Knowledge of differences in mild traumatic brain injury (mTBI) recovery by sex and age may inform individualized treatment of these patients.
To identify sex-related differences in symptom recovery from mTBI; secondarily, to explore age differences within women, who demonstrate poorer outcomes after TBI.
The prospective cohort study Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) recruited 2000 patients with mTBI from February 26, 2014, to July 3, 2018, and 299 patients with orthopedic trauma (who served as controls) from January 26, 2016, to July 27, 2018. Patients were recruited from 18 level I trauma centers and followed up for 12 months. Data were analyzed from August 19, 2020, to March 3, 2021.
Patients with mTBI (defined by a Glasgow Coma Scale score of 13-15) triaged to head computed tomography in 24 hours or less; patients with orthopedic trauma served as controls.
Measured outcomes included (1) the Rivermead Post Concussion Symptoms Questionnaire (RPQ), a 16-item self-report scale that assesses postconcussion symptom severity over the past 7 days relative to preinjury; (2) the Posttraumatic Stress Disorder Checklist for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (PCL-5), a 20-item test that measures the severity of posttraumatic stress disorder symptoms; (3) the Patient Health Questionnaire-9 (PHQ-9), a 9-item scale that measures depression based on symptom frequency over the past 2 weeks; and (4) the Brief Symptom Inventory-18 (BSI-18), an 18-item scale of psychological distress (split into Depression and Anxiety subscales).
A total of 2000 patients with mTBI (1331 men [67%; mean (SD) age, 41.0 (17.3) years; 1026 White (78%)] and 669 women [33%; mean (SD) age, 43.0 (18.5) years; 505 (76%) White]). After adjustment of multiple comparisons, significant TBI × sex interactions were observed for cognitive symptoms (B = 0.76; 5% false discovery rate-corrected P = .02) and somatic RPQ symptoms (B = 0.80; 5% false discovery rate-corrected P = .02), with worse symptoms in women with mTBI than men, but no sex difference in symptoms in control patients with orthopedic trauma. Within the female patients evaluated, there was a significant TBI × age interaction for somatic RPQ symptoms, which were worse in female patients with mTBI aged 35 to 49 years compared with those aged 17 to 34 years (B = 1.65; P = .02) or older than 50 years (B = 1.66; P = .02).
This study found that women were more vulnerable than men to persistent mTBI-related cognitive and somatic symptoms, whereas no sex difference in symptom burden was seen after orthopedic injury. Postconcussion symptoms were also worse in women aged 35 to 49 years than in younger and older women, but further investigation is needed to corroborate these findings and to identify the mechanisms involved. Results suggest that individualized clinical management of mTBI should consider sex and age, as some women are especially predisposed to chronic postconcussion symptoms even 12 months after injury.
About The Expert
Harvey S Levin
Nancy R Temkin
Jason Barber
Lindsay D Nelson
Claudia Robertson
Jeffrey Brennan
Murray B Stein
John K Yue
Joseph T Giacino
Michael A McCrea
Ramon Diaz-Arrastia
Pratik Mukherjee
David O Okonkwo
Kim Boase
Amy J Markowitz
Yelena Bodien
Sabrina Taylor
Mary J Vassar
Geoffrey T Manley
Opeolu Adeoye
Neeraj Badjatia
M Ross Bullock
Randall Chesnut
John D Corrigan
Karen Crawford
Sureyya Dikmen
Ann-Christine Duhaime
Richard Ellenbogen
V Ramana Feeser
Adam R Ferguson
Brandon Foreman
Raquel Gardner
Etienne Gaudette
Luis Gonzalez
Shankar Gopinath
Rao Gullapalli
J Claude Hemphill
Gillian Hotz
Sonia Jain
C Dirk Keene
Frederick K Korley
Joel Kramer
Natalie Kreitzer
Chris Lindsell
Joan Machamer
Christopher Madden
Alastair Martin
Thomas McAllister
Randall Merchant
Amber Nolan
Laura B Ngwenya
Florence Noel
Eva Palacios
Ava Puccio
Miri Rabinowitz
Jonathan Rosand
Angelle Sander
Gabriella Satris
David Schnyer
Seth Seabury
Xiaoying Sun
Arthur Toga
Alex Valadka
Kevin Wang
Esther Yuh
Ross Zafonte
References
PubMed