Sex Differences in Common Measures of Concussion in College Athletes

Objective: Female athletes may be more likely to sustain a concussion and may vary in symptom presentation and neurocognitive impairments as compared with males. Scientific literature is limited by subjective assessments and underproportioned representation of women-the scope and etiology of sex-based differences are unknown. This study investigates sex-based differences in sports concussion assessments among college varsity athletes. Design and Setting: Retrospective study of an institution's athletic head injury database. Participants: Acute postinjury and baseline data from 111 college athletes sustaining concussions between 2016 and 2018, diagnosed by a concussion specialist physician. Main Outcome Measures: Concussion assessments examined included the Sports Concussion Assessment Tool (SCAT5) and Vestibular Oculomotor Screening (VOMS) performed within 3 days (24-72 hours) of injury. Results: No significant difference by sex was observed in the SCAT5 total symptom evaluation scores or severity scores, Standardized Assessment of Concussion, or Balance Error Scoring System (P > .05) within 3 days of head injury. Females did report more "pressure in the head" severity scores from baseline to postconcussion (2.7 +/- 1.5 increased symptomatology in females vs 1.8 +/- 1.3 increase in males, P = .007). The VOMS test resulted in significant sex differences in smooth pursuit [0.6 +/- 1.4 increase in females (P < .001) vs 0.2 +/- 0.6 increase in males (P = .364)], horizontal saccades [0.6 +/- 1.2 increase in females (P < .001) vs 0.2 +/- 0.5 increase in males (P = .149)], and vertical saccades [0.9 +/- 1.9 increase in females (P < .001) vs 0.3 +/- 0.7 increase in males (P = .206)]. Conclusion: Our study did not show sex-based differences in baseline or acute postconcussive symptom reporting in most concussion assessment parameters, challenging previous research suggesting that females report more symptoms than males. Females did have significant differences in symptom provocation using the VOMS.