Characterizing Clinical Recovery in MS Female Athletes Following Sport-Related Concussion: A Sex-Comparative Analysis

Context: Emerging evidence suggests middle school (MS) girls are especially susceptible to sport-related concussion (SRC), yet recovery patterns and sex disparities at this age remain under-studied despite early adolescence being a period of considerable biopsychosocial change and high sport participation. Objective: To examine sex differences in clinical recovery after SRC among a cohort of MS athletes. Design: Retrospective Cohort Study. Setting: Metropolitan school division in Virginia Patients or Other Participants: 14,642 athletes participating in 12 MS sports between 2015 and 2022. Main Outcome Measures: Athletic Trainers embedded in the MS documented all injury data and measures of clinical recovery (days from SRC to: [1] return-to-learn (RTL), [2] resolution of symptoms (SR), [3] return-to-sport (RTS)). Results: 279 SRCs (female = 112; male = 167). There were no sex differences in RTL (females 0.8 ± 1.5 vs males 0.7 ± 1.0; log-rank p = 0.1) or time to SR (females 11.9 ± 7.5 vs males 12.4 ± 9.7; log-rank p = 0.3). Time to RTS was 2.4 days longer in females (19.6 ± 13.0) than males (17.2 ± 8.0; log-rank p < 0.05). Conclusion: Consistent with previous studies at the high school and collegiate levels, we found MS aged females to take longer to RTS than males. However, no significant differences in days to SR or RTL were detected between sexes. Future research should investigate additional aspects of clinical recovery from concussion in MS-age children, such as potential sex differences in symptomatology or RTL.