Concussion study indicates higher risk for females -- another reminder for coaches to review recognition protocols

My colleagues at Stanford and I have had a feeling that women are more likely to sustain concussions than men, and that the women often took longer to recover from the concussion than men.

Most of this thought was based upon our possibly unreliable experiences, with not a lot of hard data to back this up. But now there is some very good evidence out of Columbia University in New York that women are in fact more likely to sustain a concussion than men, however their recovery times are similar (both took about 14 days).

This study by primary author Cecilia Davis-Hayes and co-authors followed varsity athletes at Columbia University (in the Ivy League) over a 15-year period from 2000 through 2014. This study has a number of strengths, such as the careful monitoring of the athletes and their symptoms over time, consistency in definitions of concussion and return to play protocols, and a very high followup rate.

Females are 1.5 times more likely to have a concussion compared to males.

History of a concussion prior to attending college, 2.9 times more likely to have a collegiate concussion compared to athletes with no prior concussion.

Additionally, this study highlighted a number of other interesting findings. First, male athletes were much more likely to report memory problems in the post-concussion period than females, and the average return to play time for all athletes was 14 days. This average return to play time had a high amount of variability, with some athletes taking many months to return to play.

The interesting part about this is that we’ve come to take for granted that once an athlete is diagnosed with a concussion they typically take about a week to return to play. This was not true in the Columbia study, and is in line with my own experience with high school and collegiate athletes.

I think there are a few important take-home points from this study.

Female athletes should be particularly cautious about return to play if you’ve had a concussion.

If you’re a coach of female athletes be aware that your players are more likely to sustain a concussion than males. Know your concussion recognition protocols very well.

The real world experience with collegiate athletes shows that concussion recovery often takes longer than what we would be lead to believe in the media.

Key Points
A recently published study confirms suspicions that female athletes are more likely to sustain a concussion than males.
Average return to play times for males and females was similar, but far longer than typically reported for athletes, at about 14 days.

U.S. Soccer's Recognize to Recover:
Head & Brain Conditions
Athlete Concussion Guidelines
U.S. Soccer National Teams Concussion Testing and Management Process
U.S. Soccer National Teams Concussion Recovery and Return to Play
Concussions - "Let's Take Brain Injuries Out of Play."
USSF-CDC A Fact Sheet for Athletes
USSF-CDC A Fact Sheet for Coaches
USSF-CDC A Fact Sheet for Parents

(Dr. Dev K. Mishra, a Clinical Assistant Professor of orthopedic surgery at Stanford University, is the creator of the online injury-management course, now a requirement for US Club Soccer coaches and staff members. Mishra writes about injury recognition and management at Blog.)

2 comments about "Concussion study indicates higher risk for females -- another reminder for coaches to review recognition protocols".
  1. Kevin Sims, January 16, 2018 at 11:45 a.m.

    Helpful resource. Encourage all coaches to engage the course. 30 minutes. FREE

  2. Nick Daverese, January 17, 2018 at 8:17 a.m.

    Who decides if the player is okay to play after you remove him or her from the game. The players family doctor or a sports trainer. I can tell you from experience you can not trust the family doctor.

    better to have your sports trainer or a a specialist write the release to play again.

    we had a ambulance at every game Bravo was the best at that time. You had a head injury you went to the hospital.

    the questions I asked or our medical trainer answered were about the same. But you still were not going back in the game. 

    Each year, several players in various 
    sports die after second-impact concussions. The second-impact doesn't have to be the same day, or even the same week. Apparently, as long as the player has  symptoms there is still some brain injury which needs healing. So there is a danger of making the condition worse if they get another head injury after the first. 
    Watch out for nausea, dizziness, ringing in the ears, headaches, confusion, sensitivity to light, erratic behavior or there vision changes in some other way. They should see a doctor and or neurologist, maybe even a trip to emergency on a knock out injury for a catscan to check for bleeding under the skull which can kill you" 

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