Research Reports - Is sex an indicator of prognosis after mild traumatic brain injury

Arch Phys Med Rehabil. 2015 Feb 6

Cancelliere C(1), Donovan J(2), Cassidy JD(3)

OBJECTIVE: To determine sex differences in the recovery and prognosis after MTBI
in adults and children.
DATA SOURCES: We analyzed all scientifically admissible primary studies in the
World Health Organization (WHO) (n=120) and International Collaboration on Mild
Traumatic Brain Injury Prognosis (ICoMP) (n=101) systematic reviews regarding
prognosis of MTBI for sex-stratified findings. They searched MEDLINE and other
databases from 1980-2000 (WHO) and 2001-2012 (ICoMP) for published, peer-reviewed
reports in English and other languages.
STUDY SELECTION: We selected controlled trials, cohort and case-control studies
that assessed the effect of sex on outcomes following MTBI.
DATA EXTRACTION: Data from the eligible studies from both systematic reviews
combined (n=14, 7%) were extracted into evidence tables.
DATA SYNTHESIS: Prognostic information relating to sex was prioritized according
to design as exploratory or confirmatory and a best-evidence synthesis was
conducted. After MTBI, females may have a higher risk of epilepsy (children,
young adults) and suicide, and use more healthcare services; males may be at
higher risk for schizophrenia. The majority of studies did not find a sex
difference for post-concussion symptoms in children and adults. No sex difference
was found for risk of dementia and primary brain tumour, return-to-work, or
post-traumatic stress syndrome.
CONCLUSIONS: Sex is not a well-studied prognostic indicator for recovery after
MTBI, but small sex differences were found for some outcomes. More well-designed
studies are needed that report outcomes according to sex and control for
potential confounders.

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