Protection From Traumatic Brain Injury in Hormonally Active Women vs Men of a Similar Age

Abstract

Background: It has been suggested that women with traumatic brain injury have more favorable outcomes than do men because of higher levels of circulating estrogen and progesterone that may reduce brain edema.Objectives: To determine whether there is any association between sex and mortality in TBI patients and whether there is any association between sex and brain edema. Design: Retrospective cohort study using data from 2001 to 2007 collected from a trauma registry in Hong Kong and the Victorian State Trauma Registry.Setting: Two regional trauma centers in Hong Kong and 2 adult major trauma centers and 1 pediatric trauma center in Victoria, Australia.Main Outcome Measures: Mortality and brain edema.Patients: Trauma patients with an Abbreviated Injury Scale score (head) of at least 3 who were aged 12 to 45 years were included. Patients with minor head injury and undisplaced closed skull fracture were excluded.Results: Both the Hong Kong and Victorian data showed no significant difference in sex-related mortality. Increased mortality was associated with decreased systolic blood pressure and Glasgow Coma Scale score and with increased New Injury Severity Score or Injury Severity Score. In Hong Kong, brain edema was associated with female sex (P = .02), and the odds of brain edema in females were greater than for males. However, this association was not found in Victorian patients. Conclusion:This study found no significant association between sex and mortality in either Victoria or Hong Kong and does not support the concept that females have better outcomes after traumatic brain injury.

Gender Differences in Awareness and Outcomes During Acute Traumatic Brain Injury Recovery

“…First, a preliminary explanation of the results finds a certain degree of support in recent research into hormonal neuroprotection. [45][46][47] Hormonal neuroprotection is often proposed as an underlying mechanism 4,[48][49][50][51][52][53][54][55][56][57] in what the TBI literature collectively suggests is a gender advantage in postinjury recovery. Although typically higher in women, progesterone is produced by neurons and glial cells in the central and peripheral nervous systems by both men and women and has become a frequent target in efficacy trials.…”

“…Some have studied the postinjury effects of TBI on women's reproductive health 28 ; others have examined the possible impact of reproductive-life stage on mortality at the time of injury for women. 31,46,47 Overall, each approach to the study of hormone-related gender advantage for women following TBI has, much the same as the study of gender differences in post-TBI outcomes, yielded mixed results. 45 The finding that women with TBI in our study sample were able to appraise their injury-related impairments more accurately than men at discharge is similar to prior evidence 1,3 of superior postinjury executive functions for females.…”

Strategies for CNS repair following TBI

“…Sex differences on TBI have been investigated in multiple retrospective trials with mixed results. Increased brain edema or intracranial pressure without changes in mortality has been noted when compared to males of similar ages in some studies (Farin et al, 2003;Yeung et al, 2011). However, a decreased mortality rate has also been noted.…”

Are there cognitive and neurobehavioural correlates of hormonal neuroprotection for women after TBI?

“…A few studies have examined the possible impact of reproductive life stage on mortality at time of injury for women (Davis & Hoyt, 2006;Ponsford et al, 2008;Yeung et al, 2011). Davis et al studied females and males in two groups (aged ,50 and ≥50), using a total of 13,437 patients (n ¼ 3178 females, n ¼ 10,259 males) with moderate-to-severe TBI identified from the San Diego, California Trauma Registry.…”