Baseline Differences By Biological Sex And Sport On Clinical Measures Of Sport Related Concussion

PURPOSE: Biological sex and sport may influence baseline performance on commonly used clinical measures of concussion. This study compared baseline clinical outcome scores by sex and then between male and female sports. We hypothesized that multiple clinical outcome scores would differ by sex and separately by sport. METHODS: Division I healthy collegiate athletes (n = 2668, female = 41.3%, 19.06 ± 1.4 years of age) were first divided into two groups based on sex and then into 11 groups based on sport. Participants were administered the 7-item Generalized Anxiety Disorder Inventory (GAD-7), Immediate Post-concussion Assessment and Cognitive Test, the 9-item Patient Health Questionnaire (PHQ-9), the Revised Head Injury Scale (HIS-r), Sensory Organization Test, and Timed Tandem Gait (TG) as part of their university’s pre-season baseline concussion assessment. Mann-Whitney U Tests or Independent t-tests were used to compare clinical outcome scores by sex. Kruskal Wallis tests with pairwise comparisons were used to compare clinical outcome scores for male and female sports separately with α = 0.05. RESULTS:For sex differences, at baseline, females had significantly higher composite scores on the GAD-7 (1.8 ± 2.9 vs. 0.87 ± 1.9), PHQ-9 (1.4 ± 2.4 vs. 0.75 ± 1.4), as well as the HIS-r’s symptom quantity (0.30 ± 1.1 vs. 0.20 ± 0.64), duration (0.88 ± 3.3 vs. 0.41 ± 1.7), and severity (0.71 ± 2.8 vs. 0.30 ± 1.5) when compared to males, with all p < 0.05. Females took significantly longer to complete the TG (13.6 ± 2.9) when compared to males (11.7 ± 2.9 [p < 0.001]). For female sports, rowers endorsed significantly higher HIS-r symptom quantity (0.58 ± 1.4), duration (1.6 ± 4.6), and severity (1.3 ± 3.8) scores when compared to all other female sports (all p < 0.05). Within male sports, athletes participating in cheerleading and dance (0.20 ± .92), football (0.34 ± 1.5), and lacrosse (0.28 ± 1.2) endorsed a significantly lower HIS-r symptom duration as compared to baseball (0.54 ± 1.7 [all p < 0.05]). Male soccer athletes (10.7 ± 2.4) were significantly faster (all p < 0.05) on the TG as compared to swim and dive (13.7 ± 3.7), football (11.3 ± 2.9), and track (11.2 ± 2.3) athletes. CONCLUSIONS: Baseline performance differences were observed on commonly used clinical measures by sex and sport, reinforcing the need for concussion baseline assessments.