Gender and age effects on outcome after pediatric traumatic brain injury*

Morrison, Wynne; Arbelaez, José J.; Fackler, James C.; Maio, Antonio De; Paidas, Charles N.

doi:10.1097/01.pcc.0000112373.71645.2a

Cited by 82 publications

(47 citation statements)

References 60 publications

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“…A study for risk factors for stroke among children with sickle cell disease found no effect of sex on stroke prevalence, 26 nor was there an effect of gender on mortality after pediatric traumatic brain injury. 27 However, after pediatric traumatic brain injury, girls demonstrate a significantly better outcome in tests of learning and memory. 28 -29 In experimental animal models, reduced sensitivity to ischemic injury in females has been attributed to circulating estradiol, a factor not relevant to prepubertal animals.…”

Section: Sex and Perinatal Injurymentioning

confidence: 99%

Adult or Perinatal Brain Injury

Hurn¹,

Vannucci

Hagberg

2005

Stroke

129

105

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iological sex and sex-defining steroids are strikingly under-rated as modulators of cerebral ischemic cell death. In adults, male sex has been long identified as a risk factor for clinical stroke, yet the biology behind this fact remains veiled. We know that overall stroke incidence is lower in women than in men, across widely varying ethnic and cultural backgrounds. 1 Newer glimpses into this sexual dimorphism indicate that women continue to sustain lower stroke rates until beyond the menopausal years, suggesting that hormonal factors are not solely responsible. For example, stroke rates in female subjects of the Northern Manhattan Stroke Study did not exceed those of men until aged Ն85 years. 2 Importantly, data from sex-stratified preclinical studies indicate that stroke sensitivity (the damage resulting when an ischemic insult occurs) is also sexually dimorphic in adults. It is less clear if ischemic injury in the developing brain develops differently in males and females. However, provocative new evidence from cells cultured directly from fetal or newborn brain suggests that mechanisms of cell death are not identical in cells that are genetically male (XY) versus female (XX). This article evaluates linkages between sex, sex steroids, and neuroprotection throughout life.

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Section: Sex and Perinatal Injurymentioning

confidence: 99%

Adult or Perinatal Brain Injury

Hurn¹,

Vannucci

Hagberg

2005

Stroke

129

105

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“…Our findings warrant further study into the role age-specific mechanisms of TBI pathophysiology may have in mediating this association. [30][31][32][33][34] Sex Although several researchers [35][36][37][38][39] have suggested neuroprotection for females after TBI, other studies [40][41][42] suggest poorer outcomes for females after TBI. Additionally, high school and collegiate female athletes have a higher incidence of concussion than their male counterparts 3,43 and may be at greater risk for postconcussive syndrome after mild TBI.…”

Section: Agementioning

confidence: 99%

Concussion in Sports: Postconcussive Activity Levels, Symptoms, and Neurocognitive Performance

Majerske

Mihalik

Ren

et al. 2008

Journal of Athletic Training

384

318

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Context: Evidence suggests that athletes engaging in highintensity activities after concussion have more difficulties with cognitive recovery.Objective: To examine the role postinjury activity level plays in postconcussive symptoms and performance on neurocognitive tests in a population of student-athletes.Design: Retrospective cohort study with repeated measures of neurocognitive performance and symptom reporting.Setting: University-based sports concussion clinic.Patients or Other Participants: Ninety-five student-athletes (80 males, 15 females: age 5 15.88 6 1.35 years) were retrospectively assigned to 1 of 5 groups based on a postinjury activity intensity scale.Main Outcome Measure(s): We employed a regression analysis for repeated measures to evaluate the relationship of activity intensity to symptoms and neurocognitive outcome up to 33 days after concussion. Postconcussion symptom scores and neurocognitive (verbal memory, visual memory, visual motor speed, and reaction time) scores served as the primary outcome measures.Results: Level of exertion was significantly related to all outcome variables (P , .02 for all comparisons). With multivariate analysis, activity intensity remained significant with respect to visual memory (P 5 .003) and reaction time (P , .001).Conclusions: Activity level after concussion affected symptoms and neurocognitive recovery. Athletes engaging in high levels of activity after concussion demonstrated worse neurocognitive performance. For these tasks, those engaging in moderate levels of activity demonstrated the best performance.

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“…Controlled experiments in animals have shown improved survival and cognitive function among females after TBI compared to males (Bramlett and Dietrich, 2001;O'Connor et al, 2003;Wagner et al, 2004), suggesting that female sex is somehow neuroprotective. However, multiple observational studies in humans have reported poorer outcomes among females after both severe TBI (Cifu et al, 1997;Donders and Woodward, 2003;Edna and Cappelen, 1987;Kaplan and Corrigan, 1992;Kirkness et al, 2004;Kraus et al, 2000;Levin et al, 1987;McMordie et al, 1990;Morrison et al, 2004;Wilberger et al, 1991), and mTBI (Bazarian and Atabaki, 2001;Bazarian et al, 1999;Jensen and Nielsen, 1990;Rutherford et al, 1977Rutherford et al, , 1979.…”

mentioning

confidence: 99%

Sex Differences in Outcome after Mild Traumatic Brain Injury

Blyth¹,

Mookerjee²,

He³

et al. 2010

Journal of Neurotrauma

300

196

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The objective of this study was to estimate the independent association of sex with outcome after mild traumatic brain injury (mTBI). We performed an analysis of a subset of an established cohort involving 1425 mTBI patients presenting to an academic emergency department (ED). The associations between sex and three outcomes determined 3 months after the initial ED visit were examined: post-concussive symptom (PCS) score (0, 1-5, 6-16, and >16), the number of days to return of normal activities (0, 1-7, and >7), and the number of days of work missed (0, 1-7,and >7). Logistic regression analyses were used to determine the relationship between sex and each outcome after controlling for 12 relevant subject-level variables. Of the 1425 subjects, 643 (45.1%) were female and 782 (54.9%) were male. Three months after mTBI, males had significantly lower odds of being in a higher PCS score category (odds ratio [OR] 0.62, 95% confidence interval [CI]: 0.50, 0.78); this association appeared to be more prominent during child-bearing years for females. Males and females did not significantly differ with respect to the odds of poorer outcome as defined by the number of days to return of normal activities or the number of days of work missed. Female sex is associated with significantly higher odds of poor outcome after mTBI, as measured by PCS score, after control for appropriate confounders. The observed pattern of peak disability for females during the child-bearing years suggests disruption of endogenous estrogen or progesterone production. Attempts to better understand how mTBI affects production of these hormones acutely after injury and during the recovery period may shed light on the mechanism behind poorer outcome among females and putative therapeutic interventions.

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Gender and age effects on outcome after pediatric traumatic brain injury*

Abstract: There is evidence from this large study that girls do not have a better outcome after pediatric traumatic brain injury than boys, with a suggestion that girls may do worse.

Cited by 82 publications

References 60 publications

Adult or Perinatal Brain Injury

Adult or Perinatal Brain Injury

Concussion in Sports: Postconcussive Activity Levels, Symptoms, and Neurocognitive Performance

Sex Differences in Outcome after Mild Traumatic Brain Injury

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