Revealing Gender Differences in Concussion Reporting: A Detailed Analysis of SCAT Assessment Self-Report Symptom Ratings

Current concussion assessments used by the NCAA are typically applied across both male and female athletes to assess the effects of sports-related head impacts. However, increasing evidence suggests that female athletes exhibit different physiological and psychosocial responses to concussions compared to their male counterparts, raising concerns about the appropriateness of gender-blind concussion assessment. This study analyzes data from 1,021 NCAA athletes (379 females, 642 males) who completed the SCAT3 Symptom Severity Checklist post-concussion. A systematic use of multivariate statistical approaches including Exploratory Graph Analysis (EGA), Principal Component Analysis (PCA), Exploratory Factor Analysis (EFA), Linear Discriminant Analysis (LDA), and Rasch Partial Credit Modeling (PCM) was employed on this 22-item instrument to explore the latent factor structure and to detect assessment items sensitive to potential gender differences. Differential Item Functioning (DIF) analysis was used to investigate gender disparities in symptom reporting. Based on EGA and PCA, the SCAT3 exhibited a four-factor substructure, with an EFA accounting for 62.44% of the variance. LDA between males and females displayed a statistically significant difference in the multivariate distributions of male and female scores (χ ² (22) = 130.56, p < .001), indicating that emotional and physical symptom items loaded negatively, whereas cognitive and sensory-based items loaded positively. A closer examination of each assessment item via Rasch analysis revealed three items having zero difference between males and females. In contrast, nine symptoms indicated males were more likely to report higher severity. However, males generally reported overall lower total symptom severity scores (M = 30.06, SD = 20.88) and males (M = 24.71, SD = 21.18), t(765.06) = 3.85, p < .001. These differences in how athletes of differing genders present symptoms post-concussion may indicate that 1) males may be more conservative in their reporting and only endorse symptoms when they are felt to be more intense, contributing to high scores on a smaller number of symptoms, whereas 2) females may emphasize emotional and physical symptoms more readily. The results of this examination suggest that attention to gender differences in concussion symptom reporting should be considered in making clinical recommendations on concussion recovery and return-to-play decision-making.