in this prospective, longitudinal cohort study. Initial injury presentation characteristics, assessment, and return to activity outcomes [<48-h (acute), return to learn, initiate return to play (iRTP), uRTP] were collected. We used descriptive statistics to report injury characteristics, return to activity outcomes, and post-injury assessment performance change categorization (worsened, unchanged, improved) based on change score confidence rank criteria across sport contact classifications [contact (n = 661), limited (n = 446), non-contact (n = 286)]. The median (25th to 75th percentile) days to return to learn was 6.0 (3.0-10.0), iRTP was 8.1 (4.8-13.8), and uRTP was 14.8 (9.9-24.0), but varied by contact classification. Across contact levels, the majority experienced worse SCAT total symptom severity (72.8-82.6%), ImPACT reaction time (91.2-92.6%), and BSI-18 total score (45.2-51.8%) acutely relative to baseline, but unchanged BESS total errors (58.0-60.9%), SAC total score (71.5-76.1%), and remaining ImPACT domains (50.6-66.5%). Our findings provide robust estimates of the typical female collegiate student-athlete presentation and recovery trajectory following concussion, with overall similar findings to the limited female collegiate student-athlete literature. Overall varying confidence rank classification was observed acutely. Our findings provide clinically-relevant insights for athletes, clinicians, researchers, and policymakers to inform efforts specific to females experiencing concussion.

Keywords: Gender; Mild traumatic brain injury; Neurocognitive; Postural stability; Psychological.

Grants and funding

W81XWH-14-2-0151/Office of the Under Secretary of Defense