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Is Sex an Indicator of Prognosis After Mild Traumatic Brain Injury: A Systematic Analysis of the Findings of the World Health Organization Collaborating Centre Task Force on Mild Traumatic Brain Injury and the International Collaboration on Mild Traumatic Brain Injury Prognosis

  • Carol Cancelliere
    Affiliations
    Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada

    Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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  • James Donovan
    Correspondence
    Corresponding author James Donovan, DC, University Health Network, Toronto Western Research Institute, University of Toronto, LuCliff Place, 700 Bay St, Suite 602, Toronto, Ontario, Canada M5G 1Z6.
    Affiliations
    Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada
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  • J. David Cassidy
    Affiliations
    Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada

    Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada

    Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Institute of Sports Science and Clinical Biomechanics, Faculty of Health, University of Southern Denmark, Odense, Denmark
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Published:February 06, 2015DOI:https://doi.org/10.1016/j.apmr.2014.11.028

      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)
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