Reports of head injuries appeared to have surged in young female athletes over a 19-year period, a researcher reported.
The number of female athletes, ages 14-18, who were treated for sports-related concussions and closed-head injuries at U.S. emergency departments (ED) more than tripled, from nearly 10,000 in the year 2000 to over 30,000 in 2019, according to Kevin Pirruccio, MD, a resident at Yale-New Haven Hospital in Connecticut.
Over the 2000-2019 time period, females in that age group made up 40% of all these injuries, Pirruccio and colleagues reported in a poster session at the American Academy of Orthopaedic Surgeons annual meeting. At the time of the study, Pirruccio was at the University of Pennsylvania in Philadelphia. Study results were recently published in .
It's not clear if the rising numbers were due to factors such as increased participation in athletics, more awareness and reporting, or more danger on the field. Still, the findings "should drive further awareness and prevention surrounding the risk of sports-related concussions in females," co-author Robert L. Parisien, MD, of Mt. Sinai Hospital in New York City, told .
The researchers sought to gain insight into concussions among female athletes, a topic that's gotten little attention amid intense focus on male athletes and contact sports like football, Parisien said.
They examined data from the National Electronic Injury Surveillance System, and correlated their estimates to the number of female high-school sports athletes over the 19-year period.
Their weighted estimates of female patients (59% white) presenting with sports-related concussions or closed-head injuries were 9,835 (95% CI 7,105-12,566) for 2000 and 31,751 (95% CI 26,392-37,110) for 2019 with a statistically significant increase (P<0.001).
The sports responsible for the most injuries were soccer (21%), basketball (19%), cheerleading (10%), softball (10%), volleyball (7%), and horseback riding (5%). The activities with the fewest injuries of the 20 listed were swimming, field hockey, general exercise, rugby, and rollerskating.
The actual number of injuries is likely significantly higher, Parisien said; half the patients with concussions and closed-head injuries may not make it to the ED, according to the study, although Parisien called that "perfectly appropriate. They're managed by athletic trainers or sports medicine doctors."
While research has shown that , this increase in participation doesn't fully explain the growth in cases, Parisien said. "We believe some of that [the increase] may be due to the fact that we do have an increased awareness of concussion and the reporting of concussions," he noted.
The researchers also found that 97% of the patients in the study were released from the ED, and that fewer injuries occurred outside of the traditional school year, in June, July, and August.
Miho J. Tanaka, MD, director of the Women's Sports Medicine Program at Massachusetts General Hospital in Boston, told that "studies have shown that adolescents than adults, and many efforts have been made to identify injury and prevent the long-term consequences that can be associated with concussions."
She added that "women appear to be at greater risk and have more severe and longer lasting impairment after a concussion when compared to men. The exact reasons for this are still being studied." A found that females had "significantly worse" cognitive and somatic symptoms than men 12 months after a mild traumatic brain injury.
And a of sports-related concussions in females speculated that "possible factors that put female athletes at a higher risk for concussions include biomechanical differences and hormonal differences." The review also noted that while females "are more likely to report a concussion than their male counterparts," underreporting still exists in this population.
Tanaka, who was not involved with the current study, urged physicians to be aware that concussions don't just happen on the football field.
"In this study, noncontact sports such as softball and cheerleading, were found to be commonly associated with this injury," she pointed out. "Physicians should be aware of this fact and understand how to identify and manage such injuries."
Tanaka emphasized that "As the types of sports played by women continues to evolve, it will be important for the medical community to study these injuries and identify ways to optimize care for this growing population of female athletes."
Disclosures
Pirruccio and co-authors, as well as Tanaka, disclosed no relationships with industry.
Primary Source
American Academy of Orthopaedic Surgeons
Pirruccio K, et al "Sports-Related Concussions in High School Females: An Epidemiologic Analysis of Twenty-Year National Trends" AAOS 2021.