A group of researchers from the United States Air Force Academy, the University of Georgia, and the University of Michigan have identified that female athletes are under-represented in research efforts informing the three most influential concussion consensus statements and positions from the National Athletic Trainers’ Association (NATA), the Concussion in Sport Group (CISG), and the American Medical Society for Sports Medicine (AMSSM).

Christopher D’Lauro, professor of Cognitive Neuroscience at the United States Air Force Academy, was the lead author of the review “Under-representation of female athletes in research informing influential concussion consensus and position statements: an evidence review and synthesis” published in the British Journal of Sports Medicine. The researchers examined the development of the consensus statements by analyzing gender and biological sex information. D’Lauro explained why the CISG, NATA, and AMSSM were chosen for this review in the British Journal of Sports Medicine blog post “Under-representation of women in research informing concussion consensus and position statements #KnowledgeTranslationBlog.” “The CISG, NATA, and AMSSM statements have the longest history in this area and are frequently cited by other concussions studies, and we know clinicians use them the most,” D’Lauro wrote in the blog post. According to D’Lauro, all athletes who suffer a concussion go through the concussion protocols based on concussion consensus and position statements. However, D’Lauro’s work identified that these documents were largely based on research conducted on male athletes.  

Across 171 research articles cited by the CISG, NATA, and AMSSM, the review found a “significant under-representation of females in athletes in their cited literature, relying on samples that were overall 80.1% male (NATA: 79.9%; AMSSM: 79.4%; ICCS: 87.87%).”¹ Additionally, 69 studies (40.3%) had all male samples, while only two studies were all female (1.2%).¹  

 “If we want to support female athletes, we need concussion protocols that give equivalent representation to what male athletes get,” D’Lauro said. “Right now, that is not the case. We need protocols that guide care for all athletes.”

The study offers five strategies to support the inclusion of more female and other athlete groups in future concussion research. The strategies include:

1.       Facilitating equal representation of female, male, transgender, and non-binary authors on consensus and position statements, editorial boards, and program management.

2.       Including female-focused sections of consensus and position statements until there is enough research for a standalone document.

3.       Acknowledging the usage of predominantly male athlete samples to inform recommendations.

4.       Creating consensus/position statement checkpoints to ensure the cited research is as balanced as possible.

5.       Creating research funding opportunities focusing on women, non-binary, and transgender athletes or including a better balance between male and female athletes.¹

The Concussion in Sports Group (CISG) met in Amsterdam, Netherlands, in October 2022 to update its consensus statement. D’Lauro added the group needs to be “more mindful of the diversity – or lack of it –  in the data that informs the protocol.”

“Future editions should do a much better job of equitably representing female athlete data, and be more mindful of inclusion for data from other athlete groups too,” D’Lauro continued. 

1. D’Lauro C, Jones ER, Swope LM, et al Under-representation of female athletes in research informing influential concussion consensus and position statements: an evidence review and synthesis British Journal of Sports Medicine 2022;56:981-987.