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Cited by 74Traumatic Brain Injury and Neurovascular DisturbancesTraumatic Brain Injury ResearchTrauma and Emergency Care Studies

Gender impacts mortality after traumatic brain injury in teenagers

Ley, Eric J., Short, Scott S., Liou, Douglas Z., Singer, Matthew B., Mirocha, James, Melo, Nicolas, Bukur, Marko, Salim, Ali·2013·Journal of Trauma and Acute Care Surgery
DOI 10.1097/ta.0b013e31829d024f
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Abstract

BACKGROUND: Gender may influence outcomes following traumatic brain injury (TBI) although the mechanism is unknown. Animal TBI studies suggest that gender differences in endogenous hormone production may be the source. Limited retrospective clinical studies on gender present varied conclusions. Pediatric patients represent a unique population as pubescent children experience up-regulation of endogenous hormones that varies dramatically by gender. Younger children do not have these hormonal differences. The aim of this study was to compare pubescent and prepubescent females with males after isolated TBI to identify independent predictors of mortality. METHODS: We performed a retrospective review of the National Trauma Data Bank Research Data Sets from 2007 and 2008 looking at all blunt trauma patients 18 years or younger who required hospital admission after isolated, moderate-to-severe TBI, defined as head Abbreviated Injury Scale (AIS) score 3 or greater. We excluded all individuals with AIS score of 3 or greater for any other region to limit the confounding effect of comorbidities. Based on the median age of menarche, we defined two age groups as follows: prepubescent (0-12 years) and pubescent (>12 years). Analysis was performed to compare trauma profiles and outcomes between groups. Our primary outcome measure was in-hospital mortality. RESULTS: A total of 20,280 patients met inclusion criteria; 10,135 were prepubescent, and 10,145 were pubescent. Overall mortality was 6.9%, and lower mortality was noted among prepubescent patients compared with pubescent (5.2% vs. 8.6%, p < 0.0001). Although female gender did not predict reduced mortality in the prepubescent cohort (adjusted odds ratio, 1.05; 95% confidence interval, 0.85-1.30; p = 0.63), female gender was associated with reduced mortality in the pubescent (adjusted odds ratio, 0.78; 95% confidence interval, 0.65-0.93; p = 0.007). CONCLUSION: In contrast to prepubescent female gender, pubescent female gender predicts reduced mortality following isolated, moderate-to-severe TBI. Endogenous hormonal differences may be a contributing factor and require further investigation. LEVEL OF EVIDENCE: Prognostic study, level III.

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  • A study of over 20,000 patients showed that postpubescent teenage girls had lower mortality than age-matched boys after moderate to severe TBI.

    “This prediction is supported by a study of over 20,000 patients showing that postpubescent teenage girls had lower mortality than age-matched boys after moderate to severe TBI. 67”

    From Sex Differences in Traumatic Brain Injury: What We Know and What We Should Know (2019) · cites this paper as [67]

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Authors
Ley, E. J., Short, S. S., Liou, D. Z., Singer, M. B., Mirocha, J., Melo, N., Bukur, M., & Salim, A.
Affiliations
Cedars-Sinai Medical Center (US)
ORCID
Venue
Journal of Trauma and Acute Care Surgery
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2013-10
Volume
75
Issue
4
Pages
682-686
ISSN
2163-0755 (ISSN-L)
DOI
10.1097/ta.0b013e31829d024f
OpenAlex
W2078521160
Cited by
74
References
16
Citations by year
2026: 6 · 2025: 1 · 2024: 3 · 2023: 4 · 2022: 7 · 2021: 10 · 2020: 10 · 2019: 13 · 2018: 2 · 2017: 5 · 2016: 6 · 2015: 5 · 2014: 1 · 2013: 1
FWCI
2.75
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, gender differences, mortality, pubertal stage, prepubertal children, adolescents, endogenous hormones, sex differences in prognosis, blunt head trauma, pediatric trauma
MeSH terms
Adolescent, Age Factors, Brain Injuries, Child, Child, Preschool, Female, Humans, Infant, Infant, Newborn, Male, Retrospective Studies, Sex Factors, United States, Glasgow Coma Scale, Injury Severity Score, Abbreviated Injury Scale, Databases, Factual, Hospital Mortality

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