Sex-Based Differences in Symptoms with Mouthguard Use Following Pediatric Sport-Related Concussion

ContextCurrent evidence regarding the protective effect of mouthguard use on symptom severity in children and adolescents who sustain sport-related concussions is insufficient to make clinical recommendations.ObjectiveTo compare the association between mouthguard-use and symptoms stratified by sex in the first 4-weeks after pediatric sport-related concussion. We hypothesized that mouthguard-use would be associated with lower symptoms.DesignProspective cohort studySettingNine Canadian pediatric emergency departments (EDs).PatientsChildren aged 5–18 years presenting ≤48 hours of concussion sustained during a collision or contact sport.Main Outcome MeasuresInjury characteristics were collected using the Acute Concussion Evaluation. Primary outcome measure was symptom score (0–6), measured using age-appropriate versions (5–7 years; 8–12 years; 13–18 years) of the Post-Concussion Symptom Inventory. Independent variable was time postconcussion (at initial assessment, 1-, 2-, 4, weeks).ResultsOf 1019 children (73% male; median [IQR] age=13.43[11.01,15.27] years), 42% wore a mouthguard at time of injury. There was no significant group by sex by time interaction for symptoms (χ23=0.27; p=.965). Male mouthguard users reported similar symptom scores in the ED (diff=-0.07; 95%CI:-0.23,0.09), at week-1 (diff=−0.02; 95%CI:−0.18,0.14), week-2 (diff=-0.03; 95%CI:−0.19,0.13), and week-4 (diff=-0.13; 95%CI:-0.29,0.04) compared with males who didn't wear a mouthguard. Female mouthguard users reported minimally higher symptom scores at week-1 compared with non-mouthguard users (diff=0.29; 95%CI:0.01,0.56). Symptom scores were not significantly different for females who wore a mouthguard and those who didn't in the ED (diff=0.22; 95%CI:-0.04,0.48), at week-2 (diff=0.22; 95%CI:-0.06,0.51), or week-4 (diff=0.08; 95%CI:-0.20,0.36).ConclusionWearing a mouthguard at time of injury is not associated with reduced acute and subacute symptoms after sport-related concussion in either males or females who were treated in the ED compared with those who did not wear a mouthguard. Athletes are still encouraged to wear a mouthguard during sports since overwhelming evidence supports their use in preventing dental injuries.