Article
Sex differences in injury severity and outcome measures after traumatic brain injury1

https://doi.org/10.1016/j.apmr.2003.05.007Get rights and content

Abstract

Slewa-Younan S, Green AM, Baguley IJ, Gurka JA, Marosszeky JE. Sex differences in injury severity and outcome measures after traumatic brain injury. Arch Phys Med Rehabil 2004;85:376–9.

Objective

To investigate the effect of a patient’s sex on various measures of injury severity and outcome after rehabilitation in a matched sample of patients with traumatic brain injury (TBI).

Design

Retrospective data were retrieved from a database that contains information routinely collected on all patients admitted for inpatient rehabilitation.

Setting

Inpatient rehabilitation unit of major teaching hospital in Australia.

Participants

Fifty-four women with TBI after a motor vehicle crash (MVC) were identified from the Brain Injury Rehabilitation Database. An equal number of men were then matched for age and years of education. All subjects met the study admission criteria of having being involved in a high-speed MVC. Exclusion criteria included history of a previous head injury, chronic amnesia, psychiatric disturbance, and significant alcohol and/or substance abuse.

Interventions

Not applicable.

Main outcome measures

Differences, by sex, in patient scores on measures of injury severity and outcome after TBI.

Results

Men had significantly greater levels of injury severity as indicated by the Glasgow Coma Scale scores (U=994.0, P=.002) and length of posttraumatic amnesia (U=880.0, P=.016) when compared with women. No significant sex differences existed in the outcome measures or in injuries not associated with the central nervous system.

Conclusions

Few investigations exist on the effect of patient sex on measures of injury severity and outcome after a TBI. In the present study, men’s levels of injury severity were greater than women’s despite the same admission criteria (high-speed MVC) being applied to both sexes.

Section snippets

Sample selection

Retrospective data routinely collected on all patients admitted for inpatient rehabilitation were obtained from the Westmead Hospital Brain Injury Rehabilitation Database (BIRD) in Sydney, Australia. Data were retrieved by an independent assistant who was blinded to the objectives of this study. The database—in operation since August 1990—currently contains information on over 800 persons. Fields in the database are divided into the following 3 sections: demographics and personal history (name,

Results

Table 2 presents the variables analyzed and the significance levels.

A significant difference was noted between men and women in the severity of their TBI. Men appeared to have greater injury severity as shown by their lower GCS scores (U=971.5, P<.005) and longer PTA duration (U=858.0, P<.05) when compared with women. No other significant differences were noted between male and female patients.

Discussion

The primary aim of this study was to explore the effect of a patient’s sex on injury severity and outcome measures after TBI. More specifically, it was predicted that, given the consistent sex differences reported in both the structure and function of the healthy human brain, response to a head injury would also be mediated by a patient’s sex. Our results provided support for this prediction. Data analysis showed that men had greater injury severity than women, as reflected by their lower GCS

Conclusions

In a sample consisting of equal numbers of men and women with moderate to severe TBI, when subjects were matched by age, education status, speed of MVC, and mode and type of head injury, men continued to display greater injury severity than women. Although some of the reasons for our findings are yet to be adequately explained, our study highlights the growing importance of sex differences research in TBI.

Acknowledgements

We thank Bruce Giumelli for his valuable contributions.

References (26)

  • B. Jennett et al.

    Aspects of coma after severe head injury

    Lancet

    (1977)
  • R.L. Roof et al.

    Gender influences outcome of brain injuryprogesterone plays a protective role

    Brain Res

    (1993)
  • A.S. Dekaban

    Changes in brain weights during the span of human liferelation of brain weights to body heights and body weights

    Ann Neurol

    (1978)
  • S.F. Witelson et al.

    Sylvian fissure morphology and asymmetry in men and womenbilateral differences in relation to handedness in men

    J Comp Neurol

    (1992)
  • J.J. Kulynych et al.

    Gender differences in the normal lateralization of the supratemporal cortexMRI surface-rendering morphometry of Heschl’s gyrus and the planum temporale

    Cereb Cortex

    (1994)
  • R.L. Holloway et al.

    Sexual dimorphism of the human corpus callosum from three independent samplesrelative size of the corpus callosum

    Am J Phys Anthropol

    (1993)
  • S. Clarke et al.

    Forms and measures of adult and developing human corpus callosumis there sexual dimorphism?

    J Comp Neurol

    (1989)
  • L.S. Allen et al.

    Sex differences in the corpus callosum of the living human being

    J Neurosci

    (1991)
  • T. Rabinowicz et al.

    Gender differences in the human cerebral cortexmore neurons in males; more processes in females

    J Child Neurol

    (1999)
  • J.S. Hyde et al.

    Gender differences in verbal abilitya meta-analysis

    Psychol Bull

    (1988)
  • A.R. Delgado et al.

    Sex differences in visuospatial abilitydo performance factors play such an important role?

    Mem Cognit

    (1996)
  • C.P. Benbow

    Sex differences in mathematical reasoning ability in intellectually talented preadolescentstheir nature, effects, and possible causes

    Behav Brain Sci

    (1988)
  • A.S. Kaufman et al.

    Is the pattern of intellectual growth and decline across the adult life span different for men and women?

    J Clin Psychol

    (1992)
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