Background

The incidence and risk factors for sport-related concussion (SRC) associated with contact and collision invasion sports (CCIS) in female youth are unclear.

Objectives

This systematic review aimed to identify (i) the incidence of and (ii) risk factors for SRC in female youth athletes playing CCIS.

Methods

A systematic search of PubMed, CINAHL, Embase, SPORTDiscus and ProQuest to 8 May, 2024 was conducted. Two reviewers independently screened articles against eligibility criteria and assessed risk of bias (Joanna Briggs Institute Critical Appraisal Tool). Aetiological or intervention studies reporting on SRC incidence or risk factors in female youth athletes (aged 13–19 years and under) participating in CCIS were included. Meta-analyses were conducted to explore SRC incidence and risk factors. For each meta-analysis of SRC incidence rate, sub-group analyses were conducted by sport. Where heterogeneity was above 60% for the meta-analysis of SRC risk/protective factors, sensitivity analyses were conducted.

Results

The search yielded 4509 articles; 66 were included. Sport-related concussion incidence or risk factor data for nine CCIS were extracted. Pooled estimates revealed SRC incidence for female youth athletes in CCIS combined was 0.50/1000 match and practice hours (95% confidence interval [CI] 0.34–0.66). When examined by sport classification, SRC incidence in contact invasion sports was 0.12/1000 match and practice hours (95% CI 0.03–0.21), and in collision invasion sports was 2.08/1000 match and practice hours (95% CI 0.90–3.25). Sub-group analysis by individual sport revealed female youth soccer players had the highest overall SRC incidence rate (0.89/1000 match and practice hours, 95% CI − 0.19 to 1.97) amongst contact sports, and rugby union players had the highest overall SRC incidence rate (4.04/1000 match and practice hours, 95% CI 3.03–5.05) among collision sports. Forty-five studies (68%) reported SRC risk factor data, investigating 12 different potential risk factors. Female youth sustained over 7.5 times the rate of SRC in matches compared with practice (incidence rate ratio 7.52, 95% CI 6.32–8.95, p < 0.01) when competing in CCIS; however, considerable heterogeneity existed (I² = 84.98%). When exploring potential risk factors, no significant difference was found in SRC rate between female youth lacrosse players wearing versus not wearing headgear (p = 0.07). No significant difference was found in SRC rates between female youth athletes competing in younger versus older age groups (incidence rate ratio 0.91, 95% CI 0.52–1.61, p = 0.48, I² = 0.00%). Insufficient evidence was available to examine remaining risk factors.

Conclusions

This meta-analysis revealed SRC in female youth playing CCIS was higher than previously reported, with SRC rates higher in matches than practice. Soccer had the highest SRC incidence rate for female youth athletes competing in contact invasion sports, whilst rugby union demonstrated the highest SRC incidence rates for collision invasion sports. The results of this review should be interpreted with caution given the lack of representation from some common CCIS codes. Further research is required to examine SRC risk factors in female youth athletes participating in CCIS.

Clinical Trial Registration

OSF Registration: osf.io/s573v.

中文翻译：

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参加接触和碰撞侵入运动的女青年运动员运动相关脑震荡的发生率和危险因素：系统评价

 背景

与女性青年接触和碰撞侵入运动 （CCIS） 相关的运动相关脑震荡 （SRC） 的发生率和危险因素尚不清楚。

 目标

本系统评价旨在确定 （i） 参加 CCIS 的女青年运动员 SRC 的发生率和 （ii） 风险因素。

 方法

对 PubMed、CINAHL、Embase、SPORTDiscus 和 ProQuest 进行了系统检索，检索日期截至 2024 年 5 月 8 日。两名评价员根据合格标准独立筛选文章并评估偏倚风险 （Joanna Briggs Institute Critical Appraisal Tool）。纳入了报告参加 CCIS 的女青年运动员 （13-19 岁及以下） SRC 发病率或危险因素的病因学或干预研究。进行 Meta 分析以探讨 SRC 的发病率和危险因素。对于 SRC 发病率的每项荟萃分析，按运动进行亚组分析。当 SRC 风险/保护因素的荟萃分析的异质性高于 60% 时，进行敏感性分析。

 结果

检索得到 4509 篇文章;包括 66 个。提取了 9 例 CCIS 的运动相关脑震荡发生率或危险因素数据。汇总估计显示，CCIS 中女青年运动员的 SRC 发生率为 0.50/1000 比赛和练习时间 （95% 置信区间 [CI] 0.34-0.66）。当按运动分类检查时，接触入侵运动中的 SRC 发生率为 0.12/1000 比赛和练习时间 （95% CI 0.03-0.21），碰撞入侵运动为 2.08/1000 比赛和练习时间 （95% CI 0.90-3.25）。按单项运动进行的亚组分析显示，在接触性运动中，女子青年足球运动员的总体 SRC 发生率最高（0.89/1000 比赛和练习小时，95% CI − 0.19 至 1.97），橄榄球联盟球员的总体 SRC 发生率最高（4.04/1000 比赛和练习小时，95% CI 3.03-5.05）在碰撞运动中。45 项研究 （68%） 报告了 SRC 危险因素数据，调查了 12 种不同的潜在危险因素。参加 CCIS 比赛时，与练习相比，女性青年在比赛中的 SRC 发生率是练习的 7.5 倍以上（发生率比 7.52,95% CI 6.32-8.95，p < 0.01）; 然而，存在相当大的异质性 （I² = 84.98%）。在探索潜在风险因素时，女性青年长曲棍网球运动员佩戴与不佩戴头饰的 SRC 率没有发现显着差异 （p = 0.07）。在年轻组与老年组竞争的女青年运动员之间的 SRC 率没有发现显着差异 （发病率比 0.91,95% CI 0.52-1.61，p = 0.48，I ² = 0.00%）。没有足够的证据来检查剩余的危险因素。

 结论

这项荟萃分析显示，参加 CCIS 的女性青年的 SRC 高于以前报道的，比赛中的 SRC 率高于练习。在参加接触入侵运动的女青年运动员中，足球的 SRC 发生率最高，而橄榄球联盟在碰撞入侵运动中的 SRC 发生率最高。鉴于缺乏一些常见 CCIS 代码的代表性，应谨慎解释本综述的结果。需要进一步的研究来检查参加 CCIS 的女青年运动员的 SRC 风险因素。

临床试验注册

OSF 注册：osf.io/s573v。