Sex Differences in Resource Allocation and Access to Care After Sport-Related Concussion

Abstract

Context: After sport-related concussion (SRC), immediate access to a certified athletic trainer (AT) is important to ensure proper treatment. However, resource allocation and coverage may differ between male and female youth sports. Objective: To compare resource allocation between male and female sports in the following areas: (1) rates of immediate on-field evaluation by an AT at the time of injury, (2) time to general health care presentation, and (3) time to SRC clinic presentation. Design: Retrospective cohort study. Setting: Regional sports concussion center. Patients or Other Participants: Athletes aged 14 to 18 years who presented to a regional sports concussion center from November 2017 to April 2022. Main Outcome Measure(s): The primary exposure of interest was sex (male or female). The primary outcome was immediate on-field evaluation by an AT (yes or no). Secondary outcomes included time to general health care and SRC clinic presentation. Descriptive statistics, v2 analyses, and linear regressions were performed. Covariates included age, history of prior concussions, and statistically significant demographics. Results: A total of 832 patients with SRC were included (age = 16.2 ± 1.2 years, 66.5% male). Female athletes had lower rates of attention-deficit/hyperactivity disorder (χ2= 10.404, P = .001) and higher rates of anxiety and depression (χ2= 12.891, P < .001) compared with male athletes. The average time to presentation to general health care and the SRC clinic did not differ between males and females, but AT on-field evaluation occurred more in male (40.3%) than female (32.3%) athletes (χ2= 8.677, P = .013). Multivariable linear regression found that AT on-field evaluation was a significant predictor of time to general health care presentation (β = -.085, P = .015) but not SRC clinic presentation (β = -.055, P = .099). History of prior concussions was a significant predictor of time to initial health care contact (β = .083, P = .018). History of anxiety and depression (β = .136, P < .001) and initial evaluation by emergency department or urgent care (β = .305, P < .001) were significant predictors of delayed time to SRC clinic presentation. Conclusions: Among 832 concussed youth athletes, female athletes were evaluated less frequently by an AT immediately after injury. Furthermore, not being evaluated by an AT on field was significantly associated with a longer time to health care presentation. Future investigations should elucidate resource equity among male and female athletes.