Post-Concussion Symptom Factors in Male and Female High School and Collegiate Athletes

Abstract

Previous research suggests concussed female athletes report higher severity of total symptoms; however, sex differences for symptom factors across recovery are understudied. PURPOSE: To examine sex differences in post-concussion symptom factors across concussion recovery (i.e., ≤72 hours, return-to-play, >one-month). METHODS: Symptoms were rated from 0 (none) to 6 (severe) on the Post-Concussion Symptom Scale (PCSS), which consists of 22 total symptoms and a total symptom severity score ranging from 0-132. The PCSS was broken into two symptom factors: cognitive-migraine-fatigue (headache, dizziness, fatigue, drowsiness, sensitivity to light/noise, feeling slowed down, fogginess, difficulty concentrating/remembering) and affective (sadness, nervousness, feeling more emotional). A 2 sex (male, female)*2 group (concussed, healthy)*3 time (≤72 hours, return-to-play, >one-month) repeated measures ANOVA was used to analyze sex differences in symptom factors throughout recovery between concussed and healthy athletes. RESULTS: There were 167 (M=17.46 years, SD=2.2; male=97, female=70; concussed=78, healthy=89) total athletes. There were no significant sex differences between testing sessions at ≤72 hours (M=2.03 days, SD=0.8, p=.42), return-to-play (M=16.09 days, SD=11.7, p=.95), and >one-month (M=59.72 days, SD=21.4, p=.65). There was no significant within-subject interaction for sex*group*time for the cognitive-migraine-fatigue or affective symptom factors. There was a significant between-subjects sex*group interaction for the cognitive-migraine-fatigue symptom factor (F(1,163)=5.52, p=.02, η2=.03). Simple main effects analysis revealed concussed females (M=7.39, SE=0.57) reported significantly higher severity for the cognitive-migraine-fatigue symptom factor than concussed males (M=4.83, SE=0.48; p≤.001), yet no sex differences were observed between healthy athletes (p=.82). There was no significant between-subjects sex*group interaction for the affective post-concussion symptom factor. CONCLUSIONS: Concussed females reported greater symptom severity for the cognitive-migraine-fatigue symptom factor compared to concussed males, which may direct targeted concussion management approaches between female and male athletes.