Differences between Men and Women in Treatment and Outcome after Traumatic Brain Injury

CENTER TBI Participants and Investigators

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Traumatic brain injury (TBI) is a significant cause of disability, but little is known about sex and gender differences after TBI. We aimed to analyze the association between sex/gender, and the broad range of care pathways, treatment characteristics, and outcomes following mild and moderate/severe TBI. We performed mixed-effects regression analyses in the prospective multi-center Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study, stratified for injury severity and age, and adjusted for baseline characteristics. Outcomes were various care pathway and treatment variables, and 6-month measures of functional outcome, health-related quality of life (HRQoL), post-concussion symptoms (PCS), and mental health symptoms. The study included 2862 adults (36% women) with mild (mTBI; Glasgow Coma Scale [GCS] score 13-15), and 1333 adults (26% women) with moderate/severe TBI (GCS score 3-12). Women were less likely to be admitted to the intensive care unit (ICU; odds ratios [OR] 0.6, 95% confidence interval [CI]: 0.4-0.8) following mTBI. Following moderate/severe TBI, women had a shorter median hospital stay (OR 0.7, 95% CI: 0.5-1.0). Following mTBI, women had poorer outcomes; lower Glasgow Outcome Scale Extended (GOSE; OR 1.4, 95% CI: 1.2-1.6), lower generic and disease-specific HRQoL, and more severe PCS, depression, and anxiety. Among them, women under age 45 and above age 65 years showed worse 6-month outcomes compared with men of the same age. Following moderate/severe TBI, there was no difference in GOSE (OR 0.9, 95% CI: 0.7-1.2), but women reported more severe PCS (OR 1.7, 95% CI: 1.1-2.6). Men and women differ in care pathways and outcomes following TBI. Women generally report worse 6-month outcomes, but the size of differences depend on TBI severity and age. Future studies should examine factors that explain these differences.

Original languageEnglish
Pages (from-to)235-251
Number of pages17
JournalJournal of Neurotrauma
Issue number2
Publication statusPublished - 31 Dec 2020

Bibliographical note

Funding Information:
This study was supported by The Netherlands Organisation for Health Research and Development (ZonMw). The authors A. Mikolic, S. Polinder, A.I.R. Maas, N. von Steinbuechel, M. Zeldovich, E.J.A. Wiegers, and H.F. Lingsma were supported by the European Union 7th Framework Programme (EC grant 602150). Additional support was obtained from the Hannelore Kohl Stiftung (Germany), OneMind (USA), Integra LifeSciences Corporation (USA), and Neurotrauma Sciences (USA).

Publisher Copyright:
© Ana Mikoli‡ et al., 2021; Published by Mary Ann Liebert, Inc. 2021.

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