Severe traumatic brain injury: is there a gender difference in mortality?

Ottochian, Marcus; Salim, Ali; Berry, Cherisse; Chan, Linda S.; Wilson, Matthew T.; Margulies, Daniel R.

doi:10.1016/j.amjsurg.2008.09.008

« Previous Next »The American Journal of Surgery
Volume 197, Issue 2 , Pages 155-158, February 2009

Severe traumatic brain injury: is there a gender difference in mortality?

Presented at the 17th annual meeting of the Society of Black Academic Surgeons, April 17–20, 2008, Cleveland, OH.

Marcus Ottochian, M.D.
- Division of Trauma, Los Angeles County University of Southern California Medical Center, Los Angeles, CA, USA
Ali Salim, M.D.
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Suite 8215N, Los Angeles, CA 90048, USA
- Corresponding author: Tel.: +1-310-423-5874; fax: +1-310-423-0139
Cherisse Berry, M.D.
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Suite 8215N, Los Angeles, CA 90048, USA
Linda S. Chan, Ph.D.
- Division of Trauma, Los Angeles County University of Southern California Medical Center, Los Angeles, CA, USA
Matthew T. Wilson, M.D.
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Suite 8215N, Los Angeles, CA 90048, USA
Daniel R. Margulies, M.D.
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Suite 8215N, Los Angeles, CA 90048, USA

Received 11 May 2008; received in revised form 18 September 2008

Abstract

Background

Emerging evidence suggests that male and female nervous systems respond differently to traumatic brain injury (TBI). The objective of this study was to examine outcomes between the sexes after TBI.

Patients and methods

A retrospective review of all severe TBI patients admitted between January and December 2005 was performed. Isolated severe TBI was defined as a head abbreviated injury score greater than 3 with an abbreviated injury score of 3 or less for other anatomic regions. The population was stratified into age subgroups (<14 y, 14–44 y, 45–54 y, and ≥55 y). Logistic regression was used to identify independent predictors of mortality.

Results

A total of 1,807 TBI patients were admitted. The mortality was significantly higher for women (43.2% vs 36.2%, P < .01) with an adjusted odds ratio of 1.4 (95% confidence interval, 1.1–1.9, P < .05). After stratification, only women age 55 and older had a significant difference in mortality (odds ratio, 1.71; 95% confidence interval, 1.11–2.62, P = .02).

Conclusions

Female sex (particularly those age ≥55 y) is associated independently with higher mortality in isolated severe TBI. This increased mortality of postmenopausal women after isolated TBI may suggest a hormonal influence and warrants further investigation.

Keywords: Trauma, Traumatic brain injury, Gender, Outcome, Mortality