Vanderbilt University School of Medicine, Nashville, TN.
Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN.
J Athl Train. 2024 Aug 1;59(8):785-792. doi: 10.4085/1062-6050-0280.23.
CONTEXT: After sport-related concussion (SRC), immediate access to a certified athletic trainer (AT) is important to ensure proper treatment. However, resource allocation and coverage may differ between male and female youth sports. OBJECTIVE: To compare resource allocation between male and female sports in the following areas: (1) rates of immediate on-field evaluation by an AT at the time of injury, (2) time to general health care presentation, and (3) time to SRC clinic presentation. DESIGN: Retrospective cohort study. SETTING: Regional sports concussion center. PATIENTS OR OTHER PARTICIPANTS: Athletes aged 14 to 18 years who presented to a regional sports concussion center from November 2017 to April 2022. MAIN OUTCOME MEASURE(S): The primary exposure of interest was sex (male or female). The primary outcome was immediate on-field evaluation by an AT (yes or no). Secondary outcomes included time to general health care and SRC clinic presentation. Descriptive statistics, χ2 analyses, and linear regressions were performed. Covariates included age, history of prior concussions, and statistically significant demographics. RESULTS: A total of 832 patients with SRC were included (age = 16.2 ± 1.2 years, 66.5% male). Female athletes had lower rates of attention-deficit/hyperactivity disorder (χ2 = 10.404, P = .001) and higher rates of anxiety and depression (χ2 = 12.891, P < .001) compared with male athletes. The average time to presentation to general health care and the SRC clinic did not differ between males and females, but AT on-field evaluation occurred more in male (40.3%) than female (32.3%) athletes (χ2 = 8.677, P = .013). Multivariable linear regression found that AT on-field evaluation was a significant predictor of time to general health care presentation (β = -.085, P = .015) but not SRC clinic presentation (β = -.055, P = .099). History of prior concussions was a significant predictor of time to initial health care contact (β = .083, P = .018). History of anxiety and depression (β = .136, P < .001) and initial evaluation by emergency department or urgent care (β = .305, P < .001) were significant predictors of delayed time to SRC clinic presentation. CONCLUSIONS: Among 832 concussed youth athletes, female athletes were evaluated less frequently by an AT immediately after injury. Furthermore, not being evaluated by an AT on field was significantly associated with a longer time to health care presentation. Future investigations should elucidate resource equity among male and female athletes.
背景：运动相关性脑震荡（SRC）后，立即获得认证的运动训练师（AT）的帮助对于确保正确的治疗非常重要。然而，男女青年运动之间的资源分配和覆盖可能存在差异。
目的：比较男女运动在以下方面的资源分配：（1）在受伤时由 AT 进行即时现场评估的比率，（2）到常规医疗保健就诊的时间，以及（3）到 SRC 诊所就诊的时间。
设计：回顾性队列研究。
地点：地区运动性脑震荡中心。
患者或其他参与者：2017 年 11 月至 2022 年 4 月期间到地区运动性脑震荡中心就诊的 14 至 18 岁运动员。
主要观察指标：主要暴露因素为性别（男性或女性）。主要结局为 AT 立即进行现场评估（是或否）。次要结局包括常规医疗保健和 SRC 诊所就诊的时间。采用描述性统计、卡方分析和线性回归进行分析。协变量包括年龄、既往脑震荡史以及具有统计学意义的人口统计学特征。
结果：共纳入 832 例 SRC 患者（年龄为 16.2±1.2 岁，66.5%为男性）。与男性运动员相比，女性运动员的注意力缺陷/多动障碍（ADHD）发生率较低（χ2=10.404，P=0.001），焦虑和抑郁发生率较高（χ2=12.891，P<0.001）。男性和女性就诊常规医疗保健和 SRC 诊所的平均时间没有差异，但 AT 在现场评估中更常见于男性（40.3%）而非女性（32.3%）运动员（χ2=8.677，P=0.013）。多变量线性回归发现，AT 在现场评估是常规医疗保健就诊时间的显著预测因素（β=-0.085，P=0.015），但不是 SRC 诊所就诊时间的显著预测因素（β=-0.055，P=0.099）。既往脑震荡史是初始医疗接触时间的显著预测因素（β=0.083，P=0.018）。既往焦虑和抑郁史（β=0.136，P<0.001）和最初由急诊或紧急护理评估（β=0.305，P<0.001）是 SRC 诊所就诊时间延迟的显著预测因素。
结论：在 832 名患有脑震荡的青年运动员中，女性运动员受伤后接受 AT 即时评估的频率较低。此外，未在现场接受 AT 评估与就诊常规医疗保健的时间较长显著相关。未来的研究应阐明男女运动员之间的资源公平性。
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