Sex differences in reporting of concussion symptoms in adults

Abstract

Objective: To examine differences in concussion symptom reporting between female and male adults considering current psychological symptoms such as anxiety and depression and pre-injury factors in order to identify sex differences which may guide treatment efforts. Method: This prospective study is part of the North Texas Concussion Registry (ConTex). Subjects (N = 132) age 19 to 78 years had sustained a concussion within 30 days of clinic visit. The independent variable was sex and covariates included age, ethnicity, current anxiety and depression ratings, history of attention deficit disorder, history of headache/migraine, and time to clinic. The dependent variables were 22 post-concussion symptoms as measured by the Sport Concussion Assessment Tool-5 Post-Concussion Symptom Scale. Results: Analysis of covariance and ordinal logistic regression results both revealed that females had a greater likelihood of reporting increased symptom severity for 15/22 concussion symptoms. The largest risk ratios (effect size) in symptom reporting between sexes (higher symptoms in females) included: feeling more emotional 4.05 (0.72), fatigue or low energy 4.05 (0.72), sensitivity to light 3.74 (0.69), headache 3.65 (0.57), balance problems 3.31 (0.53), pressure in head 3.06 (0.51), and neck pain 2.97 (0.60). Conclusions: Adult females in our sample reported higher levels of many concussion symptoms than males and showed an increased risk of developing these same symptoms following concussion. Examination of the magnitude of sex difference in concussion symptom reporting will better inform medical staff to anticipate and address symptoms that may present greater challenges for adult females.

Keywords:

• Concussion
• SCAT-5
• PCSS
• Sex differences
• Symptom Clusters

Acknowledgements

The authors wish to thank the participants, as well as the cooperating institutions in the North Texas Concussion Registry (ConTex): UT Southwestern Medical Center, Texas Scottish Rite Hospital for Children, Children’s Medical Center Dallas, and Texas Health Resources.

Study data were collected and managed using REDCap electronic data capture tolls hosted at UT Southwestern Medical Center. REDCap (Research Electronic Data Capture) is a secure, web-based software platform designed to support data capture for research studies, providing 1) an intuitive interface for validated data capture; 2) audit trails for tracking data manipulation and export procedures; 3) automated export procedures for seamless data downloads to common statistical packages; and 4) procedures for data integration and interoperability with external sources.

Disclosure statement

The authors have no conflict of competing interests or financial disclosures to declare.

Data availablility statement

The data that support the findings of this study are available from the corresponding author, Stephen Bunt, Ph.D., upon reasonable request.

Additional information

Funding

This work and the North Texas Concussion Registry (ConTex) was supported by a grant from the Texas Institute for Brain Injury and Repair (TIBIR), a state-funded initiative as part of the Peter J. O’Donnell Jr. Brain Institute at the University of Texas Southwestern Medical Center. Support for the use of REDcap came from the National Center for Advancing Tranlational Sciences of the National Institutes of Health under award number UL1TR001105.