Baseline Differences by Biological Sex on Clinical Measures of Sport Related Concussion in Collegiate Athletes

Context: Biological sex has been demonstrated to influence pre-injury (baseline) performance on some clinical measures of concussion. Objective: The objective of our study was to examine sex differences across a comprehensive, multidimensional baseline assessment that included mental health (anxiety and depression), balance, cognition, and symptoms in active collegiate athletes. Design: Cross-sectional study. Setting: University sports medicine clinic. Patients or Other Participants: Healthy Division I collegiate athletes ( n = 2668 , 41.3% female, 19.1±1.41 years of age) were divided into groups based on sex. Main Outcome Measures: Participants completed the Generalized Anxiety Disorder Inventory (GAD-7), Immediate Post-concussion Assessment and Cognitive Test (ImPACT), the Patient Health Questionnaire (PHQ-9), the Revised Head Injury Scale (HIS-r), the Sensory Organization Test (SOT), the Timed Tandem Gait (TG), and the Vestibular Ocular Motor Screen (VOMS). Mann-Whitney U tests were used to compare clinical outcome scores by sex ( p < 0.05 ). Results: Females had significantly higher GAD-7 (1.8±2.91), PHQ-9 (1.4±2.37), and HIS-r symptom quantity (1.1±1.76), duration (3.14±5.69), and severity (1.1±2.61) outcome scores when compared to males (all p<0.05). Males (11.8+2.95s) completed the TG 1.9 seconds faster than females (13.6+2.92s [ p <0.001]). Males and females had similar ImPACT and SOT outcome scores. Conclusions: In alignment with existing literature, we observed sex-based differences in anxiety, depression, and concussion-like symptom severity at baseline; however, in contrast to previous research, we observed sex-specific differences on the TG and similar performance on the ImPACT and SOT clinical outcome scores. Our findings may be due the methodology which included standardized clinical environments and identical administration procedures for all student-athletes regardless of sex or sport. Our findings highlight the importance of standardized assessment protocols ensuring that clinical outcome scores accurately inform post-concussion decision-making across all student-athletes.