As sport-related concussion (SRC) awareness has increased, timely reporting and immediate removal from play have become a focal point of proper management. Delayed removal may result in additional injury and protracted recovery. Research has demonstrated that girls are more honest and likely to report their concussion symptoms compared to boys. However, it is unknown if these reporting behaviors correspond with immediate removal from play in girls compared to boys in sex-comparable sports.
PURPOSE: To compare the incidence of high school athletes not removed from activity following SRC in sex-comparable sports in Michigan.
METHODS: An epidemiological study of athletes diagnosed with SRC participating in Michigan High School Athletic Association-sponsored basketball, baseball/softball, and soccer from 2016-2019 was performed. All SRCs were recorded in a Head Injury Reporting System by certified athletic trainers, administrators, or coaches. Removal from activity indicated the athlete was removed from play at the time of an injury event. Lack of removal does not indicate mismanagement at the time of the event, but that the injury was not reported. Incidence was calculated by dividing SRCs not removed by total SRCs in each sport. Risk ratios were calculated by dividing the incidence of girls not removed by boys not removed in each sport.
RESULTS: A total of 3696 (2425 female, 1271 male) SRCs were reported, with the most occurring in girls’ soccer (n = 1024). Overall, 442 girls and 182 boys were not removed from activity, resulting in incidences of 0.18 (95% CI, 0.17-0.20) and 0.14 (95% CI, 0.12-0.16), respectively. Across all sports, girls were 1.27 (95% CI, 1.09-1.49) times as likely to not be removed from activity compared to boys. Girls had 1.16 (95% CI, 0.91-1.50), 1.19 (95% CI, 0.77-1.84), and 1.41 (95% CI, 1.12-1.78) times the risk of not being removed from basketball, softball, and soccer, respectively, when compared to the equivalent boy sports.
CONCLUSIONS: Girls were at greater risk of not being removed from activity compared to boys in sex-comparable sports. Although girls are more likely to report symptoms of SRC, there is still a gap in their removal from play, potentially due to a delayed onset or recognition of symptoms. Future research and initiatives should target reporting and removal in female sports.