Gender Biases In Sports Concussions: A Differential Item Functioning Analysis into NCAA Female Athlete Symptom Presentation and Validity of the SCAT3 Checklist

BackgroundAs a consequence of sports-related concussions, female athletes have been documented as reporting more symptoms than their male counterparts, in addition to incurring longer periods of recovery. However, the role of gender and its potential influence on symptom reporting and recovery outcomes in concussion management has not been completely explored. Study DesignThis study investigates potential differential item functioning (DIF) related to gender biases within the SCAT3 symptom severity checklist. The data was obtained from the Federal Interagency of Traumatic Brain Injury Research (FITBIR), which included information from the 2014-2017 NCAA and DoD CARE Consortium. A total of 1,258 NCAA athletes (n=473 females and n=785 males) SCAT3 Symptom Severity sub-scores were analyzed across five time points post-concussion: less than six hours post-injury, 24-48 hours post-injury, asymptomatic, unrestricted return to play, and at 6 months. ResultsDuring the recovery phase, women experienced more headaches, pressure in the head, and fatigue than male athletes. Overall, both male and female athletes had equivalent knowledge of concussions, and there was no significant difference in symptom-reporting ability for most items, including emotional-related symptoms. Only during the unrestricted return to play phase were group-level differences detected, with females being more likely to report more severe symptoms than males. However, upon further analysis, it was discovered females exhibit a relatively high difficulty level reporting symptom severity beyond Mild, therefore the group-level DIF may result from gender biases within the checklist. ConclusionThe present analysis posits that Differential Item Functioning (DIF) in specific symptoms may lead to gender bias. The findings of this study reveal that female athletes tend to exhibit symptomatic behavior upon returning to play, a phenomenon consistent with prior research. However, the possible DIF may provoke biases due to unreliable reporting measures within the SCAT3 symptom severity checklist. Furthermore, explaining why recent literature reports that female athletes do not present as symptomatic upon return to play. Additional research is warranted to determine whether females genuinely experience more symptoms or whether the presence of these potential assessment gender biases obstructs the manifestation of asymptomatic recoveries.