The Effect of Sex, Sport, and Preexisting Histories on Baseline Concussion Test Performance in College Lacrosse and Soccer Athletes.

Objective: To study sex and sport differences in baseline clinical concussion assessments. A secondary purpose was to determine if these same assessments are affected by self-reported histories of (1) concussion; (2) learning disability; (3) anxiety and/or depression; and (4) migraine.

Design: Prospective cohort.

Setting: National Collegiate Athletic Association D1 Universities.

Participants: Male and female soccer and lacrosse athletes (n = 237; age = 19.8 ± 1.3 years).

Assessment Of Risk Factors: Sport, sex, history of (1) concussion; (2) learning disability; (3) anxiety and/or depression; and (4) migraine.

Main Outcome Measures: Sport Concussion Assessment Tool 22-item symptom checklist, Standardized Assessment of Concussion, Balance Error Scoring System (BESS), Generalized Anxiety Disorder 7-item scale, and Patient Health Questionnaire.

Results: Female athletes had significantly higher total symptoms endorsed (P = 0.02), total symptom severity (P < 0.001), and BESS total errors (P = 0.01) than male athletes. No other sex, sport, or sex-by-sport interactions were observed (P > 0.05). Previous concussion and migraine history were related to greater total symptoms endorsed (concussion: P = 0.03; migraine: P = 0.01) and total symptom severity (concussion: P = 0.04; migraine: P = 0.02). Athletes with a migraine history also self-reported higher anxiety (P = 0.004) and depression (P = 0.01) scores. No other associations between preexisting histories and clinical concussion outcomes were observed (P > 0.05).

Conclusions: Our findings reinforce the need to individualize concussion assessment and management. This is highlighted by the findings involving sex differences and preexisting concussion and migraine histories.

Clinical Relevance: Clinicians should fully inventory athletes' personal and medical histories to better understand variability in measures, which may be used to inform return-to-participation decisions following injury.