PM&R
Volume 1, Issue 3 , Pages 245-253, March 2009

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

  • Sarah J. Preiss-Farzanegan, MD

      Affiliations

    • University of Rochester Medical Center, Department of Physical Medicine and Rehabilitation, Rochester, NY†
    • Corresponding Author InformationAddress correspondence to S.J.P.-F., Stanford Sports Medicine Center, 341 Galvez Street, Stanford, CA 94305-6175
    • ,
  • Benjamin Chapman, PhD

      Affiliations

    • University of Rochester School of Medicine and Dentistry, Department of Psychiatry, Rochester, NY‡
    • ,
  • Tony M. Wong, PhD

      Affiliations

    • Unity Health System, Department of Neuropsychology, University of Rochester Medical Center, Department of Physical Medicine and Rehabilitation, Rochester, NY§
    • ,
  • Joanne Wu, MD

      Affiliations

    • University of Rochester Medical Center, Department of Physical Medicine and Rehabilitation, Rochester, NY
    • ,
  • Jeffrey J. Bazarian, MD, MPH

      Affiliations

    • University of Rochester Medical Center, Departments of Emergency Medicine, Neurology, and Neurosurgery, Rochester, NY∥

Received 19 June 2008; accepted 6 January 2009.

Objective

The authors sought to define the relationship between gender and postconcussion 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.

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  • † Disclosure: nothing to disclose
  • ‡ Disclosure: nothing to disclose
  • § Disclosure: nothing to disclose
  •  Disclosure: nothing to disclose
  • ∥ Disclosure: 2A Neuren Pharmaceuticals, Roche Diagnostics; 8B NIH, New York State DOH.

 Disclosure Key can be found on the Table of Contents and at www.pmrjournal.org

PII: S1934-1482(09)00057-4

doi:10.1016/j.pmrj.2009.01.011

PM&R
Volume 1, Issue 3 , Pages 245-253, March 2009

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