Sex Differences in Recovery Trajectories of Assessments for Sport-Related Concussion Among NCAA Athletes: A CARE Consortium Study

Jaclyn B. Caccese*, Christina L. Master, Thomas A. Buckley, Sara P.D. Chrisman, James R. Clugston, James T. Eckner, Elsa Ermer, Stacey Harcum, Tamerah N. Hunt, Divya Jain, Louise A. Kelly, T. Dianne Langford, Landon B. Lempke, Jane McDevitt, Allyssa K. Memmini, Anne E. Mozel, Susan M. Perkins, Margot Putukian, Patricia R. Roby, Adam SusmarskiSteven P. Broglio, Thomas W. McAllister, Michael McCrea, Paul F. Pasquina, Carrie Esopenko

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objectives: The purpose of this study was to determine sex differences in recovery trajectories of assessments for sport-related concussion using Concussion Assessment, Research and Education (CARE) Consortium data. Methods: National Collegiate Athletic Association athletes (N = 906; 61% female) from sex-comparable sports completed a pre-season baseline assessment and post-sport-related concussion assessments within 6 h of injury, 24–48 h, when they initiated their return to play progression, when they were cleared for unrestricted return to play, and 6 months post-injury. Assessments included the Standardized Assessment of Concussion, Balance Error Scoring System, Brief Symptom Inventory-18, Immediate Post-concussion Assessment and Cognitive Testing (ImPACT), Sport Concussion Assessment Tool-3 symptom evaluation, Clinical Reaction Time, King–Devick test, Vestibular Ocular Motor Screen, 12-item Short-Form Health Survey, Hospital Anxiety and Depression Scale, and Satisfaction with Life Scale. Results: Only the Vestibular Ocular Motor Screen Total Symptom Score at the 24–48 h timepoint (p = 0.005) was statistically significantly different between sexes. Specifically, female athletes (mean = 60.2, 95% confidence interval [CI] 51.5–70.4) had higher Vestibular Ocular Motor Screen Total Symptom Scores than male athletes (mean = 36.9, 95% CI 27.6–49.3), but this difference resolved by the time of return-to-play initiation (female athletes, mean = 1.8, 95% CI 1.1–2.9; male athletes, mean = 4.1, 95% CI 1.5–10.9). Conclusions: Sport-related concussion recovery trajectories for most assessments were similar for female and male National Collegiate Athletic Association athletes except for Vestibular Ocular Motor Screen symptoms within 48 h of sport-related concussion, which was greater in female athletes. Female athletes had a greater symptom burden across all timepoints, suggesting that cross-sectional observations may indicate sex differences despite similar recovery trajectories.

Original languageEnglish
JournalSports Medicine
StateAccepted/In press - 2023
Externally publishedYes


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