Abstract
Objective
To determine sex differences in the recovery and prognosis after mild traumatic brain
injury (MTBI) in adults and children.
Data Sources
We analyzed all scientifically admissible primary studies in the World Health Organization
(WHO) (n=120) and International Collaboration on Mild Traumatic Brain Injury Prognosis
(ICoMP) (n=101) systematic reviews regarding prognosis of MTBI for sex-stratified
findings. They searched MEDLINE and other databases from 1980 through 2000 (WHO) and
2001 through 2012 (ICoMP) for published, peer-reviewed reports in English and other
languages.
Study Selection
We selected controlled trials and cohort and case-control studies that assessed the
effect of sex on outcomes after MTBI.
Data Extraction
Data from the eligible studies from both systematic reviews combined (n=14, 7%) were
extracted into evidence tables.
Data Synthesis
Prognostic information relating to sex was prioritized according to design as exploratory
or confirmatory, and a best-evidence synthesis was conducted. After MTBI, females
may have a higher risk of epilepsy (children, young adults) and suicide, and use more
health care services; males may be at higher risk for schizophrenia. Most studies
did not find a sex difference for postconcussion symptoms in children and adults.
No sex difference was found for risk of dementia and primary brain tumor, return to
work, or posttraumatic stress syndrome.
Conclusions
Sex is not a well-studied prognostic indicator for recovery after MTBI, but small
sex differences were found for some outcomes. More well-designed studies are needed
that report outcomes according to sex and control for potential confounders.
Keywords
List of abbreviations:
CI (confidence interval), ED (emergency department), ICoMP (International Collaboration on Mild Traumatic Brain Injury Prognosis), MTBI (mild traumatic brain injury), OR (odds ratio), PCS (postconcussion symptoms), PTSD (posttraumatic stress disorder), RPQ (Rivermead Postconcussion Symptoms Questionnaire), RR (relative risk), RTW (return to work), TBI (traumatic brain injury), WHO (World Health Organization)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The impact of traumatic brain injuries: a global perspective.NeuroRehabilitation. 2007; 22: 341-353
- Incidence, risk factors and prevention of mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury.J Rehabil Med. 2004; : 28-60
- Incidence and lifetime costs of injuries in the United States.Inj Prev. 2006; 12: 212-218
- Better science with sex and gender: a primer for health research.Women's Health Research Network, Vancouver2007
- Sex differences in outcome after mild traumatic brain injury.J Neurotrauma. 2010; 27: 527-539
- Sex differences in depressive symptoms and their correlates after mild-to-moderate traumatic brain injury.J Neurosci Nurs. 2009; 41 (quiz 310-11): 298-309
- Sex differences in symptoms, disability and life satisfaction three years after mild traumatic brain injury: a population-based cohort study.J Rehabil Med. 2013; 45: 749-757
- Are there gender differences in cognitive function, chronic stress, and neurobehavioral symptoms after mild-to-moderate traumatic brain injury?.J Neurosci Nurs. 2012; 44: 124-133
- Sex differences in the long-term neuropsychological outcome of mild traumatic brain injury.Brain Inj. 2009; 23: 809-814
- Prognosis for mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury.J Rehabil Med. 2004; : 84-105
- Protocol for a systematic review of prognosis after mild traumatic brain injury: an update of the WHO Collaborating Centre Task Force findings.Syst Rev. 2012; 1: 17
- WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. Systematic search and review procedures: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury.J Rehabil Med. 2004; : 11-14
- Systematic search and review procedures: results of the International Collaboration on Mild Traumatic Brain Injury Prognosis.Arch Phys Med Rehabil. 2014; 95: S101-S131
- A systematic review of the prognosis of acute whiplash and a new conceptual framework to synthesize the literature.Spine. 2001; 26: E445-E458
- Long-term risk of epilepsy after traumatic brain injury in children and young adults: a population-based cohort study.Lancet. 2009; 373: 1105-1110
- The relationship between gender and postconcussion symptoms after sport-related mild traumatic brain injury.PM R. 2009; 1: 245-253
- Head trauma and risk of dementia and Alzheimer's disease: the Rotterdam Study.Neurology. 1999; 53: 1959-1962
- Primary brain tumors following traumatic brain injury—a population-based cohort study in Sweden.Cancer Causes Control. 2001; 12: 733-737
- Is head injury a risk factor for schizophrenia?.Schizophr Res. 2002; 55: 93-98
- Health care utilization of Workers' Compensation claimants associated with mild traumatic brain injury: a historical population-based cohort study of workers injured in 1997-1998.Arch Phys Med Rehabil. 2014; 95: S295-302
- Prediction of vocational status three to four months after treated mild traumatic brain injury.J Musculoskelet Pain. 2000; 8: 193-200
- Patient complaints within 1 month of mild traumatic brain injury: a controlled study.Arch Clin Neuropsychol. 2002; 17: 319-334
- A longitudinal study of the relationship between financial compensation and symptoms after treated mild traumatic brain injury.J Clin Exp Neuropsychol. 2002; 24: 187-193
- Population-based, inception cohort study of the incidence, course, and prognosis of mild traumatic brain injury after motor vehicle collisions.Arch Phys Med Rehabil. 2014; 95: S278-S285
- Sex differences in neuropsychological function and post-concussion symptoms of concussed collegiate athletes.Neurosurgery. 2007; 61 (discussion 350-1): 345-350
- Early predictors of postconcussive syndrome in a population of trauma patients with mild traumatic brain injury.J Trauma. 2009; 66 (discussion 296-7): 289-296
- Does memory of a traumatic event increase the risk for posttraumatic stress disorder in patients with traumatic brain injury? A prospective study.Am J Psychiatry. 2005; 162: 963-969
- When a minor head injury results in enduring symptoms: a prospective investigation of risk factors for postconcussional syndrome after mild traumatic brain injury.J Neurol Neurosurg Psychiatry. 2012; 83: 217-223
- Early prediction of favourable recovery 6 months after mild traumatic brain injury.J Neurol Neurosurg Psychiatry. 2008; 79: 936-942
- Suicide after traumatic brain injury: a population study.J Neurol Neurosurg Psychiatry. 2001; 71: 436-440
- Head injury as risk factor for psychiatric disorders: a nationwide register-based follow-up study of 113,906 persons with head injury.Am J Psychiatry. 2014; 171: 463-469
- Are men shortchanged on health? Perspective on health care utilization and health risk behavior in men and women in the United States.Int J Clin Pract. 2010; 64: 475-487
- Mild traumatic brain injury after motor vehicle collisions: what are the symptoms and who treats them? A population-based 1-year inception cohort study.Arch Phys Med Rehabil. 2014; 93: S286-S294
- Sex differences in pain: a brief review of clinical and experimental findings.Br J Anaesth. 2013; 111: 52-58
- Sex, gender, and health: the need for a new approach.BMJ. 2001; 323: 1061-1063
Article info
Publication history
Published online: February 06, 2015
Footnotes
Publication of this article was supported by the American Congress of Rehabilitation Medicine.
Disclosures: none.
Identification
Copyright
© 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
