Sport concussion in female athletes: a systematic review

Concussions are very common injuries across many different sports and settings and present a significant public health concern in multiple countries. Previous studies have investigated concussion incidence, with a notable number reporting that female athletes have higher rates of sports-related concussions compared to their male counterparts. This study aims to look at risk factors linked to this increased susceptibility of female athletes, and how this affects them, rather than focusing on incidence. To investigate this, we carried out a systematic review following the PRISMA guidelines. We searched the PubMed, Cochrane, APA PsychNet and Web of Science databases Inclusion criteria consisted of papers published in the last 10 years as of the 6th November 2023, studying athletes over the age of 18 who concussed themselves during sporting activity of any level. The exclusion criteria included narrative reviews, single case reports, abstracts, letters to the editor, and studies that included chronic traumatic brain injuries, spinal cord injuries or facial bone fractures. After reviewing all the papers from the search (N= 1373), we identified 27 papers in total that met all inclusion criteria. We then extracted data from each paper relating to the biomechanics, neuropsychology, neurostructural substrates, physiology, and clinical recovery times. The main findings included women having significantly longer recovery times following concussions, increased symptom reporting, and different neurocognitive defects in testing post-concussion compared to men. There was also some evidence to suggest a difference in the neuroinflammatory process between men and women following concussive injury. Highlighting these risk factors can hopefully lead to improved prevention, diagnosis, and treatment for concussions in womens sports.