Sex Differences Across Concussion Characteristics in US Service Academy Cadets: A CARE Consortium Study,Sports Medicine

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Sex Differences Across Concussion Characteristics in US Service Academy Cadets: A CARE Consortium Study
Sports Medicine ( IF 9.3 ) Pub Date : 2024-07-12 , DOI: 10.1007/s40279-024-02068-3
Louise A Kelly ₁ , J B Caccese ₂ , D Jain ₃ , C L Master ₄ , L Lempke ₅ , A K Memmini ₆ , T A Buckley ₇ , J R Clugston ₈ , A Mozel ₉ , J T Eckner ₁₀ , A Susmarski ₁₁ , E Ermer ₁₂ , K L Cameron ₁₃ , S Chrisman ₁₄ , P Pasquina ₁₂ , S P Broglio ₅ , T W McAllister ₁₅ , M McCrea ₁₆ , C Esopenko ₃ ,

Affiliation

Department of Exercise Science, California Lutheran University, #3400, 60 W. Olsen Road, Thousand Oaks, CA, 91360, USA.
College of Medicine School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA.
Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Michigan Concussion Center, University of Michigan, Ann Arbor, MI, USA.
Department of Health, Exercise and Sports Sciences, University of New Mexico, Albuquerque, NM, USA.
Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA.
Department of Community Health and Family Medicine, University of Florida, Gainesville, FL, USA.
Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
Medical Associates Clinic, Loras College, Dubuque, IA, USA.
Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
Orthopaedic and Sports Medicine, United States Military Academy, West Point, NY, 10996, USA.
Division of Adolescence Medicine, Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, 98105, USA.
Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA.
Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA.

Objective

To describe sex differences in concussion characteristics in US Service Academy cadets.

Design

Descriptive epidemiology study.

Setting

Four US service academies.

Participants

2209 cadets (n = 867 females, n = 1342 males).

Independent Variable

Sex.

Outcome Measures

Injury proportion ratios (IPR) compared the proportion of injuries by sex (females referent) for injury situation, certainty of diagnosis, prolonged recovery, recurrent injuries, mental status alterations, loss of consciousness (LOC), posttraumatic amnesia (PTA), retrograde amnesia (RGA), motor impairments, delayed symptom presentation, and immediate reporting.

Main Results

Concussions from varsity/intercollegiate sports [IPR of 1.73, 95% confidence interval (CI) 1.43–2.10] and intramurals (IPR of 1.53, 95% CI 1.02–2.32) accounted for a larger proportion in males, whereas concussions outside of sport and military activities accounted for a smaller proportion among males (IPR of 0.70, 95% CI 0.58–0.85). The proportion of concussions with prolonged recovery was lower among males (IPR of 0.69, 95% CI 0.60–0.78), while concussions with altered mental status (IPR of 1.23, 95% CI 1.09–1.38), LOC (IPR of 1.67, 95% CI 1.17–2.37), PTA (IPR of 1.94, 95% CI 1.43–2.62), and RGA (IPR of 2.14, 95% CI 1.38–3.31) accounted for a larger proportion among males. A larger proportion of concussions that were immediately reported was observed in males (IPR of 1.15, 95% CI 1.00–2.31). Proportions of other characteristics (e.g., recurrent injuries) were not different between sexes.

Conclusions

A higher proportion of concussions occurred outside of sport and military training for female cadets, who also displayed proportionally longer recovery times than males, despite males demonstrating a higher proportion of LOC, PTA, and RGA. Possible factors may include different mechanisms of injury outside of sport and military training, different biopsychosocial states associated with sex or injury context, and delayed injury reporting when outside of an observed environment, possibly secondary to perceived stigma about reporting injuries.

中文翻译：

美国服务学院学员脑震荡特征的性别差异：CARE 联盟研究

目的

描述美国服务学院学员脑震荡特征的性别差异。

设计

描述性流行病学研究。

设置

四所美国服务学院。

参与者

2209 名学员（n = 867 名女性，n = 1342 名男性）。

自变量

性。

结果测量

伤害比例比（IPR）比较了按性别（女性指涉）的伤害比例，包括受伤情况、诊断确定性、延长恢复时间、复发性损伤、精神状态改变、意识丧失（LOC）、创伤后遗忘症（PTA）、逆行性遗忘症（RGA）、运动障碍、延迟症状表现和立即报告。

主要结果

来自校队/校际运动的脑震荡 [IPR 为 1.73,95% 置信区间（CI） 1.43-2.10] 和校内运动（IPR 为 1.53,95% CI 1.02-2.32）在男性中占较大比例，而体育和军事活动以外的脑震荡在男性中占较小比例（IPR 为 0.70,95% CI 0.58-0.85）。男性长时间恢复的脑震荡比例较低（IPR 为 0.69,95% CI 0.60-0.78），而精神状态改变的脑震荡（IPR 为 1.23,95% CI 1.09-1.38）、LOC（IPR 为 1.67,95% CI 1.17-2.37）、PTA（IPR 为 1.94,95% CI 1.43-2.62）和 RGA（IPR 为 2.14,95% CI 1.38-3.31）在男性中占较大比例。在男性中观察到的立即报告的脑震荡比例更大（IPR 为 1.15,95% CI 1.00-2.31）。其他特征（例如，复发性损伤）的比例在性别之间没有差异。