Bretzin, A. C., Covassin, T., Wiebe, D. J. and Stewart, W. (2021) Association of sex with adolescent soccer concussion incidence and characteristics. JAMA Network Open, 4(4), e218191. (doi: 10.1001/jamanetworkopen.2021.8191) (PMID:33904911) (PMCID:PMC8080231)
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Abstract
Importance: Because of the negative consequences of concussion, considerable research efforts have been directed toward understanding the risk factors for sport-related concussion (SRC) and its outcomes to better inform strategies for risk reduction. Girls are suggested to have an increased risk of concussion, warranting exploration into sex-dependent variations in concussion presentation and management, with the potential that this information might inform sex-specific rules directed toward risk reduction within sports. Objective: To compare sex-associated differences in epidemiology and concussion management in adolescent soccer players within a prospective, longitudinal high school injury surveillance project. Design, Setting, and Participants: This prospective, longitudinal cohort study assessed male and female soccer athletes from all high schools in the Michigan High School Athletic Association (MHSAA) during academic years 2016-2017 to 2018-2019. Exposures: Sport-related concussion captured in the MHSAA Head Injury Reporting System. Main Outcomes and Measures: Outcomes included details regarding each documented SRC event, including injury mechanism, immediate management, and return-to-play time. Multiple comparisons were made between male and female athletes regarding SRC risk, mechanism, short-term management, and outcomes. Results: A total of 43 741 male and 39 637 female soccer athletes participated in MHSAA soccer during the 3 consecutive academic years of study (2016-2017: n = 751 schools; 2017-2018: n = 750 schools; and 2018-2019: n = 747 schools). During the 3 years of surveillance, 1507 of the 83 378 soccer athletes (1.8%) were reported to have SRC during soccer participation, including 557 boys (37.0%) and 950 girls (63.0%). Documented SRC risk in female soccer participants was greater than in male soccer participants (risk ratio, 1.88; 95% CI, 1.69-2.09; P < .001). Male soccer athletes most often sustained SRC from contact with another player (48.4%), whereas SRCs in female soccer players recorded in the Head Injury Reporting System were most often from nonplayer contact events (41.9%; P < .001). Adolescent male soccer players with a documented SRC were more likely to be removed from play on the day of injury (odds ratio, 1.54; 95% CI, 1.15-2.06; P = .004). Although the overall median time to return to play was 11 days (interquartile range [IQR], 7-15 days), male athletes typically returned 2 days earlier than female athletes (median, 10 [IQR, 7-14] days vs 12 [IQR, 7-16] days; Peto test P < .001). Conclusions and Relevance: In this cohort study, sex-associated differences were revealed among adolescent soccer athletes in SRC risk, mechanism of injury, immediate management, and outcomes in injuries documented in a statewide injury reporting system. Thus, consideration might be given to sex-specific approaches to participation and concussion management in the sport.
Item Type: | Articles |
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Additional Information: | This work was supported by funding from: The Football Association and The Professional Footballers Association and NHS Research Scotland (WS); Penn Injury Science Center R49CE03083 (AB, DW); Brain Injury Training Grant NS043126 (AB). |
Status: | Published |
Refereed: | Yes |
Glasgow Author(s) Enlighten ID: | Stewart, Dr William |
Authors: | Bretzin, A. C., Covassin, T., Wiebe, D. J., and Stewart, W. |
College/School: | College of Medical Veterinary and Life Sciences > School of Psychology & Neuroscience |
Journal Name: | JAMA Network Open |
Publisher: | American Medical Association |
ISSN: | 2574-3805 |
ISSN (Online): | 2574-3805 |
Published Online: | 27 April 2021 |
Copyright Holders: | Copyright © 2021 Bretzin AC et al. |
First Published: | First published in JAMA Network Open 4(4): e218191 |
Publisher Policy: | Reproduced under a Creative Commons License |
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