Sport concussion in female athletes: a systematic review

Abstract Concussions are very common injuries across many different sports and settings and present a significant public health concern in multiple countries. Previous studies have investigated concussion incidence, with a notable number reporting that female athletes have higher rates of sports-related concussions compared to their male counterparts. This study aims to look at risk factors linked to this increased susceptibility of female athletes, and how this affects them, rather than focusing on incidence. To investigate this, we carried out a systematic review following the PRISMA guidelines. We searched the PubMed, Cochrane, APA PsychNet and Web of Science databases Inclusion criteria consisted of papers published in the last 10 years as of the 6th November 2023, studying athletes over the age of 18 who concussed themselves during sporting activity of any level. The exclusion criteria included narrative reviews, single case reports, abstracts, letters to the editor, and studies that included chronic traumatic brain injuries, spinal cord injuries or facial bone fractures. After reviewing all the papers from the search (N= 1373), we identified 27 papers in total that met all inclusion criteria. We then extracted data from each paper relating to the biomechanics, neuropsychology, neurostructural substrates, physiology, and clinical recovery times. The main findings included women having significantly longer recovery times following concussions, increased symptom reporting, and different neurocognitive defects in testing post-concussion compared to men. There was also some evidence to suggest a difference in the neuroinflammatory process between men and women following concussive injury. Highlighting these risk factors can hopefully lead to improved prevention, diagnosis, and treatment for concussions in women’s sports. Competing Interest Statement The authors have declared no competing interest. Clinical Protocols https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=473113 Funding Statement Brighton and Sussex Medical School Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: source data were openly available, and all used studies are cited in the review I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Footnotes Ruby Westhead – r.westhead1{at}uni.bsms.ac.uk Conceptualisation – Ruby Westhead and Natasha Sigala Resources - Ruby Westhead and Natasha Sigala Investigation – Ruby Westhead Formal Analysis – Ruby Westhead Writing – original draft – Ruby Westhead, review & editing – Ruby Westhead and Natasha Sigala The study was funded by the Brighton and Sussex Medical School Data Availability All data produced in the present study are available upon reasonable request to the authors