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Essay: Multifactorial examination of sex differences in head injuries and concussions among collegiate soccer players

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  • Published: 23 March 2018*
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This report expains, in plain English, the research article entitled [Multifactorial examination of sex differences in head injuries and concussions among collegiate soccer players: NCAA ISS, 2004–2009], which may be accessed for free, full text, at [https://injepijournal.springeropen.com/track/pdf/10.1186/s40621-017-0127-6?site=injepijournal.springeropen.com]. I choose this topic because since kindergarten, I have been actively involved with playing soccer and during my time in high school while playing soccer I received a couple head injuries that limited my involvement in playing sports. This is the first time I’ve ever read and written about primary science literature before. I completed an MS Word spelling and grammar check on this article before completing it.
The hypothesis of my research article was[If injury prevention and management programs for collegiate athletes were altered based on gender, then we expect that the injury prevention and management programs will be both equally effective for both male and female players]. The independent variables of my article were the multivariable logistical regression and negative binomial regression models which were used in testing the relation between sex and head injury collieries, and the dependent variables of my article was the type of contact,setting, and the competition level in which the injury occurred.

Reading this research article caused me to actively and intentionally expand my vocabulary. I had to define the following words to even attempt to understand what was being communicated:

Cohort is defined as a group or company.

Incidence is defined as the rate range of occurrence or influence of something, especially of something unwanted.

Parameter is defined as a variable entering into the mathematical form of any distribution such that the possible values of the variable correspond to different distributions.

Neuropsychological tests is defined as specifically designed tasks used to measure a psychological function known to be linked to a particular brain structure or pathway.

Musculature is defined as the system or arrangement of muscles in a body, a part of the body, or an organ.

Manifest is defined as to display or show.

Dichotomy is defined as a division or contrast between two things that are or are represented as being opposed or entirely different.

Sociodemographic is defined as relating to, or involving a combination of social and demographic factors.

Corollary is defined as a direct or natural consequence or result.

Etiologic is defined as assigning or seeking to assign a cause.

Covariate is defined as a variable that is possibly predictive of the outcome under study.

Athletic Exposure is defined as a single participant in a single practice session or game with any probability of injury.

The research provided in this article demonstrates that the injury prevention and management programs established within collegiate athletic programs may not be equally effective for both the male and female athletes. The results found in the study from information gathered from collegiate athletic programs across the United States can be used to help further develop injury prevention and management strategies for male and female athletes. The research article suggests that the policies for concussion management and the return-to-play guidelines must also consider the sex-differences between the injury likelihood and the specific injury mechanisms.

The study analysis was performed through The George Washington University. The authors claim that they have no funding information applicable. There are no apparent conflict of interests as stated by the authors of this article. The authors include that the conclusions of this study do not represent the views of the NCAA.

“For the experiment, a collection a data was obtained from the National Collegiate Athletic Association, and the Injury Surveillance System from 2004 until 2009” (Chandran, Barron,Westerman, and DiPietro, 2017, pg.2). “The researchers of this article used unadjusted rate ratios in order to compare the multiple incidence rate differences between each of the different categories of sexes, competition levels, injury mechanisms, and the setting in which the injuries occurred” (Chandran, Barron,Westerman, and DiPietro, 2017, pg.2). “The researchers also examined the sex differences in head injury rates amongst college athletes across each of the categories”(Chandran, Barron,Westerman, and DiPietro, 2017, pg.2).

Certified athletic trainers associated with each participating collegiate athletic program reported injuries and any supporting information about the nature of injuries from 2004 until 2009. A study performed by the NCAA-ISS recorded injury data between 2005 and 2008 and reported that the injury data from the collegiate athletic programs was reliable and valid. Based on the collection of guidelines from of the Injury Surveillance System, a reportable injury is defined on a strict criteria. The criteria states that an injury is one in which occurred during an intercollegiate game or practice, an injury that required immediate medical attention, and any injury that required restricted participation from athletic events for more than one day after the event of the injury. For this study analysis any injuries to the head, face, nose, mouth, eye and ear would be classified as a head injury. In order to correct for varying levels of playing exposure within the the study, the authors calculated the athletic exposure for each athlete. Incidence rates were calculated as the number of injury events per 1000 athletic exposures. The setting, sex and varying levels of competition amongst the athletic exposures were used to compute the incidence ratios for specific groups. The setting of an injury is defined as where the injury occurred, whether in a game scenario or practice. The sex refers to whether the injured athlete was a male or female. The varying levels of competition is classified based on which competition level each athlete is playing in, such as Division 1, Division 2 and Division 3. The unadjusted rate ratios along with a 95 percent Wald confidence intervals were used furthermore to compare the the incidence rates between different sexes, levels of contact for each athlete, the setting in which the injury occurred, and the difference in competition levels. The researchers were then able to evaluate the differences in head injury incidence rates between female and male athletes across the categories of setting, contact, and competition levels.

A multivariable logistic regression model was fitted for differences in sex, setting, contact, competition level and a first order interaction term between sex and contact, in order to evaluate sex differences in the odds of head injury observations within the sample received from the athletic collegiate programs. The study then further examines the two prominent indicators of head injury severity. A logistical regression model was then used in order to examine the sex differences in the odds of a concussion diagnosis among all reported soccer related head injuries. The researchers were then able to further analyze the sex differences in injury severity among the injured soccer players by regressing the count of days lost from any participation due to head injuries. The computations that were performed were done through WINPEPI version 11.24 and SAS 9.3.

During the 2004 and 2009 time period in which collegiate athletic programs provided injury data in order for evaluations on injuries it was reported that of the 8,116 reported injuries that met the criteria of the Injury Surveillance System, approximately eleven percent were classified as head injuries. The overall soccer related injury rate amongst males and female athletes was 7.5 injuries per 1000 athletic exposures. The rate of head injuries amongst male and female athletes recorded .8 injuries per 1000 athletic exposures. For female soccer players, there was a .87 head injury rate per 1000 athletic exposures. The male soccer players had a significantly lower rate at .71 per 1000 athletic exposures. Ninety-eight percent of the head injuries were a result of contact, within this percent, seventy one percent accounted for player to player contact, under twenty percent of head injuries were involved with contact with an object, such as a ball or goal, and under eight percent of head injuries involved contact with the surface the sport was played on,such as grass, concrete and turf. Within the sample of head injuries amongst male and female soccer players, 74 perce
nt of female head injuries resulted in a
concussion diagnosis, while 59 percent of male head injuries resulted in a concussion diagnosis. Amongst the injured players who sustained head injuries, females athletes were unable to participate in training or games for a substantially longer duration of time than that of male athletes who also sustained head injuries. The researchers report that the possibility of sex differences in the odds of head injuries, and in head injury collieries, may vary by the the mechanism of injury. In regards to concussions, female soccer players have displayed a higher percentage of having concussion symptoms when compared to male soccer players. Delaney and colleagues, examine this reasoning from a physiological perspective, suggesting that males have a stronger neck and torso than females.

The data means that there are significant differences between the male and female anatomy of the human body, because of this both sexes do not react the same when exposed to similar injuries. Males have shown higher recovery rates and have shown that they are less likely to experience concussion symptoms than that of their female counterparts, who are more likely to experience concussion symptoms following a head injury and there recover rates are drastically slower than that of the males. Although there has not been any clear evidence as to why male and females react differently to head injuries, researchers have proposed that the differences can be contributed to the fact males have a stronger neck and torso, along with varying levels of hormones, cerebral blood flow and glucose metabolism levels between the two sexes. From reading this article and dissecting it, I was able to learn that within athletic injuries as a result of contact, females are more likely to be injured, and are more likely to sustain a concussion while playing sports and their recovery periods will be a lot longer than their male counterparts. I learned that males are less likely to experience an injury while playing sports and that if males do sustain a concussion injury their recovery rates are far less time substantial than their female counterparts. Although there is no clear evidence as to why, I believe it contributes to the difference in genetic and physical makeup between males and females.

The authors did report limitations to their analysis, these include the limited amount of participation from NCAA collegiate athletic programs which limits the validity of the data reports. The injury and exposure data that was collected from the Injury Surveillance System only recorded event based injuries and limits the researchers to take account of individual characteristics of each injured athlete, such as age, weight, and years of playing experience. The NCAA and the Injury Surveillance System only accounts for injuries at NCAA sanctioned events such as practices and games, because of this the data may underestimate the entire view of injuries that occur amongst soccer players. The NCAA and Injury Surveillance System does provide the most comprehensive and up to date injury-related data among college athletes in the United States, however; if the researchers were given more comprehensive data collections that provide socio demographic characteristics as well as the specific determinants of each injury, and along with a greater amount of participation from NCAA collegiate athletic programs, the additional support would greatly enhance the research findings, improve the data findings validity, and improve the researcher’s understanding of head injury occurrences.





Cohort: https://www.merriam-webster.com/dictionary/cohort

Incidence: http://www.dictionary.com/browse/incidence

Parameter: https://www.merriam-webster.com/dictionary/parameter

Neuropsychological tests: http://www.minddisorders.com/Kau-Nu/Neuropsychological-testing.html

Musculature: https://en.oxforddictionaries.com/definition/musculature

Manifest: https://www.merriam-webster.com/dictionary/manifest

Dichotomy: https://www.merriam-webster.com/dictionary/dichotomy

Sociodemographic: https://www.merriam-webster.com/dictionary/sociodemographic

Corollary: https://www.merriam-webster.com/dictionary/corollary

Etiologic: https://www.merriam-webster.com/dictionary/etiologic

Covariate: http://www.dictionary.com/browse/covariate

Athletic Exposure: https://injepijournal.springeropen.com/track/pdf/10.1186/s40621-017-0127-6?site=injepijournal.spring

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