A Multivariable Analysis to Evaluate the Presence or Absence of Gender Differences in Baseline ImPACT Composite Scores and Symptom Severity Ratings in Student-Athletes Ages 12–18 Years

in Pediatric Exercise Science

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Theodore C. HannahIcahn School of Medicine at Mount Sinai

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Oranicha JumreornvongIcahn School of Medicine at Mount Sinai

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Naoum F. MarayatiIcahn School of Medicine at Mount Sinai

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Zachary SpieraIcahn School of Medicine at Mount Sinai

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Muhammad AliIcahn School of Medicine at Mount Sinai

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Adam Y. LiIcahn School of Medicine at Mount Sinai

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John R. DurbinIcahn School of Medicine at Mount Sinai

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Nick DreherIcahn School of Medicine at Mount Sinai

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Alex GometzConcussion Management of New York

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Mark LovellUniversity of Pittsburgh Medical Center

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Tanvir ChoudhriIcahn School of Medicine at Mount Sinai

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Introduction: Gender differences in neurocognitive function have been reported over the past few decades. However, multiple studies that report gender differences in Immediate Post-Concussion Assessment and Cognitive Tests composite scores ignore potential confounders which may lead to inaccurate results. Methods: A total of 4829 male and 2477 female baseline Immediate Post-Concussion Assessment and Cognitive Tests from 2009 to 2019 of subjects ages 12–18 years were used to evaluate gender differences in baseline neurocognitive scores and symptom severity ratings. Regression analyses were used to assess the effects of gender on neurocognitive performance at baseline while controlling for a number of potential confounders including symptom burden at the time of testing. Results: Differences in 3 of 5 composite scores as well as severity rating scores were maintained in multivariate analysis. Females had increased Post-Concussion Symptom Scale (β = 3.54, 95% confidence interval, 2.91 to 4.16, P < .0001) along with higher verbal memory (β = 1.82, 95% confidence interval, 1.15 to 2.50, P < .0001) and visual motor (β = 1.29, 95% confidence interval, 0.85–1.72, P < .0001) scores. Conclusions: Statistically significant gender differences were found in baseline neurocognitive function. This study clarifies for the first time that gender differences in these neurocognitive domains are not simply an artifact of differences in symptom burden. However, the small effect sizes call into question the clinical relevance of these differences.

Hannah, Jumreornvong, Marayati, Spiera, Ali, Li, Durbin, Dreher, and Choudhri are with the Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA. Gometz is with the Physical Medicine and Rehabilitation, Concussion Management of New York, New York, NY, USA. Lovell is with the Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

Hannah (theodore.hannah@icahn.mssm.edu) is corresponding author.

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