Research Reports - Gender impacts mortality after traumatic brain injury in teenagers

J Trauma Acute Care Surg. 2013 Oct;75(4):682-6

Ley EJ, Short SS, Liou DZ, Singer MB, Mirocha J, Melo N, Bukur M, Salim A

BACKGROUND: Gender may influence outcomes following traumatic brain injury (TBI)
although the mechanism is unknown. Animal TBI studies suggest that gender
differences in endogenous hormone production may be the source. Limited
retrospective clinical studies on gender present varied conclusions. Pediatric
patients represent a unique population as pubescent children experience
up-regulation of endogenous hormones that varies dramatically by gender. Younger
children do not have these hormonal differences. The aim of this study was to
compare pubescent and prepubescent females with males after isolated TBI to
identify independent predictors of mortality.
METHODS: We performed a retrospective review of the National Trauma Data Bank
Research Data Sets from 2007 and 2008 looking at all blunt trauma patients 18
years or younger who required hospital admission after isolated,
moderate-to-severe TBI, defined as head Abbreviated Injury Scale (AIS) score 3 or
greater. We excluded all individuals with AIS score of 3 or greater for any other
region to limit the confounding effect of comorbidities. Based on the median age
of menarche, we defined two age groups as follows: prepubescent (0-12 years) and
pubescent (>12 years). Analysis was performed to compare trauma profiles and
outcomes between groups. Our primary outcome measure was in-hospital mortality.
RESULTS: A total of 20,280 patients met inclusion criteria; 10,135 were
prepubescent, and 10,145 were pubescent. Overall mortality was 6.9%, and lower
mortality was noted among prepubescent patients compared with pubescent (5.2% vs.
8.6%, p < 0.0001). Although female gender did not predict reduced mortality in
the prepubescent cohort (adjusted odds ratio, 1.05; 95% confidence interval,
0.85-1.30; p = 0.63), female gender was associated with reduced mortality in the
pubescent (adjusted odds ratio, 0.78; 95% confidence interval, 0.65-0.93; p =
CONCLUSION: In contrast to prepubescent female gender, pubescent female gender
predicts reduced mortality following isolated, moderate-to-severe TBI. Endogenous
hormonal differences may be a contributing factor and require further
LEVEL OF EVIDENCE: Prognostic study, level III.

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