Recovery from a concussion may take longer for female athletes than for males, with a more symptomatic recovery, researchers found in a study of soccer players.
by Crystal Phend, Staff Writer, MedPage Today
ORLANDO, July 10 — Recovery from a concussion may take longer for female athletes than for males, with a more symptomatic recovery, researchers found in a study of soccer players.
Female soccer players had poorer neurocognitive scores (P<0.04) and reported more symptoms (P<0.00002) than their male peers after a concussion, reported Alexis Chiang Colvin, M.D., of the University of Pittsburgh, and colleagues at the American Orthopaedic Society for Sports Medicine meeting here.
In their cohort study of young soccer players, prior concussion was linked to poorer overall scores for both genders (P<0.05).
Note that this study was published as an abstract and presented orally at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
Although the gender differences did not appear to be the result of differences in body mass, the findings reinforce that treatment cannot be one-size-fits-all, Dr. Colvin said.
“The way concussion used to be managed was if someone lost consciousness for so many minutes they would be out for this many days,” she said. But, “we’ve learned that individuals recover differently, whether males or females.”
She recommended allowing athletes to return to play on the basis of freedom from symptoms at rest and normalization on neurocognitive testing.
Concussion is one of the most common injuries during collegiate games. In soccer, this injury is typically from a head-to-head collision with another player, other body parts, or the ground, whereas the impact with the soccer ball is not a major risk factor, Dr. Colvin’s group said.
Neurocognitive effects of concussion have been studied in other sports, typically a mix of helmeted and non-helmeted events, but not specifically in soccer despite its popularity worldwide and the roughly equal number of male and female athletes.
So, the researchers examined computer-based neuropsychological testing performed after concussion in 234 soccer players ages eight to 24.
The cohort included 141 females and 93 males who had a clinical evaluation after a diagnosis of a sports-related concussion. Those with attention-deficit disorder, a psychiatric disorder, seizures, or other known neurologic disorders were excluded.
Prior history of concussion was reported by 101 patients with an average 0.82 prior concussions among males and 0.77 among females. Average age was likewise similar between males and females (16.3 versus 16.5), as was time from injury to first assessment (13.4 versus 12.1 days).
Overall memory, reaction time, and visual processing speed as tested with the ImPACT test battery differed significantly by prior concussion history (P<0.05) and gender (P<0.04) but without an interaction between the two factors (P<0.60).
When the cognitive components were assessed individually, prior history of concussion was linked to poorer memory scores (P<0.007) and female gender was lined to slower reaction times (P<0.004).
Female athletes also self-reported significantly more symptoms such as headaches, nausea, dizziness, and memory loss compared with males (P<0.00002), including longer lasting headaches. Total symptom scores did not differ, though, by concussion history (P<0.59).
Although males’ typically stronger neck and torso have been suggested to better dissipate the force of a head injury, the study suggested body mass was not a factor in cognitive effects for soccer players. Body mass index was nearly identical between male and female patients in the study.
Nor did baseline differences between genders appear to account for the differences. In an analysis controlling for baseline differences between females and males in a subset of patients, females still did worse on reaction time (P<0.0001), verbal memory (P<0.03), and symptoms (P<0.03).
Further study is needed to determine the reason for the differences in recovery between males and females, the researchers concluded.
Dr. Colvin reported no conflicts of interest. Two co-authors reported being shareholders in the ImPACT testing system.
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Primary source: American Orthopaedic Society for Sports Medicine meeting
Source reference: Colvin AC, et al “The role of concussion history and gender in recovery from soccer-related concussion” AOSSM meeting 2008.
Reviewed by Zalman S. Agus, MD; Emeritus Professor, University of Pennsylvania School of Medicine.
Published: July 10, 2008
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