Table 3.
Summary of studies examining sex differences in concussion assessment and neurocognitive testing.
| Author(s), Year | Study Design | Key Findings |
|---|---|---|
| Petit et al., 2020 [47]. | Cross-sectional | At baseline, there was no sex differences observed in any component of SCAT5 1. |
| Norheim et al., 2018 [48]. | Retrospective Cross-sectional | At baseline, females performed better on immediate and delayed recall when testing using the 10-word list component of SCAT5. However, average scores did not vary greatly between males and females. |
| Hutchison et al., 2021 [49]. | Cross-sectional | Females performed better than males on immediate and delayed recall when tested using the 10-word list component of SCAT at baseline, and a higher percentage of females achieved a perfect score on delayed recall (11.1% vs. 4.3%). |
| Bailey et al., 2022 [50]. | Prospective cohort | When SCAT5 was administrated twice at baseline, females achieved higher symptom scores at both administrations (p < 0.05) and performed better on SCAT5 SAC 1 (p < 0.001). Use of sex normative data did not improve accuracy when using SAC RCI (p < 0.01) but did improve when using a low threshold score (p < 0.01). However, use of SAC RCI 1 (either with or without sex-normative data) was more accurate at detecting SRC than a low SAC score. |
| Covassin et al., 2020 [51]. | Case-control | Concussed female athletes reported higher symptom scores at day 0 post-concussion (p < 0.001) when testing using SCAT3; there was no significant sex difference at other time points. There was no sex difference observed on the total SAC score between males and females at any time point. |
| Hurtubise et al., 2018 [52]. | Retrospective chart review | At baseline, females performed better on cognitive scores, including attaining higher SAC (p < 0.05), delayed recall (p < 0.001) and orientation (p < 0.05) scores when assessed using SCAT3. Only 2.3% of females reported neck pain at baseline, compared to 15.6% of males (p < 0.05). Post-SRC females performed better on average on orientation (p < 0.05) and reported lower severity of blurred vision (p < 0.05) and irritability (p < 0.05). |
| Merritt et al., 2019 [53] | Retrospective cohort | No significant sex difference was observed in NCT when individual components of testing batteries were compared (including ImPACT 1). Females were significantly more cognitively impaired following SRC (p = 0.045) when a summary of all testing batteries was used. |
| Tsushima et al., 2021 [54]. | Cross-sectional | At baseline, females performed significantly better on the visual motor speed component of ImPACT. There was no significant difference observed at baseline or post-SRC or differences between scores at baseline compared to post-SRC. |
| Covasin et al., 2012 [55]. | Prospective cohort | Females performed worse on visual memory on ImPACT (mean 65.1% vs. 70.1%, p = 0.049) and reported more symptoms (14.4 vs. 10.10, p = 0.035). |
| Le et al., 2021 [56]. | Cross-sectional | No significant sex differences were observed with King–Devick testing at baseline or post-SRC. |
| Sicard et al., 2018 [57] | Cross-sectional | Females had worse reaction times on Cogstate battery tests examining attention (p < 0.01) and executive function (p < 0.01). Females with a past SRC performed worse on tests of executive function with 2-back conditions to increase cognitive load (p < 0.001), which is not included in the standard Cogstate assessment. |
| Oldham et al., 2020 [58] | Prospective longitudinal | No sex differences were observed in the assessment of tandem gait at baseline or acutely following SRC. |
| Howell et al., 2020 [59]. | Prospective longitudinal | No sex differences were observed in single-task gait recovery post-SRC; however, females had a slower dual-task gait recovery (p = 0.02). |
| Lumba-brown et al., 2020 [60]. | Retrospective review | Females affected by SRC performed worse on VOMS 1 measures including smooth pursuit (p = 0.045), convergence (p = 0.031) and visual motor sensitivity (p = 0.045). |
| Studenka and Raikes et al., 2020 [61]. | Quasi-experimental | Females with a history of previous SRC performed better on visual motor tracking tasks (p = 0.005) than males. However, females who had previously had more than two SRCs performed worse than males who had a history of more than two SRCs (p = 0.031). |
| Morissette et al., 2020 [62]. | Quasi-experimental | No sex differences were observed in cardiopulmonary response at the rest or early stages of the Buffalo concussion treadmill test. |
| Balestrini et al., 2021 [63]. | Longitudinal cohort | Concussed females showed a reduction in heart rate variability compared to non-concussed females while seated (p = 0.04). No such reduction was observed in males. |
1 Abbreviations: SCAT5, Sport Concussion Assessment Tool 5; SAC, Standardized Assessment of Concussion; RCI, Reliable Chance Index; NCT, neurocognitive testing; ImPACT, Immediate Post-Concussion and Cognitive Testing; VOMS, Vestibular Oculomotor Motor Screening.