Age and sex-mediated differences in six-month outcomes after mild traumatic brain injury in young adults: a TRACK-TBI study

Abstract

Risk factors for young adults with mTBI are not well understood. Improved understanding of age and sex as risk factors for impaired six-month outcomes in young adults is needed.Methods: Young adult mTBI subjects aged 18-39-years (18-29y; 30-39y) with six-month outcomes were extracted from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot (TRACK-TBI Pilot) study. Multivariable regressions were performed for outcomes with age, sex, and the interaction factor age-group*sex as variables of interest, controlling for demographic and injury variables. Mean-differences (B) and 95% CIs are reported.Results: One hundred mTBI subjects (18-29y, 70%; 30-39y, 30%; male, 71%; female, 29%) met inclusion criteria. On multivariable analysis, age-group*sex was associated with six-month post-traumatic stress disorder (PTSD; PTSD Checklist-Civilian version); compared with female 30-39y, female 18-29y (B=−19.55 [−26.54, −4.45]), male 18-29y (B=−19.70 [−30.07, −9.33]), and male 30-39y (B=−15.49 [−26.54, −4.45]) were associated with decreased PTSD symptomatology. Female sex was associated with decreased six-month functional outcome (Glasgow Outcome Scale-Extended (GOSE): B=−0.6 [1.0, −0.1]). Comparatively, 30-39y scored higher on six-month nonverbal processing speed (Wechsler Adult Intelligence Scale-Processing Speed Index (WAIS-PSI); B=11.88, 95% CI [1.66, 22.09]).Conclusions: Following mTBI, young adults aged 18-29y and 30-39y may have different risks for impairment. Sex may interact with age for PTSD symptomatology, with females 30-39y at highest risk. These results may be attributable to cortical maturation, biological response, social modifiers, and/or differential self-report. Confirmation in larger samples is needed, however prevention and rehabilitation/counseling strategies after mTBI should likely be tailored for age and sex.

Differences between Men and Women in Treatment and Outcome after Traumatic Brain Injury

“…Besides outcome measures and TBI severity, there are other personal and clinical factors that could impact the results of sex/ gender-based analyses such as extracranial injuries or medical history, but these are often not included. 8,31 For instance, stratified analyses on both age and sex have shown that certain subgroups are at higher risk for developing poor outcomes following TBI, such as young women for post-traumatic stress disorder (PTSD), 34 women in ''child-bearing years'' for post-concussion symptoms (PCS), 35 and older women for mortality after isolated TBI. 36 Nevertheless, sex/gender differences in treatment and outcomes after TBI remain inconclusive.…”

Evidence Limitations in Determining Sexually Dimorphic Outcomes in Pediatric Post-Traumatic Hypopituitarism and the Path Forward

“…Pre-pubertal and pubertal females have increased ICU admissions and lengths of stay (LOS) (24); however, post-pubertal, perimenopausal, and postmenopausal women have lower hospital and ICU LOS than their male counterparts (25). Interestingly, adult men and women have different frequencies of post-concussive symptoms such as headache, dizziness, irritability, and insomnia, as well as in functional outcomes measured by the Glasgow Outcome Scales-Extended (GOS-E); however, this data has not yet been reported in children based on pubertal stage (27,28).…”

“…A post-TBI study found that male sex increased risk of post-injury substance use disorder (96). Perimenopausal women have an increased susceptibility to psychiatric disorders following TBI such as depression and anxiety (28). Although there are many aspects predisposing patients to psychiatric disorders, reasons for sexually dimorphic psychiatric responses remain unclear.…”

Psychological status and intervention strategy of maintenance hemodialysis patients in COVID-19 epidemic

“…Post-traumatic stress disorder (PTSD) is a psychological disorder characterized by intense fear, helplessness, and avoidance, resulting from exposure to a traumatic event or catastrophic life event. It is clinically manifested with three main syndromes: re-experiencing, avoidance behavior or numbness, and physiological hyperarousal [10,11]. The current study used the post-traumatic checklist scale (PCLS-L) to measure the PTSD of MHD patients.…”