The Relationship Between Gender and Postconcussion Symptoms After Sport-Related Mild Traumatic Brain Injury

Objective: The authors sought to define the relationship between gender and post-concussion symptoms (PCSx) at 3 months after sport-related mild traumatic brain injury (mTBI) and, further, to examine whether age (minors vs. adults), source of PCSx reporting (self-reported vs. proxy), previous head injury or loss of consciousness, or the sport type in which the mTBI was incurred explain any observed gender differences in PCSx. Design: Prospective nested cohort study. Setting: Regional trauma center emergency department. Patients: A total of 260 patients who presented with sport-related mTBI, as defined by American Congress of Rehabilitation Medicine criteria, began the study. The participants who lacked litigation concerning the mTBI and had participated in the follow-up assessment completed the study (n = 215). Assessment of Risk Factors: Self, proxy, and interviewer report of age, gender, previous head injury or loss of consciousness, and sport in which injury was sustained. Main Outcome Measurements: Rivermead Post Concussion Symptoms Questionnaire (RPQ). Results: Adult females are at greater risk for elevated RPQ scores (odds ratio [OR] = 2.89, 95% confidence interval [95% CI] = 1.25-6.71; P = .013) but not female minors (OR = 0.87, 95% CI = 0.45-1.71]; P = .695), as compared with male subjects. Adjustment for empirically identified confounders in each age group revealed persisting elevated risk for adult females (OR = 2.57, 95% CI = 1.09-6.08; P = .031), but not minor females (OR = 1.07, 95% CI = 0.52-2.19, P = .852). The risk associated with female gender in adults could not be explained by characteristics of the sports, such as helmeted versus not, or contact versus no contact, in which women incurred mTBIs. No sport characteristics were associated with increased risk of PCSx after mTBI. Conclusions: Adult females, but not female minors, are at increased risk for PCSx after sport-related mTBI as compared with male patients. This increased risk cannot be explained by self-report, rather than proxy report, of symptoms, previous head injury or loss of consciousness, age, or sport characteristics. Further research is needed to elucidate the processes of age-differential recovery from mild brain injury in women and on how to most effectively incorporate appropriate follow-up after emergency department evaluation.