This is an interesting article reviewing gender differences in symptom reporting at baseline and after sports related concussion.

Title is appropriate. Aims and objectives are clearly described. Abstract provides a good summary of the article. Methodology is appropriate. For data collection, 43 out of 64 full text articles were excluded - It would be better to define what were the 'Other' reasons for excluding the 11 studies. Statistical analysis appears appropriate, but I recommend expert statistical review. Results are well described. Tables are relevant and clearly presented. References are appropriate.

Discussion and conclusions- The total symptoms score was higher for females, although not clinically relevant. It is right to state hormonal influences and PMS symptoms should be considered in females and should be included in baseline and post-concussion assessments. Post concussion, females had higher odds of reporting confusion. This is not included in the discussion. It would be nice to discuss why females would report less confusion- ?cultural factors playing a role?

Discussion should also mention other factors like migraine headache being more common in females. There are several psychiatric conditions that have known gender differences like anorexia nervosa and depression being more common in females and ADHD more common in boys than girls. This should be discussed as these conditions can influence symptom reporting.

I think it is more appropriate to state that baseline symptoms should be considered for both males and females when making return to play decisions.

Overall, the study design is appropriate. Article is consistent and well written. Discussion could have included a few extra things.