# Sex Differences in Concussion Rates among Middle School Sex-comparable Sports

## TL;DR

Girls in middle school sports are more than twice as likely as boys to suffer concussions, with differences seen in most sports.

## Contribution

This study reveals that sex-based concussion risk differences emerge in early adolescence, earlier than previously documented.

## Key findings

- Girls had a 2.26 times higher overall concussion rate than boys in sex-comparable middle school sports.
- Concussion rates were higher for girls in three of four sports during both competition and practice.
- No sex differences were found in track and field or in concussion mechanisms.

## Abstract

To investigate sex differences in sports-related concussion (SRC) rates among early adolescents participating in sex-comparable middle school (MS) sports.

This prospective epidemiological study was conducted as part of the Advancing Health Care Initiatives for Underserved Students project in Virginia from 2015 to 2022. Athletic trainers collected injury and athlete exposure (AE) data from athletes MS athletes participating in sex-comparable sports, including baseball/softball, basketball, soccer, and track and field. Outcomes included SRC injury rates (IR)/1000 AE, IR ratios (IRRs) for overall sex and event-type differences (competition vs practice), and injury proportion ratios for injury mechanisms.

A total of 11,213 athletes (girls, n = 5647; boys, n = 5566) contributed 329,269 AEs, during which 97 SRCs were diagnosed (0.29/1000 AE). Girls were more than twice as likely as boys to sustain an SRC overall (IRR, 2.26). In 3 of the 4 sex-comparable MS sports, girls had higher SRC rates in competition and practice than boys: softball/baseball (competition/practice IRR, 4.19/2.35), basketball (3.77/2.74), and soccer (1.75/4.92). No sex differences were observed in track and field or in the proportional distribution of SRC mechanisms.

Among early adolescents participating in sex-comparable MS sports, girls were more than twice as likely as boys to sustain a SRC. The magnitude of the sex difference in SRC rates observed among MS athletes exceeded that previously reported in high school and collegiate populations. These findings demonstrate that sex-based differences in SRC risk are evident by early adolescence and highlight the need for developmentally appropriate, female-specific concussion prevention and clinical care strategies.