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Role of sex and gender in concussion outcome differences among patients presenting to the emergency department: a systematic review
  1. Shaina Corrick1,
  2. Nicholas Lesyk1,
  3. Esther Yang1,
  4. Sandra Campbell2,
  5. Cristina Villa-Roel1,
  6. Brian H Rowe1,3
  1. 1 Emergency Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
  2. 2 John W. Scott Health Sciences Library, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
  3. 3 Clinical Epidemiology, School of Public Health, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
  1. Correspondence to Dr Brian H Rowe, Emergency Medicine, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, T6G 2B7, Canada; browe{at}ualberta.ca

Abstract

Objective This systematic review aimed to identify research involving adults presenting to the emergency department (ED) with a concussion to document the reporting of sex and/or gender according to the Canadian Institutes of Health Research (CIHR) guidelines, the prevalence of sex and gender-based analysis (SGBA) and to summarise sex and/or gender-based differences in ED presentation, management and outcomes.

Design Systematic review.

Methods Electronic databases and grey literature were searched to identify studies that recruited adult patients with concussion from the ED. Two independent reviewers identified eligible studies, assessed quality and extracted data. A descriptive summary of the evidence was generated, and sex and/or gender reporting was examined for accuracy according to standardised criteria.

Results Overall, 126 studies were included in the analyses. A total of 80 (64%) studies reported sex and/or gender as demographic information, of which 51 (64%) included sex and/or gender in their analysis; however, 2 (3%) studies focused on an SGBA. Sex was more accurately reported in alignment with CIHR definitions than gender (94% vs 12%; p<0.0001). In total, 25 studies used an SGBA for outcomes of interest. Males and females experience different causes of concussion, 60% of studies documented that females had less frequent CT scanning while in the ED, and 57% of studies reported that postconcussion syndrome was more prevalent in females and women.

Conclusion This systematic review highlighted that sex is reported more accurately than gender, approximately half of studies did not report either sex and/or gender as demographic information, and one-third of studies did not include SGBA. There were important sex and gender differences in the cause, ED presentation, management and outcomes of concussions.

PROSPERO registration number CRD42021258613.

  • Concussion
  • Traumatic Brain Injury
  • Systematic Review
  • Gender

Data availability statement

All data relevant to the study are included in the article.

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Data availability statement

All data relevant to the study are included in the article.

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Footnotes

  • Contributors SCorrick contributed to writing the protocol, PROSPERO submission, study screening, quality assessment, data analysis and interpretation and manuscript preparation. NL contributed to study screening, quality assessment, acquisition of data, data analysis and interpretation and manuscript preparation. EY contributed to study screening, quality assessment, acquisition of data, data analysis and interpretation and manuscript preparation. SCampbell contributed to the development of the electronic search and manuscript preparation. CV-R contributed to the design of the review, writing the protocol, PROSPERO submission, study screening, data analysis and interpretation and manuscript preparation. BHR secured funding and contributed to the conception and design of the review, writing the protocol, PROSPERO submission, data analysis and interpretation, and manuscript preparation. BHR is the author responsible for the overall content as the guarantor.

  • Funding SCorrick received studentship funding from the Northern Alberta Clinical Trials and Research Centre Summer Studentship Award 2021 (No grant number available) and the Edmonton Emergency Physicians' Association (EEPA) Summer Studentship Award 2022 (No grant number available). BHR’s research is supported by a Scientific Director’s Grant (SOP 168483) from the Canadian Institutes of Health Research (CIHR) through the Government of Canada (Ottawa, Ontario). These funding agencies were not involved in any aspect of the conduct, analysis and manuscript preparation of this study; CIHR takes no responsibility for the findings reported in this review.

  • Competing interests None declared.

  • Patient and public involvement The lead author (SCorrick) has sustained concusisions from competitive women's soccer and was involved in the design, conduct, reporting, and dissemination plans of this research. No other members of the public were involved.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.