PURPOSE: This systematic review aimed to identify (i) the incidence of and (ii) risk factors for sport-related concussion (SRC) in female youth athletes playing contact or collision invasion sports.

 

METHODS: A systematic search of the literature from root to December 12, 2022 was conducted utilising five electronic databases (PubMed, CINAHL, Embase (Elsevier), SPORTDiscus and ProQuest). Two reviewers independently screened articles against the eligibility criteria and assessed risk of bias (using the Joanna Briggs Institute Critical Appraisal Tool for prevalence and incidence studies). Aetiological or intervention study designs reporting on SRC incidence or risk factors in female youth athletes (13 to <19 years) participating in contact or collision invasion sports were included. Incidence rate and risk of SRC were presented as grouped data and by sport. When appropriate, meta-analyses were conducted using the DerSiminian and Laird random effects model using Stata v.16 software to address the research questions.

 

RESULTS: The literature search yielded 4060 articles, with 66 articles included.  Female youth SRC incidence or risk factor data for 10 contact or collision sports were collected. Most (n = 52, 79%) investigated high-school athlete populations. Remaining studies examined youth elite (n = 7), amateur (n = 5), or tournaments (n = 2). When examining incidence per athletic exposure (AE), pooled estimates revealed the overall SRC incidence for female youth athletes in contact/collision invasion sports combined was 0.44/1000 AE [95% CI 0.37-0.51]. When examining incidence per match and practice hours, pooled estimates revealed the overall SRC incidence for female youth athletes in contact/collision invasion sports combined was 0.50/1000 match and practice hours [95% CI 0.34-0.67]. Forty studies (61%) reported SRC risk data investigating 11 different risk factors for SRC in female youth athletes, including: sex, age, playing position, mechanism of injury, previous history of SRC, exposure (period of practice or match), exposure (match vs practice), access to medical staff, neck strength, protective equipment, and laws or governance. Female youth have 70% higher risk [Risk Ratio (RR) 1.71, 95% CI 1.44-2.04, p <0.01] and 40% higher rate [Incidence Rate Ratio (IRR) 1.41, 95% CI 1.22-1.63, p <0.01] of SRC compared to youth males when competing in contact/collision invasion sports. Where exposure is concerned, female youth sustain over 7.5 times the rate of SRC in matches compared with practice [IRR 7.52, 95% CI 6.32-8.95, p <0.01] when competing in contact/collision invasion sports. The use of headgear to prevent SRC in female youth lacrosse was deemed inconclusive [p = 0.07]. Insufficient evidence is available to examine remaining risk factors.

 

CONCLUSION: There is limited evidence available to determine risk factors for SRC in female youth athletes. Future research is needed to better understand modifiable determinants of SRC in this population.