title: Sex Differences in Time to Return-to-Play Progression After Sport-Related Concussion.
abstract: BACKGROUND
  Recently, female sports participation has increased, and there is a tendency for women to experience more symptoms and variable presentation after sport-related concussion (SRC). The purpose of this study was to determine whether sex differences exist in time to begin a return-to-play (RTP) progression after an initial SRC.
  
  
  OBJECTIVE
  After initial SRC, female athletes (11-20 years old) would take longer to begin an RTP progression compared with age-matched male athletes.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Level 3.
  
  
  METHODS
  A total of 579 participants (365 males [mean age, 15.0 ± 1.7 years], 214 females [mean age, 15.2 ± 1.5 years]), including middle school, high school, and collegiate athletes who participated in various sports and experienced an initial SRC were included and underwent retrospective chart review. The following information was collected: sex, age at injury, sport, history of prior concussion, date of injury, and date of initiation of RTP progression. Participants with a history of more than 1 concussion or injury sustained from non-sport-related activity were excluded.
  
  
  RESULTS
  Despite American football having the greatest percentage (49.2%) of sport participation, female athletes took significantly longer to start an RTP progression after an initial SRC (29.1 ± 26.3 days) compared with age-matched male athletes (22.7 ± 18.3 days; P = 0.002).
  
  
  CONCLUSIONS
  On average, female athletes took approximately 6 days longer to begin an RTP progression compared with age-matched male athletes. This suggests that sex differences exist between athletes, aged 11 to 20 years, with regard to initiation of an RTP progression after SRC.
  
  
  CONCLUSIONS
  Female athletes may take longer to recover after an SRC, and therefore, may take longer to return to sport. Sex should be considered as part of the clinical decision-making process when determining plan of care for this population.
authors.affiliation: Texas Health Ben Hogan Sports Medicine, Fort Worth, Texas.
authors.forename: Sarah
authors.initials: S
authors.lastname: Stone
authors.affiliation: Texas Health Ben Hogan Sports Medicine, Fort Worth, Texas.
authors.forename: Bobby
authors.initials: B
authors.lastname: Lee
authors.affiliation: Texas Health Ben Hogan Sports Medicine, Fort Worth, Texas.
authors.forename: J Craig
authors.initials: JC
authors.lastname: Garrison
authors.affiliation: Texas Health Ben Hogan Concussion Center, Fort Worth, Texas.
authors.forename: Damond
authors.initials: D
authors.lastname: Blueitt
authors.affiliation: Texas Health Ben Hogan Sports Medicine, Fort Worth, Texas.
authors.forename: Kalyssa
authors.initials: K
authors.lastname: Creed
keywords: concussion; return-to-play progression; sex