Sex Differences in Resource Allocation and Access to Care After Sport-Related Concussion

Abstract

Context: Following sport-related concussions (SRC), immediate access to a certified athletic trainer (ATC) is important to ensure proper treatment. However, resource allocation and coverage may differ between male/female youth sports. Objective: We sought to compare resource allocation between male/female sports in the following areas: 1) rates of immediate on-field evaluation by an ATC at the time of injury, 2) time to general healthcare presentation, and 3) time to SRC clinic presentation. Design: A retrospective cohort study Setting: Regional sports concussion center Patients: Athletes ages 14-19 who presented to a regional sports concussion center from 11/2017-04/2022 was conducted. Main Outcome Measures: The primary exposure of interest was sex (male/female). The primary outcome was immediate on-field evaluation by an ATC (yes/no). Secondary outcomes included time to general healthcare and SRC clinic presentation. Descriptive statistics, chisquared analyses, and linear regressions were performed. Covariates included age, history of prior concussions, and statistically significant demographics. Results: A total of 832 patients with SRC were included (age 16.2±1.2, 66.5% male). Female athletes had lower rates of ADHD (X2=10.404, p=.001) and higher rates of anxiety/depression (X2=12.891, p< 0.001) compared to male athletes. Average time to presentation to general healthcare and SRC clinic did not differ between males/females, but ATC on-field evaluation occurred more in male (40.3%) than female (32.3%) athletes (X2=8.677, p=.013). Multivariable linear regression foun 24 d that ATC on-field evaluation was a significant predictor of time to general healthcare presentation (β=-0.085, p=.015) but not SRC clinic presentation (β=-0.055, p=.099). History of prior concussions was a significant predictor of time to initial healthcare contact (β=0.083, p=.018). History of anxiety/depression (β=0.136, p<.001) and initial evaluation by emergency department (ED)/urgent care (β= 0.305, p<.001) were significant predictors of delayed time to SRC clinic presentation. Conclusions: Among 832 concussed youth athletes, female athletes were evaluated less frequently by an ATC immediately after injury. Furthermore, not being evaluated by an ATC on field was significantly associated with longer time to healthcare presentation. Future investigations should elucidate resource equity among male and female athletes.