Gender differences found in concussion assessment; push for a more gender-specific approach
By Emily Sugg. This article was initially published in the 11/6/25 edition of our Concussion Update newsletter; please consider subscribing.
A study published in Neurotrauma identified key gender differences in sport-related concussion (SRC) not captured by standard unidimensional assessment tools––in this case, the Sport Concussion Assessment Tool (SCAT). Lead researcher Rachel Edelstein and her colleagues employed a systematic statistical approach to analyze data from 1,021 National Collegiate Athletic Association (NCAA) athletes (379 females and 642 males), who completed a Symptom Severity Checklist 3.0 (SCAT3) within 48 hours of sustaining a concussion. The researchers found that male athletes tended to be more conservative when reporting symptoms, and female athletes tended to more readily endorse emotional and physical symptoms, such as emotional distress, drowsiness, and sadness. The net effect of these observed trends was that female athletes’ average self-reported symptom severity was 21.6% higher than their male counterparts (30.06 vs. 24.71).
Edelstein et al. suggest that the SCAT incorporate a section specific to female athletes with items that assess menstrual cycle changes, mood changes, sleep disturbances related to hormonal fluctuations, migraine-like symptoms, and neck pain. The authors say that “by adopting a more nuanced, multidimensional approach, athletic training staff and healthcare providers can ensure more precise diagnosis and tailored interventions, ultimately improving outcomes for all athletes.”
In their analysis, the researchers found that the symptoms listed in the SCAT3 fell into four subcategories: neurocognitive, neurophysiological, neurosensory, and neuropsychiatric. The SCAT3 provides a single, composite score intended to capture the overall severity of concussion symptoms. However, combined with the gender differences the researchers found, these results suggest that a more nuanced, multidimensional scale would better reflect the range of experiences that athletes have with SRC.
This study has a few key limitations. First, although Edelstein et al. discuss the possibility that cultural influences may play a role in male underreporting, they acknowledge that their study does not account for psychological or social factors that might impede symptom reporting, and that further research is needed in this area. They also restricted their analysis to investigating differences based on biological sex rather than gender identity, using only “male” and “female” labels and excluding transgender and nonbinary athletes from the study. Finally, the authors mention that the uneven distribution of male and female athletes in their study has the potential to skew their results. However, they were able to verify that this imbalance was not affecting their results by performing additional statistical tests.
The authors note that males tended to try to exhibit “toughness” to conform to social norms of masculinity. This cultural norm may contribute to their findings of lower total self-reported symptom severity in male athletes, and the authors hypothesize that males are more likely to report symptoms only when they perceive them as severe enough to warrant concern.
In conclusion, this study emphasizes the need to modify standard concussion assessment tools, such as the SCAT, to incorporate gender-specific measures. While the SCAT3 effectively generalizes symptoms with a brief checklist, it fails to capture a full spectrum of symptoms that are often present in female athletes. Discrepancies in male reporting underscore the need to refine the SCAT3 assessment tools to more effectively capture underreporting among males, thereby avoiding the potential for overlooking symptom severity. Ultimately, this research provides a strong foundation for future adaptations for the SCAT. Clinicians need to understand the gender-specific responses to concussed athletes to enhance their diagnosis process and recovery. Edelstein et al. also recommend adding neuropsychological tests alongside the SCAT to better capture subtle or hidden symptoms, though they admit that this addition is not essential.