D’Lauro C, Jones ER, Swope LM, Anderson MN, Broglio S, Schmidt JD. Br J Sports Med. July 18, 2022: bjsports-2021-105045. doi: 10.1136/bjsports-2021-105045.
Full text freely available
Female athletes are underrepresented in the data used to inform concussion consensus and position papers.
Medical professionals rely on concussion consensus and position statements to design their diagnosis and treatment protocols. These papers are based on evidence suggesting that men and women have similar presentations and recoveries; However, there may be clinically meaningful differences in concussion risk, presentation, and recovery among male, female, transgender, and non-binary athletes. Although this disparity is recognized, it remains unclear whether a gender imbalance in concussion research influences concussion consensus and position statements.
The authors evaluated the three influential consensus and position papers to quantify the composition of the research data for clinical practice among female athletes.
The authors conducted a PubMed search in August 2021 using the terms “concussion position statement” and “concussion consensus statement.” The English language was the only limitation. The authors selected the International Conference on Concussion in Sport (ICCS, 2017), the National Athletic Training Association (NATA) Concussion Position Statement (2014), and the American Medical Society for Sports Medicine (AMSSM) Concussion Position Statement (2019). They selected these statements based on citation patterns, the publication of updated versions, and research into the use of these documents by physicians. The authors counted the total number of male and female participants in each study cited in the three documents that recorded or implied gender information. If the original authors failed to clearly state the ratio for sex or gender, the current authors excluded that study.
Across all three statements, 375 citations were reviewed, including 171 articles with relevant gender and sex information (93 from NATA, 17 from ICCS and 68 from AMSSM). Eighteen were cited in two of the statements, while all three cited zero. Overall, the studies were ~80% male (NATA 80%, ICCS 88%, and AMSSM 79% male). Only two manuscripts contained an all-female sample, while 69 manuscripts contained an all-male sample.
The information doctors receive about concussion care relies heavily on data among men. This is alarming because medical professionals rely on these expert-curated documents to guide their clinical decisions; however, the scientific evidence fails to adequately represent female and non-binary athletes. This disparity can lead to unequal treatment of these athletes who sustain a concussion. For example, men and women differ in responses to medications, substance abuse, and risk factors for other health problems. Therefore, this could indicate that female and non-binary athletes respond differently than men to concussion, both on a physiological and psychosocial level. It would be interesting to see if this trend also occurs in other consensus and position statements. Additionally, it would be helpful if future statements clearly describe how well the evidence represents the intended patient population (e.g., sex, gender, race/ethnicity).
Consensus and position statements should be a starting point and not a shortcut. Medical professionals should seek research beyond consensus and position statements to guide their concussion practices toward female and non-binary athletes. Additionally, when educating a female or non-binary athlete about what to expect after a concussion, we should seek out relevant research or explain to the patient that their personal experience may differ from what they find online or hear from professionals who rely solely on consensus. or position statements.
Do you mainly get your medical data from position statements? Have you noticed any differences between gender, race/ethnicity, or gender? If so, what have you done to fill the knowledge gaps in the position statements?
Written by: Jane McDevitt
Review by: Jeffrey Driban
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