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Absence of Differences Between Male and Female Adolescents With Prior Sport Concussion

Brooks, Brian L. PhD; Mrazik, Martin PhD; Barlow, Karen M. MB, ChB, MRCPCH; McKay, Carly D. PhD; Meeuwisse, Willem H. MD, PhD; Emery, Carolyn A. PhD

Section Editor(s): Caplan, Bruce PhD, ABPP; Bogner, Jennifer PhD, ABPP

Journal of Head Trauma Rehabilitation: May/June 2014 - Volume 29 - Issue 3 - p 257–264
doi: 10.1097/HTR.0000000000000016
Original Articles
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Objective: Sex differences following concussion are poorly understood. The purpose of this study was to examine whether male and female adolescent athletes with prior concussions differ regarding neurocognitive function and symptom reporting.

Setting: Community-based hockey teams.

Participants: Participants included 615 elite hockey players 13 to 17 years old (mean = 15.5, 95% confidence interval [CI] = 15.4-15.6). There were 517 males and 98 females. Players with English as a second language, attention or learning problems, a concussion within 6 months of baseline, or suspected invalid test profiles were excluded from these analyses.

Design: Cross-sectional.

Main Measure: Domain scores and symptom ratings from the ImPACT computerized battery.

Results: There were no significant neurocognitive differences between males and females with (F5,227 = 1.40, P = .227) or without (F5,376 = 1.33, P = 0.252) a prior history of concussion. Male and female athletes with a history of concussion reported higher raw symptom scores than those without a prior concussion; however, sex differences disappear when symptom scores are adjusted for known sex differences in controls (total score, F2,230 = 0.77, P = .46; Cohen d = 0.01 or domain scores (F4,227 = 1.52, P = .197; Cohen d = 0.07-0.18).

Conclusions: Although those with prior concussions report more symptoms (but do not differ on neurocognition), this study does not support sex differences with cognition or symptoms in adolescent athletes with prior concussions.

Neurosciences (Brain Injury and Rehabilitation programs), Alberta Children's Hospital, Departments of Paediatrics and Clinical Neurosciences, Faculty of Medicine, University of Calgary, Alberta Children's Hospital Research Institute for Child and Maternal Health, University of Calgary, Calgary, Alberta, Canada (Dr Brooks); Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada (Dr Mrazik); Paediatric Neurology, Faculty of Medicine, University of Calgary, Neurosciences (Brain Injury and Rehabilitation programs), Alberta Children's Hospital, Alberta Children's Hospital Research Institute for Child and Maternal Health, University of Calgary, Calgary, Alberta, Canada (Dr Barlow); Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada (Dr McKay); Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada (Dr Meeuwisse); and Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Alberta Children's Hospital Research Institute for Child and Maternal Health, University of Calgary, Calgary, Alberta, Canada (Dr Emery).

Corresponding Author: Brian L. Brooks, PhD, Neurosciences Program, Alberta Children's Hospital, 2888 Shaganappi Trail NW, Calgary, Alberta T3B 6A8, Canada (brian.brooks@albertahealthservices.ca).

None of the authors have a financial interest in the ImPACT battery. B.L.B. receives funding from a test publisher (Psychological Assessment Resources, Inc), book royalties from Oxford University Press, and in-kind test credits for research from another computerized test publisher (CNS Vital Signs). In-kind support from ImPACT was provided to M.M. for the assessments conducted in Edmonton.

Computerized cognitive testing in this study was funded in Calgary by the McCarthy Tetrault award (administered by the Alberta Children's Hospital Research Institute for Child & Maternal Health on behalf of the Alberta Children's Hospital Foundation) to B.L.B. for a computerized neurocognitive laboratory (computers, test credits) and in Edmonton by funding provided to M.M. and in-kind support by ImPACT to M.M. The Sport Injury Prevention Research Centre is one of the International Research Centres for Prevention of Injury and Protection of Athlete Health supported by the International Olympic Committee. W.H.M. and C.A.E. acknowledge funding from Alberta Innovates Health Solutions (AIHS), Canadian Institutes of Health Research (CIHR), and the Alberta Children's Hospital Research Institute for Child & Maternal Health (ACHRI; Professorship in pediatric rehabilitation for C.A.E.). None of the funding sources were involved in design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript.

The authors thank Tracy Blake, MSc, Andrea Jubinville, MA, Nicole Lemke, Maria Romiti, and Kathryn Schneider, PhD, for their help with data collection and data management (alphabetical order); Helen Carlson, PhD, for her help with entering the demographically adjusted normative scores and formatting the manuscript; and Hockey Calgary, Females Hockey Calgary, Hockey Edmonton, Edmonton Females Hockey, the Edge School (Calgary), the team designates, research assistants, coaches, families, and the players for participating in this study.

The authors declare no conflicts of interest.

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