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  • Response to Acute Concussive Injury in Soccer Players: Is Gender a Modifying Factor?

    Final Number:

    Scott L. Zuckerman MD, BS; Gary Solomon PhD; Richard F Haase PhD; Jonathan Forbes MD; Young M. Lee; Mitchell Odom; Allen K. Sills MD; Mark R. Lovell PHD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    Introduction: The Concussion in Sport Group (CIS) did not include gender as a modifying factor in SRC, concluding that the evidence at that point was equivocal. We assessed acute neurocognitive and symptom responses to SRC in equivalent cohorts of male and female soccer players. We hypothesized that female athletes would experience greater levels of acute symptoms and neurocognitive impairment than males.

    Methods: Forty male and 40 female soccer players with baseline symptom and neurocognitive scores (ImPACT), who sustained a SRC, and completed post-concussion symptom and neurocognitive testing, were carefully matched on a wide array of biopsychosocial variables. Their baseline and post-concussion symptom and neurocognitive test scores were compared.

    Results: Specific a-priori hypotheses on differences between males and females at baseline and at post-concussion measurements on verbal and visual memory ImPACT scores were evaluated by simple main effects of the gender by baseline-to-post-concussion interaction of 2 x 2 split plot analysis of variance. Neither the interaction nor the main effects, nor the simple main effects for either ImPACT variable were found to be statistically significant. Exploratory analyses of variance applied to the remaining ImPACT variables of visual-motor speed, reaction time, impulse control, and symptom total scores revealed only a single statistically significant baseline to post-concussion main effect for the symptom total. The mean change, averaged across males and females, increased substantially from baseline (M = 7.5) to post-concussion (M = 17.24).

    Conclusions: Our results failed to replicate prior findings of gender-specific baseline neurocognitive differences in verbal and visual memory. Our findings also indicated no differential gender-based acute response to concussion (symptoms or neurocognitive scores) among high school soccer athletes. The implications of these findings for the inclusion of gender as a modifying factor in our tightly matched cohort are addressed. Potential explanations for the null findings are discussed.

    Patient Care: By stratifying acute concussion outcomes based on gender, we can modify return to play guidelines and treatment measures to accommodate gender differences.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1)Describe the importance of matching cohorts when assessing post-concussion outcomes; 2) Discuss how gender may or may not affect post-concussion assessment and treatment; 3) Integrete our findings with the existing literature, that females have been shown to have better verbal memory scores, poorer visual memory scores, and endorse more symptoms.

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