Sex-Based Differences in Symptoms With Mouthguard Use After Pediatric Sport-Related Concussion

Context: Current evidence regarding the protective effect of mouthguard use on symptom severity in children and adolescents who sustain sport-related concussions is insufficient to make clinical recommendations. Objective: To compare the association between mouth guard use and symptoms stratified by sex in the first 4 weeks after pediatric sport-related concussion. We hypothesized that mouthguard use would be associated with less severe symptoms. Design: Prospective cohort study. Setting: Nine Canadian pediatric emergency departments (EDs). Patients or Other Participants: Children aged 5 to 18 years who were assessed within 48 hours of concussions sustained during a collision or contact sport. Main Outcome Measure(s): Injury characteristics were collected using the Acute Concussion Evaluation. The primary outcome measure was symptom score (range = 0-6), measured using age-appropriate versions (5-7, 8-12, or 13-18 years) of the Post-Concussion Symptom Inventory. The independent variable was time postconcussion (initial assessment and 1, 2, and 4 weeks). Results: Of 1019 children (73% male; median [interquartile range] age = 13.43 years [11.01-15.27 years]), 42% wore a mouthguard at the time of injury. No significant group-by-sex-by time interaction was present for symptoms (chi(2)(3) = 0.27; P = .965). Male mouthguard users reported similar symptom scores in the ED (difference in Post-Concussion Symptom Inventory D scores [diff] = -0.07; 95% CI = -0.23, 0.09) and at weeks 1 (diff = -0.02; 95% CI = -0.18, 0.14), 2 (diff = -0.03; 95% CI = -0.19, 0.13), and 4 (diff = -0.13; 95% CI = -0.29, 0.04) compared with males who did not wear a mouthguard. Female mouthguard users described minimally higher symptom scores at week 1 compared with non-mouthguard users (diff = 0.29; 95% CI = 0.01, 0.56). In the ED, symptom scores were not different for females who wore a mouthguard and those who did not (diff = 0.22; 95% CI = -0.04, 0.48) or at weeks 2 (diff = 0.22; 95% CI = -0.06, 0.51) or 4 (diff = 0.08; 95% CI = - 0.20, 0.36). Conclusions: Wearing a mouthguard at the time of injury was not associated with reduced acute or subacute symptoms after sport-related concussion in either males or females who were treated in the ED compared with those who did not wear a mouthguard. Athletes are still encouraged to wear mouthguards during sports because overwhelming evidence supports their use in preventing dental injuries.