Sex Differences in Post-concussion Care: Resource Allocation for Youth Athletes

Introduction: In youth sports, immediate access to a Certified Athletic Trainer (ATC) is important to ensure appropriate injury evaluation after sport-related concussion (SRC). However, resource allocation and coverage differs between male/female sports. We sought to compare resource allocation between male/female sports in the following areas: 1) rates of immediate on-field evaluation by an ATC at the time of injury, 2) time to general healthcare presentation, and 3) sports concussion center presentation.

Methods: A retrospective, cohort study of athletes 14-19-years-old who presented to a regional sports concussion center from 11/2017-04/2022 was conducted. Primary exposure of interest was sex (male/female). Primary outcome was immediate on-field evaluation by an ATC (yes/no). Secondary outcomes included time to general healthcare and sports concussion center presentation. Descriptive statistics, chi-squared analyses, and linear regressions were performed. Covariates included age and statistically significant demographics.

Results: A total of 832 patients were included (age 16.2 ± 1.2, 66.5% male). Female athletes had lower rates of ADHD (2 = 10.404, p=0.001) and higher rates of anxiety/depression (2 = 12.891, p< 0.001) compared to male athletes. Other demographics and medical histories did not differ between males/females. ATC on-field evaluation occurred more in male (40.3%) than female (32.3%) athletes (2 = 8.677, p=0.013). Multivariable linear regression found that ATC on-field evaluation was a significant predictor of time to general healthcare presentation (𝛽= -0.086, p=0.014) but not sports concussion center presentation (𝛽= -0.058, p=0.081). History of anxiety/depression (𝛽=0.163, p< 0.001) and initial evaluation by ED/urgent care (𝛽= 0.299, p< 0.001) were significant predictors for time-to-present to the concussion clinic.

Conclusion : Among 832 concussed athletes, female athletes were less often evaluated by an ATC immediately after injury. Furthermore, not being evaluated by an ATC on-field was significantly associated with longer time to healthcare presentation. Future investigations should further elucidate resource equity among male and female athletes.