Presenting features of female collegiate sports-related concussion in South Africa: a descriptive analysis

Abstract

Sports-related concussion (SRC) is defined as a traumatic sports-related brain injury induced by biomechanical forces, caused either by a direct blow to the head, face, neck or elsewhere on the body, with an impulsive force transmitted to the head.[1] Symptomatology (e.g. somatic, cognitive and/or emotional symptoms, physical signs, balance impairment, behavioural changes, cognitive impairment, and sleep/wake disturbances) generally develops predictably but can vary in number, type, severity and time course, and is not due to any other cause (i.e. drugs, alcohol, medication, etc.).[1] Females face a greater SRC risk, sustain SRC at an increased rate, have increased time loss, report more symptoms at baseline and in the immediate post-concussion period, and experience greater neurocognitive impairment. In addition, females have a higher risk for post-concussion syndrome, suffer prolonged recovery from SRC, have an increased risk for depression, and may report a higher number of SRC-related symptoms one year after an SRC.[2-4] Thus, the symptom burden of SRC in female collegiate athletes appears to be high. Furthermore, Wilmoth et al.[5] suggest that student athletes experience several psychological challenges. These challenges may include emotional and social functioning, behavioural problems, academic difficulties, sleep disturbances, headaches and reduced quality of life following SRC, given the importance of athletics and related social activities in their lives. Students have also been shown to experience increased levels of anxiety and depression.[6] Evidence regarding SRC assessment in females is scarce, compared to SRC assessment in males. More data are needed, specifically evaluating females independently,[7] to expand the current evidence base and determine whether females with SRC are presently assessed and managed appropriately.[3] To our knowledge, the association between potential pre-existing risks and SRC has not been investigated to specific symptom type in female collegiate athletes in a culturally diverse developing nation, as the majority of the research in this field has been conducted in developed Northern hemisphere settings. Therefore, we aimed to describe presenting features of female SRC at a collegiate campus-based sports medicine service and investigated the association of presenting symptoms with prior concussion history (PCONC) or mental health conditions (PMHDx).