Gender Differences in Neurological Emergencies Part II: A Consensus Summary and Research Agenda on Traumatic Brain Injury

Traumatic injury remains an unacceptably high contributor to morbidity and mortality rates across the United States. Gender-specific research in trauma and emergency resuscitation has become a rising priority. In concert with the 2014 Academic Emergency Medicine consensus conference “Gender-specific Research in Emergency Care: Investigate, Understand, and Translate How Gender Affects Patient Outcomes,” a consensus-building group consisting of experts in emergency medicine, critical care, traumatology, anesthesiology, and public health convened to generate research recommendations and priority questions to be answered and thus move the field forward. Nominal group technique was used for the consensus-building process and a combination of face-to-face meetings, monthly conference calls, e-mail discussions, and preconference surveys were used to refine the research questions. The resulting research agenda focuses on opportunities to improve patient outcomes by expanding research in sex- and gender-specific emergency care in the field of traumatic injury and resuscitation.

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“…46 Clinical studies using progesterone as a neuroprotective drug after traumatic brain injury (TBI) have demonstrated safety. 47 …”

Section: Discussionmentioning

confidence: 99%

Gender-specific Issues in Traumatic Injury and Resuscitation: Consensus-based Recommendations for Future Research

Sethuraman

Marcolini

McCunn³

et al. 2014

Acad Emerg Med

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“…Specifically, research on sex/gender difference has resulted in evidence that “biological variances between males and females and gendered social norms result in distinct experiences of brain injury for men and women” [18]. For example, female survivors of a TBI often report neuroendocrine dysfunction [18-20] that is known to result in hormonal changes caused by stress [18, 21, 22]. Among women survivors, fulfilling roles that fall within the women's unpaid labour such as motherhood, caregiving, and domestic roles, are often cited as sources of stress post TBI [18, 23, 24].…”

mentioning

confidence: 99%

Sex-Specific Predictors of Inpatient Rehabilitation Outcomes After Traumatic Brain Injury

Chan

Mollayeva

Ottenbacher

et al. 2016

Archives of Physical Medicine and Rehabilitation

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Objective To identify sex-specific predictors of inpatient rehabilitation outcomes among patients with a traumatic brain injury (TBI) from a population based perspective. Design Retrospective cohort study Setting Ontario, Canada Participants Patients in inpatient rehabilitation for a TBI within one year of acute care discharge between 2008/09 and 2011/12 (N=1,730, 70% male, 30% female). Interventions None Main Outcome Measures Inpatient rehabilitation length of stay, total Functional Independence Measure (FIM™) score, and motor and cognitive FIM™ ratings at discharge. Results Sex, as a covariate in multivariable linear regression models, was not a significant predictor of rehabilitation outcomes. While many of the predictors examined were similar across males and females, sex-specific multivariable models identified some predictors of rehabilitation outcome that are specific for males and females; mechanism of injury (p<.0001) was a significant predictor of functional outcome only among females while comorbidities (p<.0001) was a significant predictor for males only. Conclusions Predictors of outcomes after inpatient rehabilitation differed by sex, providing evidence for a sex-specific approach in planning and resource allocation for inpatient rehabilitation services for patients with TBI.

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“…It remains unclear whether there are similar differences in humans [32] . However, these data demonstrate the importance of carefully testing therapeutic agents in both sexes, as recommended by the National Institutes of Health [33] .…”

Section: Discussionmentioning

confidence: 92%

In the Era of Therapeutic Hypothermia, How Well Do Studies of Perinatal Neuroprotection Control Temperature?

et al. 2016

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In the era of therapeutic hypothermia, reliable preclinical studies are integral to successfully identify neuroprotective strategies to further improve outcomes of encephalopathy at term. We reviewed preclinical neuroprotection studies reported between January 2014 and June 2016 to assess the use of effective temperature monitoring and control. As a secondary measure, we examined whether studies addressed other methodological issues such as stage of brain development, sex differences, the timing of the treatment relative to the insult, and the histological and functional endpoints used after hypoxia-ischemia. The extent and duration of temperature monitoring was highly inconsistent. Only a minority of papers monitored core (19/61; 31%) or brain temperature (3/61; 5%). Most (40/45) of the neuroprotectants either were likely to affect thermoregulation or their impact is unknown. In 85% of papers neonatal rodents were used (67% at P7); 51% of papers did not report the sex of the animals or tested the effect of potential neuroprotectants on just one sex. In 76% of studies, treatment was before or immediately after the insult (within the first 2 h), and few studies assessed long-term histological and behavioral outcomes. In conclusion, many recent preclinical neonatal studies cannot exclude the possibility that apparent neuroprotection might be related to drug-induced hypothermia or to other methodological choices. Close monitoring and control of brain temperature during, as well as for many days after, experimental hypoxia-ischemia are now critical to reliably develop new ways to improve neurodevelopmental outcomes after perinatal hypoxic-ischemic encephalopathy.

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Gender Differences in Neurological Emergencies Part II: A Consensus Summary and Research Agenda on Traumatic Brain Injury

Cited by 32 publications

References 49 publications

Gender-specific Issues in Traumatic Injury and Resuscitation: Consensus-based Recommendations for Future Research

Gender-specific Issues in Traumatic Injury and Resuscitation: Consensus-based Recommendations for Future Research

Sex-Specific Predictors of Inpatient Rehabilitation Outcomes After Traumatic Brain Injury

In the Era of Therapeutic Hypothermia, How Well Do Studies of Perinatal Neuroprotection Control Temperature?

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