Male and Female Differences in Concussion Recovery: The Influence of Time to Clinic Presentation
Matthew Lorincz1, Douglas Weibe4, Andrea Almeida2, Jere Freeman1, Jason Goldstick1, Michael Popovich1, Ingrid Ichesco5, eckner james3, Abigail Bretzin1
1University of Michigan, 2Neurology, 3PMR, University of Michigan, 4University of Michigan Injury Prevention Center, 5Michigan Medicine
Objective:
The aim of this study was to investigate the relationship between sex, time to clinic presentation, and recovery time
Background:
Recovery time following concussion has previously been demonstrated to vary by sex. Time to clinic presentation may influence timing of treatment initiation and thereby affect concussion recovery outcomes.
Design/Methods:
Secondary analysis of existing clinical data between 2017 and 2019. Patients ages 6-24 years diagnosed with concussion were eligible for inclusion if their initial clinic visit occurred within 3 weeks from the date of injury. Unadjusted Kaplan Meier survival curves were used to display time to clinic presentation and time to recovery by sex. To test the association between time to recovery and sex, we conducted three separate cox proportional hazard regressions to estimate hazard ratios (HR) with 1) sex as the primary exposure, 2) sex while adjusting for age, concussion history, symptom severity, and distance from the clinic, 3) sex while adjusting for days to clinic presentation, age, concussion history, symptom severity, and distance from the clinic.
Results:
A total of 486 patients (15.5 ± 3.1 years; 285 males, 58.6%) presenting to the clinic within 20 days. Unadjusted cox regression revealed females had slower recovery (HR: 0.70, 95%CI: 0.56,0.86) than males. When adjusting for age, concussion history, symptom severity, and clinic distance females had slower recovery than males (aHR 0.80, 95% CI: 0.64,1.00). When adding days to first clinic visit as a covariate sex differences were null (aHR: 0.91, 95% CI: 0.73, 1.13).
Conclusions:
Males and females treated at a specialty concussion clinic displayed overall differences in recovery outcomes, aligning with prior research suggesting females exhibit slower recovery outcomes. However, when adjusting for notable covariates, specifically time to clinic presentation, there were no significant sex differences. These findings suggest a potential sex-based disparity in post-concussion healthcare activation and highlight opportunities to improve concussion outcomes.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.