Sex Differences in Recovery Trajectories of Assessments for Sport-Related Concussion Among NCAA Athletes: A CARE Consortium Study

Jaclyn B Caccese; Christina L Master; Thomas A Buckley; Sara P D Chrisman; James R Clugston; James T Eckner; Elsa Ermer; Stacey Harcum; Tamerah N Hunt; Divya Jain; Louise A Kelly; T Dianne Langford; Landon B Lempke; Jane McDevitt; Allyssa K Memmini; Anne E Mozel; Susan M Perkins; Margot Putukian; Patricia R Roby; Adam Susmarski; Steven P Broglio; Thomas W McAllister; Michael McCrea; Paul F Pasquina; Carrie Esopenko; CARE Consortium Investigators

doi:10.1007/s40279-023-01982-2

Sex Differences in Recovery Trajectories of Assessments for Sport-Related Concussion Among NCAA Athletes: A CARE Consortium Study

Sports Med. 2023 Dec 22. doi: 10.1007/s40279-023-01982-2. Online ahead of print.

Authors

Jaclyn B Caccese¹, Christina L Master², Thomas A Buckley³, Sara P D Chrisman⁴, James R Clugston⁵, James T Eckner⁶, Elsa Ermer⁷, Stacey Harcum⁷, Tamerah N Hunt⁸, Divya Jain⁹, Louise A Kelly¹⁰, T Dianne Langford¹¹, Landon B Lempke⁶, Jane McDevitt¹¹, Allyssa K Memmini¹², Anne E Mozel², Susan M Perkins¹³, Margot Putukian¹⁴, Patricia R Roby², Adam Susmarski¹⁵, Steven P Broglio⁶, Thomas W McAllister¹³, Michael McCrea¹⁶, Paul F Pasquina¹⁷, Carrie Esopenko⁹; CARE Consortium Investigators

Collaborators

CARE Consortium Investigators:
April Hoy, Justus D Ortega, Nicholas Port, Patrick G O'Donnell, Christopher D'Lauro, Kenneth L Cameron, Joshua T Goldman, Holly J Benjamin, Thomas W Kaminski, Julianne Schmidt, Michael Collins, Jeffrey J Bazarian, Stefan Duma

Affiliations

¹ School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, 453 W. 10th Avenue, Columbus, OH, 43210, USA. jaclyn.caccese@osumc.edu.
² Children's Hospital of Philadelphia, Philadelphia, PA, USA.
³ University of Delaware, Newark, DE, USA.
⁴ Seattle Children's Hospital, Seattle, WA, USA.
⁵ University of Florida, Gainesville, FL, USA.
⁶ University of Michigan, Ann Arbor, MI, USA.
⁷ Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
⁸ Georgia Southern University, Statesboro, GA, USA.
⁹ Icahn School of Medicine at Mount Sinai, New York, NY, USA.
¹⁰ California Lutheran University, Thousand Oaks, CA, USA.
¹¹ Temple University, Philadelphia, PA, USA.
¹² University of New Mexico, Albuquerque, NM, USA.
¹³ Indiana University School of Medicine, Indianapolis, IN, USA.
¹⁴ Major League Soccer, New York, NY, USA.
¹⁵ Loras College, Dubuque, IA, USA.
¹⁶ Medical College of Wisconsin, Milwaukee, WI, USA.
¹⁷ Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD, USA.

PMID: 38133787
DOI: 10.1007/s40279-023-01982-2

Abstract

Objectives: The purpose of this study was to determine sex differences in recovery trajectories of assessments for sport-related concussion using Concussion Assessment, Research and Education (CARE) Consortium data.

Methods: National Collegiate Athletic Association athletes (N = 906; 61% female) from sex-comparable sports completed a pre-season baseline assessment and post-sport-related concussion assessments within 6 h of injury, 24-48 h, when they initiated their return to play progression, when they were cleared for unrestricted return to play, and 6 months post-injury. Assessments included the Standardized Assessment of Concussion, Balance Error Scoring System, Brief Symptom Inventory-18, Immediate Post-concussion Assessment and Cognitive Testing (ImPACT), Sport Concussion Assessment Tool-3 symptom evaluation, Clinical Reaction Time, King-Devick test, Vestibular Ocular Motor Screen, 12-item Short-Form Health Survey, Hospital Anxiety and Depression Scale, and Satisfaction with Life Scale.

Results: Only the Vestibular Ocular Motor Screen Total Symptom Score at the 24-48 h timepoint (p = 0.005) was statistically significantly different between sexes. Specifically, female athletes (mean = 60.2, 95% confidence interval [CI] 51.5-70.4) had higher Vestibular Ocular Motor Screen Total Symptom Scores than male athletes (mean = 36.9, 95% CI 27.6-49.3), but this difference resolved by the time of return-to-play initiation (female athletes, mean = 1.8, 95% CI 1.1-2.9; male athletes, mean = 4.1, 95% CI 1.5-10.9).

Conclusions: Sport-related concussion recovery trajectories for most assessments were similar for female and male National Collegiate Athletic Association athletes except for Vestibular Ocular Motor Screen symptoms within 48 h of sport-related concussion, which was greater in female athletes. Female athletes had a greater symptom burden across all timepoints, suggesting that cross-sectional observations may indicate sex differences despite similar recovery trajectories.