Study examines gender role in concussions
Compared with other medical science, concussion studies are so relatively new that trends and tendencies are still up for debate.
That includes this premise referenced at an Ottawa concussion symposium: are girls more prone to concussions than boys? And why do girls tend to take longer to recover from concussion?
Dr. Roger Zemek was the lead researcher on a comprehensive study involving more than 3,000 children between ages five and 18. More than 8,000 children were screened for this study, which was published in the Journal of the American Medical Association (JAMA) in 2016 and gathered data from five centres, including Ottawa.
Nearly half the concussion cases involved girls.
From that data, and also citing other studies, Zemek determined that girls and boys suffer concussion rates that vary according to the sport involved, and that girls are at much higher risk for longer recovery time, making them susceptible to lingering post-concussion syndrome.
“There are several possible explanations,” Zemek said in an email, referencing anatomical, physiological and societal differences.
“Boys have a greater neck musculature than females. So, during the mechanism of injury that causes the concussion, girls necks and heads may whiplash more than boys. The greater these accelerations and decelerations (especially the rotational aspect), the greater the strain on the brain.”
Zemek, and others, postulate that hormonal differences could also be a factor in the duration and intensity of a concussion. Historically, females are also considered more apt to be forthcoming about reporting concussions and their symptoms compared with boys.
Another CHEO concussion specialist, Dr. Kristian Goulet, notes that this last point could be changing somewhat.
“In the 12 years I’ve been doing this, you do see a bit of that bravado, girls saying they can play through a concussion and not report the symptoms,” Goulet said in an interview.
Fortunately, awareness in this area has grown with the creation of Rowan’s Law, a concussion program in Ontario that came into being after the death of Rowan Stringer, an Ottawa teenager who returned to rugby action too soon after suffering a concussion. Coaches and trainers in amateur sport programs are keenly aware of the dangers of repetitive brain injury and in most cases are ensuring players are taken off the field of play and follow a concussion protocol before resuming sport.
In a 2015 study published in the British Journal of Sports Medicine, data pointed to higher rates of concussions for females playing soccer and higher rates for males in lacrosse and basketball.
Earlier this month, Scientific American shared a report involving a study of more than 200 boys and girls in middle and high school in the U.S. These 110 boys and 102 girls were experiencing their first concussions playing such sports as football, field hockey and wrestling. The median recovery time for boys was 11 days, and for girls was 28 days, more than twice as long.
Experts discussing this study caution that it relied on selfreporting, and was therefore dependent on the degree of disclosure from the patient involved.
In a video presentation at a recent symposium put on by the Concussion Legacy Foundation and the University of Ottawa brain and mind research institute, Zemek outlined a prototypical concussion case.
The case he presented was that of a hypothetical 14-year-old girl involved in a soccer collision. She did not lose consciousness and remembers what occurred, so did not suffer amnesia.
“She was unsteady on her feet when evaluated,” said Zemek, following through on the hypothetical case. “She was slow to answer questions. She has a headache and feels foggy.”
It was her first concussion and there was no history of migraine headaches.
Zemek uses this example to point out that what might seem a low-risk situation, a girl with no concussion history, and no loss of consciousness, is actually someone at high risk for symptoms that could linger.
Worth noting from the study data: the Children’s Hospital of Eastern Ontario treats roughly 1,000 concussion cases per year, or about three per day. That number has quadrupled over the past decade, which Zemek puts down to increased awareness.
In fact, there is a giant spike on the reporting graph in 2011, as the number of reported cases almost doubled in a single year.
Could it have been the Sidney Crosby factor? The Pittsburgh Penguins star suffered a serious concussion in January 2011.
“It wasn’t necessarily a change in diagnosis, or a change in how we code it when we present to the emergency department,” Zemek said of the explosion in concussion cases.
“It was because of a high profile person — and I think most of us in Canada know who that is (Crosby), and he missed the playoffs that year because of a concussion.
“The silver lining? His injury impacted awareness.”
According to Zemek, one in five Canadians have suffered a concussion.
Among them is Mackenzie Stone, a hockey player from Kars who suffered a concussion in the first game of her 2015-16 NCAA season with the Rochester Institute of Technology (RIT). Stone, who spoke at the Ottawa concussion symposium, needed a full year of therapy before returning to action in the fall of 2016. Her symptoms were so debilitating she spent weeks on the school’s academic disability list.