Sex-Based Differences as a Predictor of Recovery Trajectories in Young Athletes After a Sports-Related Concussion

Background: To date, few studies have delineated clear sex-based differences in symptom resolution after a sports-related concussion (SRC), and equivocal results have been identified in sex-based differences on baseline assessments. Purpose: To assess whether female athletes displayed prolonged recovery and more symptoms at baseline and after an SRC compared with male athletes. Study Design: Cohort study; Level of evidence, 3. Methods: The current study assessed 135 male and 41 female athletes (10-18 years old) who participated in high-impact sports in metropolitan Atlanta middle and high schools. All athletes completed a baseline assessment and at least 1 postconcussion assessment from the Immediate Post-Concussion Assessment and Cognitive Testing battery. Longitudinal hierarchical linear modeling was employed to examine individual-level variables and their associations with adolescents' rates of recovery in concussive symptoms after controlling for age and number of prior concussions. Results: Aggregate symptoms were rated as higher in female athletes compared with male athletes at baseline (mean SD: females, 13.49 +/- 11.20; males, 4.88 +/- 8.74; F(1,175) = 10.59, P < .001) and immediately after a concussion (females: 16.75 +/- 18.08; males: 10.58 +/- 14.21; F(1,175) = 3.99, P = .05). There were no group differences in the slope of recovery between male and female athletes, indicating generally similar trajectories of change for both groups. Post hoc analyses revealed higher baseline levels of migraine and neuropsychological symptoms in female athletes. Conclusion: Although female athletes in the current study reported increased symptoms, identical recovery patterns were observed in both sexes, suggesting that sex-based differences in concussion recovery are better explained by increased symptom frequency among female athletes when compared with their male counterparts.