This past month, the CIRP Concussion Research team published a retrospective study of 117 children ages 7 to 18 years presenting to a specialty care practice for a sports-related concussion. We wanted to look at their recovery trajectories and what factors were associated with a longer recovery. It was published in the Clinical Journal of Sports Medicine.
We found that females took longer than males to recover and that the factor most associated with this trajectory was longer time to their first visit in specialty care as compared to males. Females had significant delays in their return to full sport and their recovery of vision, balance, and neurocognitive markers. When we limited the analysis to those patients that presented to the specialty practice for evaluation within the first seven days of injury, the differences in recovery between males and females on all outcomes disappeared.
The bottom line is, female athletes seek specialty care significantly later than their male peers, and this may contribute to longer recovery trajectories.
The results of this study re-affirmed the importance of early identification and treatment for concussion in order to reduce the time to recovery for males and females.
(Read about methods and results by clicking on the links below.)
Solutions Lie in Policy Change
I have been asked really good questions around why there is a gender inequity in identifying athletes with a sports-related concussion.
Those who set policies concerning youth sports should consider how to level the playing field for early recognition of concussions, especially at the youth interscholastic or local club level. A measurable goal for an updated policy should be that females and males should have the same time-to-concussion-recognition. This is ideally within 24 to 48 hours of the injury event. To increase the likelihood of a shorter recovery trajectory, it’s important to begin specific clinical management within seven days.
The National Athletic Training Association’s guidelines for appropriate medical coverage classify men’s and women’s soccer, lacrosse, and women’s basketball (and other sports) as moderate-risk sports based on all-cause injury and recommend, at minimum, an athletic trainer be available within 3 to 5 minutes of the area of play.
This is in contrast to football, men’s basketball, and men’s and women’s ice hockey, where a certified athletic trainer is recommended to be physically present at all practices and games because they are designated as higher risk sports.
These guidelines are merely recommendations and not mandates, and are inconsistently applied throughout schools, generally due to limited resources and personnel, with female sports teams often having less coverage.
So, 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 couple of days after injury where specific, knowledgeable clinical management may be of utmost benefit, with the evidence that removal from play is correlated with more rapid recovery. The lack of removal from play, and therefore, a delay in initiation of concussion management, may have a detrimental effect on outcomes for those without consistent athletic training coverage, namely females.
In the meantime, coaches, athletes and parents should have heightened suspicion for whether a female athlete may have a concussion at the time of an injury event and seek out a qualified health professional for a diagnosis immediately. Regardless of athletic trainer presence, coaches should be trained in the signs and symptoms of concussion so that they can recognize when an athlete should seek care.
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