Context: Past work has identified sex differences in sport-related concussion (SRC) incidence and recovery time; however, few have examined sex differences in specific recovery trajectories: time to symptom resolution, return-to-academics, and return-to-athletic activity across collegiate sports.

Objective: To examine sex differences in SRC recovery trajectories across a number of varsity sports with differing levels of contact.

Design: Descriptive Epidemiology Study.

Setting: College varsity and club sports. Patients or Other Participants: SRCs sustained by student-athletes (N=1,974; 38.7% female) participating in Ivy League sports were tracked from 2013/14-2018/19.

Intervention(s): Athletic trainers collected concussive injury and recovery characteristics as part of the Ivy League-Big Ten Epidemiology of Concussion Study's surveillance system.

Main Outcome Measure(s): Time to symptom resolution, return-to-academics, and return-to-limited and full athletic activity were collected. Survival analyses determined time from injury to each recovery outcome for males and females by sport. Peto tests compared recovery outcomes between males and female athletes and by sport.

Results: The median time to symptom resolution overall was 9 days [IQR:4,18], return-to-academics was 8 days [IQR:3,15], return-to-limited activity was 12 days [IQR:8,23], and return-to-full activity was 16 days [IQR:10,29]. There were significant differences overall between sexes for median time to symptom resolution (males: 8 days [IQR:4,17], females: 9 days [IQR:5,20], p=0.029) and return-to-academics (males: 7 days [IQR:3,14], females: 9 days [IQR:4,17], p<.001), but not return to athletics (limited activity, p=0.107; full activity, p=0.578). Within-sport comparisons found that female lacrosse athletes had longer symptom resolution (p=0.030) and return to academics (p=0.035) compared to males, while male volleyball athletes took longer to return to limited (p=0.020) and full (p=0.049) athletic activity compared to females.

Conclusion: There were significant differences in recovery timelines between sexes. Females experienced longer symptom duration and time to return-to-academics compared to male athletes, but females and males presented similar timelines for return-to-athletics.

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