March 29, 2011 — Female athletes who sustain a concussion report different symptoms than their male counterparts, according to research performed at the University of Virginia's Curry School of Education.
Sue Saliba, an assistant professor of kinesiology in the Curry School, and Leah Frommer, now an assistant athletic trainer at the University of California at Santa Barbara, conducted the study while Frommer was a graduate student at U.Va. Frommer graduated from Curry in 2008 with a master's degree in athletic training and sports medicine.
The research revealed that in addition to headache, high school girl athletes were more likely to complain of neurological symptoms like sensitivity to light or sleeplessness. Their male peers, conversely, are more likely to report neuro-cognitive issues, like loss of memory or balance control.
“We found a difference in the symptom type, and that's never been documented before,” Saliba said. However, there was no difference in the students' recovery time.
There are more than 1.6 million sport-related concussions reported each year in the United States. More than 5 percent of participants in high school contact sports are affected by concussions.
Their paper, “Sex Differences in Concussion Symptoms of High School Athletes,” was published in the January/February issue of the Journal for Athletic Trainers.
The study used Internet-based surveillance software designed for high school sports – called Reporting Information Online, or RIO – that is similar to injury-reporting software used by national sports teams, Saliba explained.
“At the time of the study, we only had two years of data,” she said, noting that the software is relatively new. It was developed in 2004 under the direction of Dr. Dawn Comstock by Research Information Services for the Research Institute at the Nationwide Children's Hospital in Columbus, OH.
Only certified athletic trainers can report injuries using RIO, Saliba said, adding that not all high schools have certified trainers, thus limiting the sample pool. The athletic trainers recorded the symptoms that were reported by the athletes, tracked how long the symptoms lasted, whether the student-athlete required any additional medical care and when the player was returned to practice or competition.
Saliba said the study evaluated 812 concussions from 100 different high schools. Of those, 610 occurred in males and 202 occurred in females. Though more boys suffered concussions overall because fewer girls participate in contact sports, Saliba explained, females had a higher rate of concussion.
Using RIO's information database, Frommer was able to examine the differences between reported symptoms in male and female athletes.
“It's really difficult to determine the severity of a concussion,” Saliba said, explaining that comparisons are made difficult because severity is often based on the symptoms reported, how long they last, as well as other factors such as performance on neurocognitive testing. Instead, Frommer focused her attention on the types of symptoms reported by student athletes.
While no difference was found in the number of symptoms reported, Frommer did find a difference in the types of symptoms reported.
Saliba said that the trends Frommer identified could encourage doctors to take more care in diagnosing concussions. In some cases, neurologically based symptoms, like having difficulty concentrating, can be attributed to attention deficit disorder when they actually may be indicative of a brain injury.
Moreover, Saliba said that the study makes an argument for having certified athletic trainers in schools.
“In the case where you have a certified athletic trainer, 90 percent of the concussions were resolved in the first three days,” Saliba said, explaining that most students were able to return to play in five to seven days, clearly after the symptoms had resolved. “I think that is very healthy.”
Saliba said that she intends to collaborate with Donna Broshek, an associate professor of psychiatry and behavioral sciences at U.Va., and other doctoral and master's students for further research on the subject.
“We're working on some other studies looking at assessment tools to determine cerebral blood flow changes and are planning to examine more of the high school injury data to try to determine a relationship of the severity of injury, symptoms and sex,” she said.
– by Samantha Koon