Female athletes seek specialty concussion care later, leading to longer recovery times than males

Researchers discovered that female athletes seek specialty care following a sport-related concussion later when compared with males and indicate association to prolonged recovery time.

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Up to one-third of children with concussion experience post-concussion symptoms that persist longer than 4 weeks and females have been indicated to have prolonged recovery times compared with males.  

A study published in the Clinical Journal of Sports Medicine discovered that females seek specialty medical attention later than males following a sport-related concussion, which may cause them to experience more symptoms. 

In a retrospective cohort study, a team of researchers from the Sports Medicine Program at the Children’s Hospital of Philadelphia (PA, USA) analyzed pediatric health records of 192 sports participants aged 7–18 years. 

The median time to present to specialist care after sport-related concussions was 15 days for females versus 9 days for males. Additionally, researchers reported that females also took longer to recover on five markers of recovery: 

  • Time to return to school without accommodations (4 vs 3 days);  
  • Time to return to non-contact exercise (13 vs 7 days); 
  • Time to return to full sport (119 vs 45 days);
  • Time to recovery of neurocognitive function (68 vs 40 days);
  • Time to clinical recovery of vision and vestibular function (77 vs 34 days).

However, the team discovered that these sex-based differences disappeared when time to presentation to specialty care was controlled. 

“There is speculation in the scientific community that the reasons adolescent female athletes might suffer more symptoms and prolonged recoveries than their male counterparts include weaker neck musculature and hormonal differences,” commented senior author, Christina Master (Children’s Hospital of Philadelphia). “We now see that delayed presentation to specialty care for concussion is associated with prolonged recovery, and that is something we can potentially address.”

In sports that result in the highest rates of female concussions – such as soccer, basketball and cheerleading – there is less medical coverage during practices and games as they are identified as ‘moderate-risk sports’. In contrast, many high school leagues require medical coverage in all games and practices in male-dominated sports such as American football and hockey. 

“It is possible that the lack of athletic training coverage at the time of injury may affect the time to concussion recognition during the first critical hours and days after injury,” commented Master. “This period is a window of opportunity where specific clinical management, such as immediate removal from play, activity modification and sub-symptom threshold exercise is correlated with more rapid recovery.”

The findings from this study suggest that the reason females take longer to recover is due to them seeking specialty care later when compared with males. Furthermore, this study builds current knowledge of why some concussions take longer to resolve than others, which can help to identify them early and quickly implement the appropriate management. 

Sources: Desai N, Wiebe D, Corwin D et al. Factors affecting recovery trajectories in pediatric female concussion. Clin. J. Sport Med. doi:10.1097/JSM.0000000000000646 (2019) (Epub ahead of print); www.chop.edu/news/female-athletes-seek-specialty-care-concussion-later-males 

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Kimberley Ndungu

Editor, Concussion Zone

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