Research Reports - Are boys and girls that different? An analysis of traumatic brain injury in children

Emerg Med J. 2013 Aug;30(8):675-8

Collins NC, Molcho M, Carney P, McEvoy L, Geoghegan L, Phillips JP, Nicholson AJ

INTRODUCTION: The Phillips Report on traumatic brain injury (TBI) in Ireland
found that injury was more frequent in men and that gender differences were
present in childhood. This study determined when gender differences emerge and
examined the effect of gender on the mechanism of injury, injury type and
severity and outcome.
METHODS: A national prospective, observational study was conducted over a 2-year
period. All patients under 17 years of age referred to a neurosurgical service
following TBI were included. Data on patient demographics, events surrounding
injury, injury type and severity, patient management and outcome were collected
from 'on-call' logbooks and neurosurgical admissions records.
RESULTS: 342 patients were included. Falls were the leading cause of injury for
both sexes. Boys' injuries tended to involve greater energy transfer and involved
more risk-prone behaviour resulting in a higher rate of other (non-brain) injury
and a higher mortality rate. Intentional injury occurred only in boys. While
injury severity was similar for boys and girls, significant gender differences in
injury type were present; extradural haematomas were significantly higher in boys
(p=0.014) and subdural haematomas were significantly higher in girls (p=0.011).
Mortality was 1.8% for girls and 4.3% for boys.
CONCLUSIONS: Falls were responsible for most TBI, the home is the most common
place of injury and non-operable TBI was common. These findings relate to all
children. Significant gender differences exist from infancy. Boys sustained
injuries associated with a greater energy transfer, were less likely to use
protective devices and more likely to be injured deliberately. This results in a
different pattern of injury, higher levels of associated injury and a higher
mortality rate.

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