title: Sex-Based Differences as a Predictor of Recovery Trajectories in Young Athletes After a Sports-Related Concussion.
abstract: BACKGROUND
  To date, few studies have delineated clear sex-based differences in symptom resolution after a sports-related concussion (SRC), and equivocal results have been identified in sex-based differences on baseline assessments.
  
  
  OBJECTIVE
  To assess whether female athletes displayed prolonged recovery and more symptoms at baseline and after an SRC compared with male athletes.
  
  
  METHODS
  Cohort study; Level of evidence, 3.
  
  
  METHODS
  The current study assessed 135 male and 41 female athletes (10-18 years old) who participated in high-impact sports in metropolitan Atlanta middle and high schools. All athletes completed a baseline assessment and at least 1 postconcussion assessment from the Immediate Post-Concussion Assessment and Cognitive Testing battery. Longitudinal hierarchical linear modeling was employed to examine individual-level variables and their associations with adolescents' rates of recovery in concussive symptoms after controlling for age and number of prior concussions.
  
  
  RESULTS
  Aggregate symptoms were rated as higher in female athletes compared with male athletes at baseline (mean ± SD: females, 13.49 ± 11.20; males, 4.88 ± 8.74; F(1,175) = 10.59, P < .001) and immediately after a concussion (females: 16.75 ± 18.08; males: 10.58 ± 14.21; F(1,175) = 3.99, P = .05). There were no group differences in the slope of recovery between male and female athletes, indicating generally similar trajectories of change for both groups. Post hoc analyses revealed higher baseline levels of migraine and neuropsychological symptoms in female athletes.
  
  
  CONCLUSIONS
  Although female athletes in the current study reported increased symptoms, identical recovery patterns were observed in both sexes, suggesting that sex-based differences in concussion recovery are better explained by increased symptom frequency among female athletes when compared with their male counterparts.
authors.affiliation: Children's Healthcare of Atlanta, Atlanta, Georgia, USA kim.ono@choa.org.
authors.forename: Kim E
authors.initials: KE
authors.lastname: Ono
authors.affiliation: Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Burns
authors.affiliation: Boston Children's Hospital, Boston, Massachusetts, USA.
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Bearden
authors.affiliation: Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
authors.forename: Susan M
authors.initials: SM
authors.lastname: McManus
authors.affiliation: Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
authors.forename: Harold
authors.initials: H
authors.lastname: King
authors.affiliation: Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Reisner
mesh_terms: D000293:Adolescent; D056352:Athletes / Q000706:statistics & numerical data*; D001265:Athletic Injuries / Q000175:diagnosis / Q000453:epidemiology*; D001924:Brain Concussion / Q000175:diagnosis / Q000453:epidemiology*; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008881:Migraine Disorders / Q000453:epidemiology; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D020127:Recovery of Function; D012574:Schools; D012727:Sex Characteristics; D012737:Sex Factors; D013177:Sports / Q000706:statistics & numerical data*
keywords: adolescents; concussion; sex-based difference; trajectories of recovery