Hi, my name is Zachary Spira, and I'm a third-year medical student at the Icahn School of Medicine at Mount Sinai, and I'm excited to present our research in sex differences and the incidence, severity, and recovery of concussion in adolescent student-athletes. Concussion risk is a significant concern in youth sports, and the number of female student-athletes is rising across the country. Previous research has demonstrated that females are at higher risk for concussion than males competing in the same sport. While the relationship between sex and concussion incidence has been discussed, the relationship between sex and concussion severity and recovery has been less well-studied, in part due to lack of quantitative metrics. The Severity Index is a novel quantitative metric published in 2020 by our research group. In this study, we used Severity Index to assess sex differences in concussion incidence, severity, and recovery in adolescent student-athletes. Results from over 25,000 impact tests in athletes ages 12 to 22 years old were acquired through a research agreement with impact applications. Data included 11,563 baseline tests from 7,454 students. Over 5,000 subjects had post-injury testing that could be used to evaluate concussion incidence, severity, and recovery. Multivariable, logistic, and linear regressions were used to assess sex differences and incidence and severity. Kaplan-Meier and Cox hazard regression were used to assess recovery. For the purposes of this study, concussion was defined as at least two out of five impact composite scores significantly deviated from baseline based on previously established reliable change indices. Recovery was defined as follow-up impact testing indicating return to zero or one composite score significantly deviated from baseline. The Severity Index calculation is shown here. In short, it is the sum of the differences between post-injury and baseline scores standardized by the reliable change index for each significantly deviated composite score. Severity Index has been shown to correlate with recovery time. Males in this study were more likely than females to play football and report diagnosed ADHD. At baseline, females reported more symptoms than males and performed better in verbal memory, processing speed, and reaction time tasks, while males performed better in visual memory tasks. In unadjusted analysis, there was no significant difference between males and females in concussion incidence or severity. However, in symptom reporting and processing speed tasks, females' scores deviated significantly more from baseline at initial post-injury impact evaluation. These differences in symptom score and processing speed persisted at follow-up impact evaluation despite females, on average, having a more prolonged duration between tests. In multivariable regression analysis controlling for baseline demographic differences, including age, sport, ADHD, and prior concussion history, females were more likely to suffer concussion with odds ratio 1.62. Females also suffered more severe concussions, according to Severity Index scores. Unadjusted Cox regression showed that females took longer to recover compared to males. However, this effect disappeared when controlling for initial concussion severity. In summary, females experienced higher incidence of concussion compared to males, driven by greater deviation from baseline in symptom score and processing speed. Females also suffered more severe concussions, resulting in prolonged recovery time on unadjusted analysis. However, there were no significant differences in recovery when controlling for initial concussion severity, suggesting that concussion severity and not sex is the major determinant of recovery time. This study has a number of limitations. The study was a retrospective analysis. Recovery time may have been overestimated as athletes may have recovered from concussion in the days prior to returning for follow-up impact evaluation. Additionally, impact is an imperfect proxy for concussion diagnosis and is susceptible to false positives and negatives. Finally, recovery time is unclear for athletes who remain concussed at follow-up post-concussion testing. Here you can see the relevant references for this presentation. Thank you very much for your time and interest.

Zachary Spira

medical student

concussion incidence

sex differences

adolescent student-athletes