A Systematic Review and Meta-Analysis of Sex-Based Differences in Recurrent Concussion Incidence Across Sports
Keywords:Brain Concussion, Recurrence, Meta-Analysis, Women in sport, Athletic injuries
BACKGROUND: Disparities in concussion incidence exist on the basis of sex. This meta-analysis aimed to summarize the evidence for recurrent concussion incidence between male and female athletes across various sports.
METHODS: Systematic review and meta-analysis. Data Sources - PubMed, EMBASE, and Cochrane Library databases. Eligibility Criteria for Selecting Studies - Studies written in English containing sex comparisons of recurrent concussion data published between January 2000 and June 2021 were included.
RESULTS: A total of 1,509 records were identified, of which 114 studies were assessed for eligibility with full-text review. Six studies were ultimately included. Women were found to have more recurrent concussions than men across all sex-comparable sports, which included soccer, basketball, and baseball/softball [RR=2.16 (95% CI: 1.09-4.30)]. More specifically, women were found to have more recurrent concussions in soccer [RR=3.01 (95% CI: 2.08-4.35)] and basketball [RR=2.68 (95% CI: 1.39-5.17)], but inconclusive results were seen for baseball/softball [RR=2.54 (95% CI: 0.54-11.94)].
CONCLUSION: Recurrent concussion rates are greater in sex-comparable women’s sports than in men’s sports. Not all sports had sufficient evidence for inclusion in the meta-analysis. There are sex differences in recurrent concussion incidence in soccer and basketball.
Baldwin GT, Breiding MJ, Dawn Comstock R. Epidemiology of sports concussion in the United States. Handb Clin Neurol. 2018;158:63-74. doi:10.1016/B978-0-444-63954-7.00007-0
Kontos AP, Sufrinko A, Sandel N, Emami K, Collins MW. Sport-related Concussion Clinical Profiles: Clinical Characteristics, Targeted Treatments, and Preliminary Evidence. Curr Sports Med Rep. 2019;18(3):82-92. doi:10.1249/JSR.0000000000000573
Collins MW, Kontos AP, Reynolds E, Murawski CD, Fu FH. A comprehensive, targeted approach to the clinical care of athletes following sport-related concussion. Knee Surg Sports Traumatol Arthrosc 2014;22(2):235-246. doi:10.1007/s00167-013-2791-6
Makdissi M, Cantu RC, Johnston KM, et al. The difficult concussion patient: what is the best approach to investigation and management of persistent (>10 days) postconcussive symptoms?. Brit J Sports Med 2013;47:308-13 doi:10.1136/bjsports-2013-092255.
Ellis MJ, Leddy J, Willer B. Multi-Disciplinary Management of Athletes with Post-Concussion Syndrome: An Evolving Pathophysiological Approach. Front Neurol 2016;7:136 doi:10.3389/fneur.2016.00136.
Leddy JJ, Haider MN, Ellis M, Willer BS. Exercise is Medicine for Concussion. Curr Sports Med Rep. 2018;17(8):262-270. doi:10.1249/JSR.0000000000000505
McCrory P, Meeuwisse W, Dvořák J, et al. Consensus statement on concussion in sport-the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. 2017;51(11):838-847. doi:10.1136/bjsports-2017-097699
French J, Jennings S, Eagle SR, Collins MW, Kontos AP. A Within-Subjects Comparison of Clinical Outcomes for Patients' First and Second Concussions. J Head Trauma Rehabil. 2021;36(2):114-119. doi:10.1097/HTR.0000000000000612
Leddy JJ, MD, Baker JG, PhD, Willer B, PhD. Active Rehabilitation of Concussion and Post-concussion Syndrome. Phys Med Reh Clin N 2016;27:437-54 doi:10.1016/j.pmr.2015.12.003.
Dvorak J, McCrory P, Kirkendall DT. Head injuries in the female football player: incidence, mechanisms, risk factors and management. Brit J Sports Med 2007;41:i44-6 doi:10.1136/bjsm.2007.037960.
Kroshus E, Garnett B, Hawrilenko M, et al. Concussion under-reporting and pressure from coaches, teammates, fans, and parents. Soc Sci Med 2015;134:66-75 doi:10.1016/j.socscimed.2015.04.011.
Guskiewicz KM, McCrea M, Marshall SW, et al. Cumulative Effects Associated With Recurrent Concussion in Collegiate Football Players: The NCAA Concussion Study. JAMA 2003;290:2549-55 doi:10.1001/jama.290.19.2549.
Castile L, Collins CL, McIlvain NM, et al. The epidemiology of new versus recurrent sports concussions among high school athletes, 2005–2010. Brit J Sports Med 2012;46:603-10 doi:10.1136/bjsports-2011-090115.
Kerr ZY, Chandran A, Nedimyer AK, et al. Concussion Incidence and Trends in 20 High School Sports. Pediatrics 2019;144:e20192180 doi:10.1542/peds.2019-2180.
Zuckerman SL, Kerr ZY, Yengo-Kahn A, Wasserman E, Covassin T, Solomon GS. Epidemiology of Sports-Related Concussion in NCAA Athletes From 2009-2010 to 2013-2014: Incidence, Recurrence, and Mechanisms [published correction appears in Am J Sports Med. 2016 Jan;44(1):NP5]. Am J Sports Med. 2015;43(11):2654-2662. doi:10.1177/0363546515599634
Giza C, Kutcher J, Ashwal S, et al. Summary of evidence-based guideline update: Evaluation and management of concussion in sports: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology 2013;80:2250-7 doi:10.1212/WNL.0b013e31828d57dd.
Cheng J, Ammerman B, Santiago K, et al. Sex-Based Differences in the Incidence of Sports-Related Concussion: Systematic Review and Meta-analysis. Sports Health: A Multidisciplinary Approach 2019;11:486-91 doi:10.1177/1941738119877186.
Dave U, Kinderknecht J, Cheng J, Santiago K, Jivanelli B, Ling DI. Systematic review and meta-analysis of sex-based differences for concussion incidence in soccer. Phys Sportsmed. 2022;50(1):11-19. doi:10.1080/00913847.2020.1868955
Ling DI, Cheng J, Santiago K, et al. Women Are at Higher Risk for Concussions Due to Ball or Equipment Contact in Soccer and Lacrosse. Clin Orthop Relat R 2019 doi:10.1097/CORR.0000000000000995.
van Ierssel J, Osmond M, Hamid J, Sampson M, Zemek R. What is the risk of recurrent concussion in children and adolescents aged 5-18 years? A systematic review and meta-analysis. Br J Sports Med. 2021;55(12):663-669. doi:10.1136/bjsports-2020-102967
Lau J, Ioannidis JPA, Schmid CH. Quantitative Synthesis in Systematic Reviews. Ann Intern Med 1997;127:820 doi:10.7326/0003-4819-127-9-199711010-00008.
O'Connor KL, Baker MM, Dalton SL, Dompier TP, Broglio SP, Kerr ZY. Epidemiology of Sport-Related Concussions in High School Athletes: National Athletic Treatment, Injury and Outcomes Network (NATION), 2011-2012 Through 2013-2014. J Athl Train. 2017;52(3):175-185. doi:10.4085/1062-6050-52.1.15
Kerr ZY, Campbell KR, Fraser MA, et al. Head Impact Locations in U.S. High School Boys' and Girls' Soccer Concussions, 2012/13–2015/16. J Neurotraum 2019;36:273-2082 doi:10.1089/neu.2017.5319.
Vedung F, Hänni S, Tegner Y, Johansson J, Marklund N. Concussion incidence and recovery in Swedish elite soccer - Prolonged recovery in female players. Scand J Med Sci Sports. 2020;30(5):947-957. doi:10.1111/sms.13644
Brook EM, Luo X, Curry EJ, Matzkin EG. A heads up on concussions: are there sex-related differences?. Phys Sportsmed. 2016;44(1):20-28. doi:10.1080/00913847.2016.1142834
Wasserman EB, Kerr ZY, Zuckerman SL, Covassin T. Epidemiology of Sports-Related Concussions in National Collegiate Athletic Association Athletes From 2009-2010 to 2013-2014: Symptom Prevalence, Symptom Resolution Time, and Return-to-Play Time. Am J Sports Med. 2016;44(1):226-233. doi:10.1177/0363546515610537
Hänni S, Vedung F, Tegner Y, Marklund N, Johansson J. Soccer-Related Concussions Among Swedish Elite Soccer Players: A Descriptive Study of 1,030 Players. Front Neurol. 2020;11:510800. Published 2020 Sep 23. doi:10.3389/fneur.2020.510800
Decq P, Gault N, Blandeau M, et al. Long-term consequences of recurrent sports concussion. Acta Neurochir (Wien). 2016;158(2):289-300. doi:10.1007/s00701-015-2681-4
Noble JM, Hesdorffer DC. Sport-related concussions: a review of epidemiology, challenges in diagnosis, and potential risk factors. Neuropsychol Rev. 2013;23(4):273-284. doi:10.1007/s11065-013-9239-0
Neidecker JM, Gealt DB, Luksch JR, Weaver MD. First-Time Sports-Related Concussion Recovery: The Role of Sex, Age, and Sport. J Am Osteopath Assoc. 2017;117(10):635-642. doi:10.7556/jaoa.2017.120
Wallace J, Covassin T, Beidler E. Sex Differences in High School Athletes' Knowledge of Sport-Related Concussion Symptoms and Reporting Behaviors. J Athl Train. 2017;52(7):682-688. doi:10.4085/1062-6050-52.3.06
Bretzin AC, Mansell JL, Tierney RT, McDevitt JK. Sex Differences in Anthropometrics and Heading Kinematics Among Division I Soccer Athletes. Sports Health. 2017;9(2):168-173. doi:10.1177/1941738116678615
Aubry M, Cantu R, Dvorak J, et al. Summary and agreement statement of the First International Conference on Concussion in Sport, Vienna 2001. Recommendations for the improvement of safety and health of athletes who may suffer concussive injuries. Br J Sports Med. 2002;36(1):6-10. doi:10.1136/bjsm.36.1.6
Johnston KM, McCrory P, Mohtadi NG, Meeuwisse W. Evidence-Based review of sport-related concussion: clinical science. Clin J Sport Med. 2001;11(3):150-159. doi:10.1097/00042752-200107000-00005
Scott Delaney J, Puni V, Rouah F. Mechanisms of injury for concussions in university football, ice hockey, and soccer: a pilot study. Clin J Sport Med. 2006;16(2):162-165. doi:10.1097/00042752-200603000-00013
Chandran A, Barron MJ, Westerman BJ, DiPietro L. Multifactorial examination of sex-differences in head injuries and concussions among collegiate soccer players: NCAA ISS, 2004-2009. Inj Epidemiol. 2017;4(1):28. Published 2017 Oct 25. doi:10.1186/s40621-017-0127-6
Rubin TG, Catenaccio E, Fleysher R, et al. MRI-defined White Matter Microstructural Alteration Associated with Soccer Heading Is More Extensive in Women than Men. Radiology. 2018;289(2):478-486. doi:10.1148/radiol.2018180217
Sollmann N, Echlin PS, Schultz V, et al. Sex differences in white matter alterations following repetitive subconcussive head impacts in collegiate ice hockey players. Neuroimage Clin. 2017;17:642-649. Published 2017 Nov 21. doi:10.1016/j.nicl.2017.11.020
Swenson DM, Yard EE, Fields SK, Comstock RD. Patterns of recurrent injuries among US high school athletes, 2005-2008. Am J Sports Med. 2009;37(8):1586-1593. doi:10.1177/0363546509332500
Zynda AJ, Petit KM, Anderson M, Tomczyk CP, Covassin T. Removal From Activity After Sports- Related Concussion in Sex-Comparable Sports From the Michigan High School Athletic Association. Am J Sports Med.2021;49(10):2810-2816. doi:10.1177/03635465211020007
Rethlefsen ML, Farrell AM, Osterhaus Trzasko LC, Brigham TJ. Librarian co-authors correlated with higher quality reported search strategies in general internal medicine systematic reviews. J Clin Epidemiol. 2015;68(6):617-626. doi:10.1016/j.jclinepi.2014.11.025
How to Cite
Copyright (c) 2022 Journal of Women's Sports Medicine
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.