Gender Does Not Impact Return to Learn Following Sport-Related Concussion

Gender is not predictive of return to learn following sports-related concussion among high school athletes, according to study results published in Neurosurgical Focus.

Researchers conducted a retrospective cohort study between February 2015 and January 2023 using data from a prospective surveillance program that tracked concussion recovery of high school student athletes in Maine to compare patterns of return to learn between boys and girls who are student athletes and investigate whether a relationship exists between sex and time to return to learn.

High school athletes who sustained a sport-related concussion and were evaluated within 5 days of injury using a symptom questionnaire were eligible for study inclusion. The Post-Concussion Symptom Scale (PCSS), included in Immediate Post-Concussion Assessment and Cognitive Test (ImPACT), as well as the Sport Concussion Assessment Tool (SCAT3/SCAT5) were used to evaluate symptoms in terms of severity. Return to learn status was dichotomized (ie, returned vs not returned) at several timepoints post-injury.

The primary outcome was days to return to learn, defined as the total number of days it took an athlete to fully return to school without any academic accommodations.

Multivariable linear regression models were used in statistical analyses.

A total of 895 high school athletes were included in the final analysis, 488 (54.5%; mean age, 16.3; ≥1 previous concussion, 31.4%) of whom were boys and 407 (45.5%; mean age, 16.1; ≥1previous concussion, 29.0%) of whom were girls. The most common sport among boys and girls was football (43.9%) and soccer (35.6%), respectively.

Days to evaluation did not differ by sex (boys, 1.4 days vs girls, 1.5 days; P =.481). Similarly, the mean acute symptom burden severity was also comparable among boys and girls (PCSS/ImPACT score, 19.0 and 17.7, respectively; P =.203; SCAT3/SCAT5 score, 28.8 and 32.3, respectively; P =.052).

Median days to return to learn did not significantly differ between boys (6.0; 95% CI, 3.0-11.0) and girls (6.0; 95% CI, 3.0-12.0; P <.375). At 3 weeks post-initial injury, however, the percentage of athletes who returned to learn was significantly different between boys (93.5%) and girls (89.4%; P =.030). The 2 groups did not differ significantly in the percentage of athletes who returned to learn at 1, 2, or 4 weeks.

According to all 3 multivariable regression analyses, sex was not a significant independent predictor of return to learn. The second analysis indicated that longer days to evaluation (β, 0.10; 95% CI, 0.13-1.56; P =.021) and higher initial symptom severity score per the SCAT3/SCAT5 (β, 0.15; 95% CI, 0.04-0.14; P <.001) were associated with longer return to learn, while the third model indicated that the greater number of previous concussions (β, 0.20; 95% CI, 1.02-3.54; P <.001) and higher initial symptom severity score per the PCSS/ImPACT (β, 0.11; 95% CI, 0.00-0.14; P =.045) were associated with longer return to learn.

Study limitations included reduced generalizability of results to athletes from a broader geographic area, variations in the characterization of return to learn, inability to capture external factors that may have contributed to return to learn, and the use of a dichotomous definition of sex.

Disclosure: This research was supported by Amgen Inc. Several study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.