Sex Differences in Athletic Trainer Coverage and Recovery After Sport-Related Concussion in High School Athletes

Context Several factors influence recovery times after sport-related concussion (SRC) in adolescent athletes. Sex (male versus female) and on-field evaluation by an athletic trainer (AT) have been shown to affect recovery, yet the interaction between these variables has not been evaluated. Objectives To investigate the associations between (1) athlete sex and on-field AT evaluation, (2) athlete sex and recovery times after SRC, and (3) the interaction between sex, on-field evaluations by an AT, and recovery. Demographics, medical history, and initial presentation variables were reported for the cohort, and group differences (male versus female) were presented. Design Retrospective cohort study. Setting Regional sport concussion center. Patients or Other Participants Adolescent athletes aged 14 to 18 years evaluated at a regional concussion center between November 2017 and April 2022. Main Outcome Measure(s) Primary exposure variables were sex and receiving an on-field AT evaluation. Primary outcomes were time to return to learn, symptom resolution, and return to play, measured in days since injury. Results A total of 832 athletes (average age = 16.2 ± 1.2 years) were included, of whom 279 (33.5%) were female. A significantly higher percentage of males received an on-field AT evaluation compared with females (40.3% versus 32.3%, χ 2 = 8.677, P = .013). Males presented with lower initial Post-Concussion Symptom Scale scores compared with females (21.4 ± 21.0 versus 34.9 ± 26.5, t = 7.448, P = .001), although recovery timelines did not differ. In a 2-way analysis of variance, receiving an on-field AT evaluation was associated with a shorter time to symptom resolution (21.6 ± 23.6 versus 27.8 ± 23.2, P = .01), measured in days, but there was no interaction between sex and on-field AT evaluation ( F 1,462 = 0.011, P = .92). Conclusions Males received an on-field AT evaluation more often than females. Receiving an on-field AT evaluation was significantly associated with a shorter time to symptom resolution after an SRC; this association did not differ between sexes.