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Cited by 197Traumatic Brain Injury and Neurovascular DisturbancesTraumatic Brain Injury ResearchTrauma and Emergency Care Studies

The Effect of Gender on Patients With Moderate to Severe Head Injuries

Berry, Cherisse, Ley, Eric J., Tillou, Areti, Cryer, Gil, Margulies, Daniel R., Salim, Ali·2009·Journal of Trauma: Injury, Infection & Critical Care
DOI 10.1097/ta.0b013e3181ba3354
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Abstract

BACKGROUND: Male and female nervous systems respond differently to traumatic brain injury (TBI) and in vivo research relates this difference to neuroprotection from female sex hormones. Attempts to replicate female sex hormone-related neuroprotection in clinical studies have been unsuccessful. The objective of this study was to determine whether gender or menopausal status affects mortality in patients with moderate to severe TBI. METHODS: A retrospective review of all patients with isolated moderate to severe TBI was undertaken using data from the National Trauma Database version 6.2 (2000-2005). Isolated TBI was defined as head Abbreviated Injury Score >/=3 in patients without significant extracranial injuries (Abbreviated Injury Score <3 for other anatomic regions). Demographics, Injury Severity Score, and outcomes (mortality, intensive care unit and hospital length of stay, and complications) were compared. The population was stratified into age subgroups: 14 to 45 years (premenopausal), 46 to 55 years (perimenopausal), and older than 55 years (postmenopausal). Logistic regression analysis was used to determine the relationship among female gender, mortality, and development of complications after moderate to severe TBI. RESULTS: A total of 72,294 patients with moderate to severe TBI were evaluated. Females showed a significantly lower risk in both mortality (adjusted odds ratios [AOR], 0.82; 95% confidence intervals [CI], 0.77-0.87; p < 0.0001) and in developing any type of complications (AOR, 0.88; 95% CI, 0.84-0.93; p < 0.0001) than the male population after adjusting for differences in patient characteristics. After age stratification, perimenopausal women (46-55 years) and postmenopausal women (older than 55 years) showed a significantly lower risk in mortality (AOR, 0.76; 95% CI, 0.63-0.92; p < 0.0044 and AOR, 0.79; 95% CI, 0.73-0.86; p < 0.0001, respectively). There was no difference in mortality in premenopausal women compared with their male age-matched counterparts (AOR, 1.09; 95% CI, 0.99-1.21; p = 0.0917). CONCLUSIONS: Female gender is independently associated with reduced mortality and decreased complications after TBI. As peri- and postmenopausal women demonstrated improved survival, and premenopausal women did not, estrogen unlikely confers neuroprotection in women after TBI. Future TBI treatment may benefit with further research focused on why peri- and postmenopausal women show decreased mortality after TBI.

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Crossref · 10.1097/ta.0b013e3181ba3354

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  • Peri- and post-menopausal, but not younger (reproductive age) women had better outcomes including lower mortality than age-matched men in more than 72,000 survivors of moderate to severe TBI.

    “Peri- and post-menopausal, but not younger (reproductive age) women had better outcomes including lower mortality than age-matched men in more than 72,000 survivors of moderate to severe TBI. 71”

    From Sex Differences in Traumatic Brain Injury: What We Know and What We Should Know (2019) · cites this paper as [71]

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Authors
Berry, C., Ley, E. J., Tillou, A., Cryer, G., Margulies, D. R., & Salim, A.
Affiliations
Cedars-Sinai Medical Center (US)
ORCID
Venue
Journal of Trauma: Injury, Infection & Critical Care
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2009-11
Volume
67
Issue
5
Pages
950-953
ISSN
0022-5282 (ISSN-L)
DOI
10.1097/ta.0b013e3181ba3354
OpenAlex
W2070497752
Cited by
197
References
18
Citations by year
2026: 6 · 2025: 5 · 2024: 12 · 2023: 9 · 2022: 14 · 2021: 13 · 2020: 13 · 2019: 18 · 2018: 13 · 2017: 14 · 2016: 11 · 2015: 13 · 2014: 10 · 2013: 14 · 2012: 8
FWCI
6.77
Type
journal article
Language
en
Open access
closed
Locations
  • The Journal of Trauma: Injury, Infection, and Critical Care (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Neurology › Traumatic Brain Injury and Neurovascular Disturbances
  • Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
  • Health Sciences › Medicine › Emergency Medicine › Trauma and Emergency Care Studies
Keywords
traumatic brain injury, sex differences, menopause, mortality, postmenopausal women, perimenopausal women, neuroprotection, female sex hormones, post-traumatic complications, length of hospital stay, ICU length of stay
MeSH terms
Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Brain Injuries, Female, Humans, Male, Menopause, Middle Aged, Retrospective Studies, Risk Factors, Sex Factors, Abbreviated Injury Scale, Logistic Models, Odds Ratio, Outcome Assessment, Health Care, Young Adult

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