The relationship between gender and postconcussion symptoms after sport-related mild traumatic brain injury.
ABSTRACT The authors sought to define the relationship between gender and postconcussion symptoms (PCSx) at 3 months after sport-related mild traumatic brain injury (mTBI) and, further, to examine whether age (minors vs. adults), source of PCSx reporting (self-reported vs. proxy), previous head injury or loss of consciousness, or the sport type in which the mTBI was incurred explain any observed gender differences in PCSx.
Prospective nested cohort study.
Regional trauma center emergency department.
A total of 260 patients who presented with sport-related mTBI, as defined by American Congress of Rehabilitation Medicine criteria, began the study. The participants who lacked litigation concerning the mTBI and had participated in the follow-up assessment completed the study (n = 215).
Self, proxy, and interviewer report of age, gender, previous head injury or loss of consciousness, and sport in which injury was sustained.
Rivermead Post Concussion Symptoms Questionnaire (RPQ).
Adult females are at greater risk for elevated RPQ scores (odds ratio [OR] = 2.89, 95% confidence interval [95% CI] = 1.25-6.71; P = .013) but not female minors (OR = 0.87, 95% CI = 0.45-1.71]; P = .695), as compared with male subjects. Adjustment for empirically identified confounders in each age group revealed persisting elevated risk for adult females (OR = 2.57, 95% CI = 1.09-6.08; P = .031), but not minor females (OR = 1.07, 95% CI = 0.52-2.19, P = .852). The risk associated with female gender in adults could not be explained by characteristics of the sports, such as helmeted versus not, or contact versus no contact, in which women incurred mTBIs. No sport characteristics were associated with increased risk of PCSx after mTBI.
Adult females, but not female minors, are at increased risk for PCSx after sport-related mTBI as compared with male patients. This increased risk cannot be explained by self-report, rather than proxy report, of symptoms, previous head injury or loss of consciousness, age, or sport characteristics. Further research is needed to elucidate the processes of age-differential recovery from mild brain injury in women and on how to most effectively incorporate appropriate follow-up after emergency department evaluation.
- SourceAvailable from: Pieter Leffers[show abstract] [hide abstract]
ABSTRACT: To identify parameters at first presentation after mild traumatic brain injury (MTBI) that are predictive of the severity of post-traumatic complaints (PTC) after six months. Early recognition of patients with MTBI who are at risk of developing PTC would be useful because early follow up at the outpatient clinic may help to reduce the severity of these complaints in the long run. The presence of symptoms in the emergency room (ER) (headache, dizziness, nausea, vomiting, and neck pain) and biochemical markers (neurone specific enolase and S-100B) in serum were assessed as possible predictive variables for the severity of PTC. Outcome variables were the severity of 16 PTC six months after the trauma. After six months, the severity of most complaints had declined to pretrauma levels but medians for headache, dizziness, and drowsiness were still increased. In a series of 79 patients, 22 (28%) reported one or more PTC after six months. After adjustment for baseline variables, an at least twofold increased severity of all PTC subgroups was reported by those patients reporting headache, dizziness, or nausea in the ER. A twofold increased severity of "cognitive" and "vegetative" PTC was also found in those with increased concentrations of biochemical serum markers at first presentation. The prevalence of full recovery after six months increased from 50% in patients with three symptoms to 78% in those with no symptoms in the ER. Inclusion of biochemical markers showed that all 10 patients with no symptoms in the ER and normal markers recovered fully. The presence of headache, dizziness, or nausea in the ER after MTBI is strongly associated with the severity of most PTC after six months. Identifying MTBI patients in the ER without headache, dizziness, nausea, or increased serum marker concentrations may be a promising strategy for predicting a good outcome.Journal of Neurology Neurosurgery & Psychiatry 01/2003; 73(6):727-32. · 4.92 Impact Factor
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ABSTRACT: Outcome following traumatic brain injury (TBI) is not only dependent on the nature and severity of injury and subsequent treatment, but also on constituent characteristics of injured individuals. We aimed to describe and quantify the relationship between demographic characteristics and six month outcome assessed by the Glasgow Outcome Scale (GOS) after TBI. Individual patient data on age (n = 8719), gender (n = 8720), race (n = 5320), and education (n = 2201) were extracted from eight therapeutic Phase III randomized clinical trials and three surveys in moderate or severe TBI, contained in the IMPACT database. The strength of prognostic effects was analyzed with binary and proportional odds regression analysis and expressed as an odds ratio. Age was analyzed as a continuous variable with spline functions, and the odds ratio calculated over the difference between the 75 th and 25 th percentiles. Associations with other predictors were explored. Increasing age was strongly related to poorer outcome (OR 2.14; 95% CI 2.00-2.28) in a continuous fashion that could be approximated by a linear function. No gender differences in outcome were found (OR: 1.01; CI 0.92-1.11), and exploratory analysis failed to show any gender/age interaction. The studies included predominantly Caucasians (83%); outcome in black patients was poorer relative to this group (OR 1.30; CI 1.09-1.56). This relationship was sustained on adjusted analyses, and requires further study into mediating factors. Higher levels of education were weakly related to a better outcome (OR: 0.70; CI 0.52-0.94). On multivariable analysis adjusting for age, motor score, and pupils, the prognostic effect of race and education were sustained. We conclude that outcome following TBI is dependent on age, race, to a lesser extent on education, but not on gender.Journal of Neurotrauma 03/2007; 24(2):259-69. · 4.30 Impact Factor
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ABSTRACT: To examine the possibility that athletes with multiple concussions show cumulative effects of injury. Amateur athletes with a history of three or more concussions were carefully matched (gender, age, education and sport) with athletes with no prior concussions. All completed a computerized neuropsychological test battery at preseason (ImPACT) and then within 5 days of sustaining a concussion (mean = 1.7 days). There were differences between groups in symptom reporting and memory performance. At baseline (i.e. preseason), athletes with multiple concussions reported more symptoms than athletes with no history of concussion. At approximately 2 days post-injury, athletes with multiple concussions scored significantly lower on memory testing than athletes with a single concussion. Athletes with multiple concussions were 7.7 times more likely to demonstrate a major drop in memory perfomance than athletes with no previous concussions. This study provides preliminary evidence to suggest that athletes with multiple concussions might have cumulative effects.Brain Injury 06/2004; 18(5):433-43. · 1.51 Impact Factor