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The Effect of Gender on Patients With Moderate to Severe Head Injuries
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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“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]
Citations
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Progesterone Rapidly Decreases Brain Edema: Treatment Delayed up to 24 Hours Is Still Effective
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Hormonally Active Women Tolerate Shock-Trauma Better Than Do Men
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Does Sexual Dimorphism Influence Outcome of Traumatic Brain Injury Patients? The Answer Is No!
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Insight into the mechanism by which estradiol improves organ functions after trauma-hemorrhage
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The Effects of Early Post-Traumatic Hyperthermia in Female and Ovariectomized Rats
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Use of a Pediatric Cohort to Examine Gender and Sex Hormone Influences on Outcome After Trauma
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Animal models of traumatic brain injury
Xiong, Y., Mahmood, A., & Chopp, M. (2013) · Nature reviews. Neuroscience · doi:10.1038/nrn3407 · Cited by 1,456
Sex Differences in Traumatic Brain Injury: What We Know and What We Should Know
Gupte, R. P., Brooks, W. M., Vukas, R. R., Pierce, J. D., & Harris, J. L. (2019) · Journal of Neurotrauma · doi:10.1089/neu.2018.6171 · Cited by 533
Microglial Activation in Traumatic Brain Injury
Donat, C. K., Scott, G., Gentleman, S., & Sastre, M. (2017) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2017.00208 · Cited by 512
Haider, A. H., Saleem, T., Leow, J. J. J., Villegas, C. V., Kisat, M. T., Schneider, E. B., Haut, E. R., Stevens, K. A., Cornwell, E. E., MacKenzie, E. J., et al. (2012) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2011.12.013 · Cited by 268
Xiong, Y., Mahmood, A., & Chopp, M. (2018) · Chinese Journal of Traumatology · doi:10.1016/j.cjtee.2018.02.003 · Cited by 253
Metadata
- Authors
- Berry, C., Ley, E. J., Tillou, A., Cryer, G., Margulies, D. R., & Salim, A.
- Affiliations
- Cedars-Sinai Medical Center (US)
- Venue
- Journal of Trauma: Injury, Infection & Critical Care
- Published
- 2009-11
- Volume
- 67
- Issue
- 5
- Pages
- 950-953
- ISSN
- 0022-5282 (ISSN-L)
- 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 › Clinical Neurology › Traumatic Brain Injury and Neurovascular Disturbances
- Health Sciences › Medicine › Clinical Neurology › 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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