Removal From Activity After Sports- Related Concussion in Sex-Comparable Sports From the Michigan High School Athletic Association

Abstract

Background: Research has demonstrated that female athletes are more likely to report their sports-related concussion (SRC) symptoms compared with male athletes; however, it is unknown if these reporting behaviors correspond to immediate removal from activity in sex-comparable sports. Purpose: To compare the incidence of high school student-athletes removed and not removed from activity after SRC in sex-comparable sports in Michigan. Study Design: Descriptive epidemiology study. Methods: Participants included student-athletes diagnosed with SRC participating in Michigan High School Athletic Association–sponsored athletic activities (22 sex-comparable sports) between 2016 and 2019. All SRCs were recorded in the association’s Head Injury Reporting System (HIRS) by certified athletic trainers, administrators, or coaches. Removal from activity indicated that the student-athlete was removed from play at the time of an injury event. If the student-athlete reported that his or her suspected injury event occurred earlier during activity or if symptom onset was delayed, “not removed from activity” was entered into the HIRS. Incidence proportions were calculated by dividing SRCs not removed by total SRCs in each sport. Risk ratios were calculated by dividing the incidence proportions of girls not removed by boys not removed in each sport. Results: A total of 4418 (2773 female, 1645 male) SRCs were reported, with the most occurring in female soccer players (n = 1023). Overall, 515 girls and 243 boys were not removed from activity, resulting in incidences of 0.19 (95% CI, 0.17-0.20) and 0.15 (95% CI, 0.13-0.17), respectively. Across all sports, girls were 1.26 (95% CI, 1.09-1.45) times as likely to not be removed from activity compared with boys. Of the sports with the most SRCs—soccer, basketball, baseball/softball, and lacrosse—girls had 1.37 (95% CI, 1.09-1.72), 1.15 (95% CI, 0.89-1.47), 1.19 (95% CI, 0.77-1.84), and 1.35 (95% CI, 0.94-1.95) times the risk of not being removed, respectively. Conclusion: Girls were at greater risk of not being removed from activity compared with boys in sex-comparable sports. Results from this study should be incorporated into SRC education in Michigan and potentially elsewhere to inform affiliated personnel of potential sex differences and protect female student-athletes from further harm.