The Effect of Sex, Sport, and Preexisting Histories on Baseline Concussion Test Performance in College Lacrosse and Soccer Athletes.

OBJECTIVE: To study sex and sport differences in baseline clinical concussion assessments. A secondary purpose was to determine if these same assessments are affected by self-reported histories of (1) concussion; (2) learning disability; (3) anxiety and/or depression; and (4) migraine. DESIGN: Prospective cohort. SETTING: National Collegiate Athletic Association D1 Universities. PARTICIPANTS: Male and female soccer and lacrosse athletes (n = 237; age = 19.8 ± 1.3 years). ASSESSMENT OF RISK FACTORS: Sport, sex, history of (1) concussion; (2) learning disability; (3) anxiety and/or depression; and (4) migraine. MAIN OUTCOME MEASURES: Sport Concussion Assessment Tool 22-item symptom checklist, Standardized Assessment of Concussion, Balance Error Scoring System (BESS), Generalized Anxiety Disorder 7-item scale, and Patient Health Questionnaire. RESULTS: Female athletes had significantly higher total symptoms endorsed (P = 0.02), total symptom severity (P < 0.001), and BESS total errors (P = 0.01) than male athletes. No other sex, sport, or sex-by-sport interactions were observed (P > 0.05). Previous concussion and migraine history were related to greater total symptoms endorsed (concussion: P = 0.03; migraine: P = 0.01) and total symptom severity (concussion: P = 0.04; migraine: P = 0.02). Athletes with a migraine history also self-reported higher anxiety (P = 0.004) and depression (P = 0.01) scores. No other associations between preexisting histories and clinical concussion outcomes were observed (P > 0.05). CONCLUSIONS: Our findings reinforce the need to individualize concussion assessment and management. This is highlighted by the findings involving sex differences and preexisting concussion and migraine histories. CLINICAL RELEVANCE: Clinicians should fully inventory athletes' personal and medical histories to better understand variability in measures, which may be used to inform return-to-participation decisions following injury.

Sex and Sport Differences in College Lacrosse and Soccer Head Impact Biomechanics.

PURPOSE: Sport-related head impact biomechanics research has been male-centric and focused primarily on American football and ice hockey, which do not address popular sports in which both sexes participate. The purpose of this study was to quantify college female and male lacrosse and soccer head impact biomechanics. METHODS: Head impact biomechanics were collected from college lacrosse and soccer players across two Division 1 college athletic programs (96 female athletes, 141 male athletes; age, 19.8 ± 1.3 yr; height, 174.8 ± 9.2 cm; mass, 72.4 ± 11.7 kg). We deployed helmetless head impact measurement devices (X2 Biosystems xPatch) before each event. Peak linear and rotational accelerations were log-transformed for random intercepts general linear mixed models, and subsequently categorized based on impact magnitude for additional categorical analyses. RESULTS: Most linear (69.4%) and rotational (72.3%) head impact accelerations sustained by our study cohort were categorized as mild. On average, male athletes sustained impacts with higher linear accelerations than females (P = 0.04), and lacrosse athletes sustained higher linear acceleration impacts than soccer athletes (P = 0.023). Soccer athletes sustained significantly higher-magnitude impacts during competitions versus practices (linear, P < 0.001, rotational, P < 0.001), whereas lacrosse athletes sustained higher-magnitude impacts during practices versus competition (linear, P < 0.001; rotational, P < 0.001). Male athletes sustained higher accelerations in competitions versus practice (linear, P = 0.004; rotational, P < 0.001), whereas female athletes sustained higher accelerations in practice versus competitions (linear, P < 0.001; rotational, P = 0.02). There were no interactions between sex and sport on impact magnitude. CONCLUSIONS: Male athletes and lacrosse athletes experience higher-magnitude head impacts. Given the limited literature in this area, future research should continue characterizing head impact biomechanics in women's and nonhelmeted sports as well as validate nonhelmeted head impact technologies.