Sex-based differences in concussion incidence and its underlying injury mechanism in team bat/stick sports: A systematic review and meta-analysis

This study aimed to synthesize and quantify the sex-based differences in concussion incidences rate and associated mechanism of injuries in team bat/stick sports. Following a systematic search across five electronic databases, 46 studies were included in the review; 24 were included in the incidence rate (IR) meta-analysis and 13 of the 24 studies met the eligibility criteria for the meta-analysis involving injury mechanism. DerSimonian and Laird random effects models were used for pooling the Rate Ratio (RR) data. Ice-hockey had the highest overall risk of concussion, followed by lacrosse and baseball/softball. Female players had higher concussion IRs compared to males (RR 0.74 [95% CI 0.58-0.95], p = .02) across all sports included in this study. Sex-based differences in concussion IRs for ice-hockey and lacrosse were not statistically significant. Male athletes were more statistically likely to sustain concussion because of player-contact in ice-hockey (RR 1.55 [95% CI 1.29-1.86], p < .001) and lacrosse (RR 3.20 [95% CI 1.54-6.64], p = .002). Conversely, female athletes showed a higher risk of concussion due to equipment contact in lacrosse (RR 0.29 [95% CI 0.20-0.43], p < .001). Injury mechanism varies between male and female athletes across these bat/stick sports. Female athletes have a higher risk of getting concussed due to the impact of players with equipment (ball/puck) and surface contact for lacrosse and ice-hockey. Findings from this study can help coaches, sports administrators, and health care providers with further data on the current information regarding concussion-related factors in these respective sports.