ORLANDO—Soccer players with a history of concussion perform worse on certain aspects of initial postconcussion neurocognitive testing than those without such a history, and female players perform worse than their male counterparts, according to research reported at the 2008 Annual Meeting of the American Orthopaedic Society for Sports Medicine. Alexis Chiang Colvin, MD, urged physicians to take an individualized approach to treating patients with concussion.
“Concussion used to be managed according to the number of minutes of lost consciousness,” stated Dr. Colvin. “However, an athlete does not need to lose consciousness to have a concussion, and this is a message that we as clinicians need to get across to everyone involved in sports—coaches, trainers, team physicians, parents, and athletes.” Dr. Colvin, who conducted this research as a Sports Medicine Fellow in the Department of Orthopaedics at the University of Pittsburgh Medical Center, is now Assistant Professor of Sports Medicine at Mount Sinai School of Medicine in New York City.
Gender Differences in Recovery From Concussion
Dr. Colvin and colleagues defined a concussion, based on standard American Academy of Neurology classification, as a traumatically induced alteration in mental status with or without a loss of consciousness. Athletes were diagnosed with concussion if they reported symptoms such as headache, dizziness, balance problems, or nausea after a blow to the head or body. The investigators chose to examine concussion recovery patterns in soccer players primarily because soccer is a nonhelmeted sport with identical rules at all participation levels for both genders.
The study included 234 soccer players (60% female), ages 8 to 24, who underwent clinical evaluation at the University of Pittsburgh following a diagnosis of a sports-related concussion. None had a history of seizures, attention-deficit disorder, or a psychiatric disorder for which they were taking medication. All patients were tested within 13 days of their concussion with the ImPACT test battery. ImPACT is a computer-based neuropsychologic test that measures attention, memory, visual motor processing speed, and reaction time. The ImPACT inventory also queries athletes about their subjective experience of symptoms such as headaches, nausea, dizziness, and memory loss.
The researchers analyzed whether there were group differences in performance between male and female participants with or without a history of prior concussion. They found that following concussion, females performed significantly worse than males on tests of reaction time and were significantly more symptomatic. In particular, females had longer-lasting headaches.
A nonsignificant trend was also observed regarding greater deficits in verbal memory and processing speed in females, compared with males. Regardless of gender, however, soccer players with a history of concussion performed significantly worse on verbal memory testing after another concussion.
Does BMI Affect Postconcussion Outcomes?
Differences in postinjury neurocognitive outcomes were not attributable to differences in BMI, according to Dr. Colvin. “Our study demonstrated that gender may be more important than the mass of the player in postconcussive testing,” she said.
“There’s a theory that males typically have a stronger neck and torso that can handle forces better,” she commented. “However, there are differences in recovery between genders that cannot simply be attributed to size difference. More studies are needed to determine the reason for differences in recovery between males and females.”
An Individualized Approach
“The results of this study suggest that physicians should not be taking a one-size-fits-all approach to treating concussions,” Dr. Colvin concluded. “Our study shows that patients with a history of a previous concussion perform worse than patients without a previous history on neurocognitive tests taken after they sustain a concussion. Furthermore, females perform worse than males on postconcussion testing.”
—Janis Kelly