title: Response to acute concussive injury in soccer players: is gender a modifying factor?
abstract: OBJECTIVE
  Several studies have suggested a gender difference in response to sports-related concussion (SRC). The Concussion in Sport group did not include gender as a modifying factor in SRC, concluding that the evidence at that point was equivocal. In the present study the authors endeavored to assess acute neurocognitive and symptom responses to an SRC in equivalent cohorts of male and female soccer players. The authors hypothesized that female athletes would experience greater levels of acute symptoms and neurocognitive impairment than males.
  
  
  METHODS
  Baseline symptom and neurocognitive scores were determined in 40 male and 40 female soccer players by using the Immediate Postconcussion Assessment and Cognitive Testing (ImPACT) scale prior to any SRC. After sustaining an SRC, each athlete completed postconcussion ImPACT tests and was carefully matched on a wide array of biopsychosocial variables. Baseline symptom and neurocognitive test scores were compared, and their acute symptoms and neurocognitive responses to concussive injury were assessed.
  
  
  RESULTS
  Specific a priori hypotheses about differences between males and females at baseline and at postconcussion measurements of verbal and visual memory ImPACT scores were evaluated according to simple main effects of the gender variable and according to baseline-to-postconcussion main effect and interaction of 2 × 2 split-plot ANOVA. Neither the interaction nor the main effects nor the simple main effects for either ImPACT variable were found to be statistically significant. Exploratory ANOVAs applied to the remaining ImPACT variables of visualmotor speed, reaction time, impulse control, and symptom total scores revealed only a single statistically significant baseline-to-postconcussion main effect for the symptom total.
  
  
  CONCLUSIONS
  The results failed to replicate prior findings of gender-specific baseline neurocognitive differences in verbal and visual memory. The findings also indicated no differential gender-based acute response to concussion (symptoms or neurocognitive scores) among high school soccer players. The implications of these findings for the inclusion of gender as a modifying factor in this tightly matched cohort are addressed. Potential explanations for the null findings are discussed.
authors.affiliation: Vanderbilt University School of Medicine, Department of Neurological Surgery, T-4224 Medical Center North, Nashville, Tennessee 37232-2380, USA. scott.zuckerman@vanderbilt.edu
authors.forename: Scott L
authors.initials: SL
authors.lastname: Zuckerman
authors.forename: Gary S
authors.initials: GS
authors.lastname: Solomon
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Forbes
authors.forename: Richard F
authors.initials: RF
authors.lastname: Haase
authors.forename: Allen K
authors.initials: AK
authors.lastname: Sills
authors.forename: Mark R
authors.initials: MR
authors.lastname: Lovell
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000704:Analysis of Variance; D001924:Brain Concussion / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology*; D003071:Cognition; D003072:Cognition Disorders / Q000209:etiology; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008568:Memory; D008569:Memory Disorders / Q000209:etiology; D009483:Neuropsychological Tests; D011597:Psychomotor Performance; D011930:Reaction Time; D012737:Sex Factors; D012916:Soccer / Q000293:injuries*; D013334:Students / Q000523:psychology; D013997:Time Factors; D055815:Young Adult