Access to athletic trainers and sex as modifiers of time to reach clinical milestones after sport-related concussion in collegiate athletes

ABSTRACT

Objective

Investigate whether an athlete's biological sex and exposure to a dedicated athletic trainer (AT) were related to clinical milestones after a sports-related concussion (SRC).

Design

Retrospective chart review.

Methods

Medical charts of collegiate athletes (n = 196 [70.9% female]) diagnosed with SRC were reviewed to extract: biological sex, dedicated AT exposure for their sport (yes/no), and time (days) to reaching clinical milestones (diagnosis, symptom resolution, unrestricted return to sport [RTS]). Mann–Whitney U tests were used to determine whether time to clinical milestones differed by sex, AT exposure, or their interaction. Proportions of same-day diagnoses and times to diagnosis, symptom resolution, and unrestricted RTS were evaluated with chi-squared and spearman’s rank correlations, respectively.

Results

There were no significant differences in times to reaching any clinical milestone by sex, AT exposure, or their interaction (ps > 0.05). Forty-three percent of participants were diagnosed on the day of their SRC. This did not differ by sex or AT exposure (ps > 0.29). Longer times to SRC diagnosis were associated with more days to symptom resolution (ρ = 0.236, p = 0.001) and unrestricted RTS (ρ = 0.223, p < 0.001).

Conclusions

Athlete sex and AT exposure were not associated with times to reach any clinical milestone; however, delayed diagnosis was associated with longer times to reach clinical recovery.

KEYWORDS:

• Sex differences
• gender differences
• social determinants of health
• healthcare disparities
• health iniquities
• mild traumatic brain injury (mTBI)

Acknowledgments

The authorship would like to acknowledge the contributing LIMBIC MATARS site investigators: Michelle Kirk, M.D. and David Gable, ATC, (Texas Christian University), Brett Mortensen, Ph.D., Michael J. Larson, Ph.D., (Brigham Young University), James Day, Ed.D. (Augustana University), Allison Peplowski (University of South Dakota), Nyaz Didehbani, Ph.D., and C. Munro Cullum, Ph.D., (The University of Texas Southwestern Medical Center), Meredith Decker, Ph.D., (The University of Texas at Arlington), Tom Campbell, M.S. (Old Dominion University), Monique Pappadis, Ph.D. (The University of Texas Medical Branch), Sean Ahonen, ATC (Virginia Union University), Verle Valentine, M.D. (Sanford Health), Kate Higgins, Psy.D. and Heather Bouchard, M.A. (University of Nebraska), Jessica Wallace, Ph.D. (University of Alabama), Jessica Gill, Ph.D. (Johns Hopkins University), Catherine Donahue, M.Ed., Rachel Smetana, Ph.D. (University of Virginia), Tenesha Helm (University of Lynchburg), as well as the NCAA collegiate athletes who contributed to this dataset.

Disclosure statement

In accordance with Taylor & Francis policy and our ethical obligations as researchers, the authorship team reports the following potential conflicts of interest: SRW reports receipt of honorarium and travel costs from the National Athletic Trainers’ Association (NATA; 2022); DKB is Executive Director of the Sports Neuropsychology Society and receives an annual stipend for that work; JER has received funding by the Medical Technology Enterprise Consortium. The remaining authors (PMK; EB; JRO; TGB; TAM; KM; DJR; DXC) have nothing to declare.

Additional information

Funding

Partial funding was provided by the University of Virginia School of Education and Human Development Foundation, with support from the U.S. Army Medical Research and Material Command and from the U.S. Department of Veterans Affairs Long-term Impact of Military-relevant Brain Injury Consortium under Award No. W81XWH-18/TBIRP-LIMBIC.