Pediatric Concussions in Female Contact Sports: A 10-Year Analysis of Mechanisms and Associated Symptoms

Background: Increased popularity and accessibility for female athletes has led to an increased incidence of sports-related injuries. Concussions make up a significant proportion of sports injuries and are associated with immediate and long-term consequences for youth athletes. However, despite the increasing participation in female contact sports, there is relatively little research on gender-specific characteristics in concussions. The objective of this study is to describe the characteristics, mechanisms of injury (MOI), and associated symptoms of pediatric female patients diagnosed with concussions from contact sports. Methods: The National Electronic Injury Surveillance System (NEISS) database of the US Consumer Product Safety Commission was queried from 2012-2021 for concussions evaluated in emergency departments (EDs) sustained by athletes aged 4 to 18. The contact sports analyzed included Basketball, Cheerleading, Gymnastics, Hockey, Lacrosse, Soccer, Softball, and Volleyball. Demographics, incidence rates, mechanism of injury, and associated symptoms were analyzed for each sport during the study period. Results: There were 3,906 female athletes who sustained concussions from 2012-2021 from contact sports with a national estimate of 87,468. Most sports-related concussions were treated as outpatients (97.4%). From 2012-2019 there were no significant differences in the number of concussions, while 2020 and 2021 saw a significantly lower number of concussions. Soccer had the greatest number of concussions at 34.1%, followed by basketball 21%, and Softball 14.1%. The most common MOI was player-to-player contact (1214, 31%) and head-to-ground (1103, 28.2%). MOI was sport specific with soccer and basketball having the highest proportion of player-to-player and gymnastics and cheerleading comprising mostly head-to-ground injuries. Loss of consciousness (LOC) was reported in 5.5% of concussions with hockey having the highest rate at 6.9%. The most frequently reported associated symptoms were headache/head pain (41.1%), dizziness (28.12%), and confusion (9.2%). Conclusion: There was a significant decrease in the number of concussions in 2020 and 2021 compared to 2012-2019, which may be attributed to social restrictions that occurred during the COVID-19 pandemic and raises concerns for undertreatment of concussions in female contact sports. Mechanism of injury in female concussions is sport specific with high rates of player-to player and player-to-ground injuries. Finally, there were no significant differences in symptom presentation among the different contact sports analyzed. Athletes, coaches, and physicians aware of common symptoms and mechanisms of injury for each sport can better develop preventative strategies and improve patient care for concussions in female contact sports.