@article{ref1,
title="Association of sex and age with mild traumatic brain injury-related symptoms: a TRACK-TBI Study",
journal="JAMA network open",
year="2021",
author="Levin, Harvey S. and Temkin, Nancy R. and Barber, Jason and Nelson, Lindsay D. and Robertson, Claudia and Brennan, Jeffrey and Stein, Murray B. and Yue, John K. and Giacino, Joseph T. and McCrea, Michael A. and Diaz-Arrastia, Ramon and Mukherjee, Pratik and Okonkwo, David O. and Boase, Kim and Markowitz, Amy J. and Bodien, Yelena and Taylor, Sabrina and Vassar, Mary J. and Manley, Geoffrey T. and Adeoye, Opeolu and Badjatia, Neeraj and Bullock, M. Ross and Chesnut, Randall and Corrigan, John D. and Crawford, Karen and Dikmen, Sureyya and Duhaime, Ann-Christine and Ellenbogen, Richard and Feeser, V. Ramana and Ferguson, Adam R. and Foreman, Brandon and Gardner, Raquel and Gaudette, Étienne and González, Luis and Gopinath, Shankar and Gullapalli, Rao and Hemphill, J. Claude and Hotz, Gillian and Jain, Sonia and Keene, C. Dirk and Korley, Frederick K. and Kramer, Joel and Kreitzer, Natalie and Lindsell, Chris and Machamer, Joan and Madden, Christopher and Martin, Alastair and McAllister, Thomas and Merchant, Randall and Nolan, Amber and Ngwenya, Laura B. and Noel, Florence and Palacios, Eva and Puccio, Ava and Rabinowitz, Miri and Rosand, Jonathan and Sander, Angelle and Satris, Gabriella and Schnyer, David and Seabury, Seth and Sun, Xiaoying and Toga, Arthur and Valadka, Alex and Wang, Kevin and Yuh, Esther and Zafonte, Ross",
volume="4",
number="4",
pages="e213046-e213046",
abstract="IMPORTANCE: Knowledge of differences in mild traumatic brain injury (mTBI) recovery by sex and age may inform individualized treatment of these patients. <br><br>OBJECTIVE: To identify sex-related differences in symptom recovery from mTBI; secondarily, to explore age differences within women, who demonstrate poorer outcomes after TBI. DESIGN, SETTING, AND PARTICIPANTS: The prospective cohort study Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) recruited 2000 patients with mTBI from February 26, 2014, to July 3, 2018, and 299 patients with orthopedic trauma (who served as controls) from January 26, 2016, to July 27, 2018. Patients were recruited from 18 level I trauma centers and followed up for 12 months. Data were analyzed from August 19, 2020, to March 3, 2021. EXPOSURES: Patients with mTBI (defined by a Glasgow Coma Scale score of 13-15) triaged to head computed tomography in 24 hours or less; patients with orthopedic trauma served as controls. MAIN OUTCOMES AND MEASURES: Measured outcomes included (1) the Rivermead Post Concussion Symptoms Questionnaire (RPQ), a 16-item self-report scale that assesses postconcussion symptom severity over the past 7 days relative to preinjury; (2) the Posttraumatic Stress Disorder Checklist for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (PCL-5), a 20-item test that measures the severity of posttraumatic stress disorder symptoms; (3) the Patient Health Questionnaire-9 (PHQ-9), a 9-item scale that measures depression based on symptom frequency over the past 2 weeks; and (4) the Brief Symptom Inventory-18 (BSI-18), an 18-item scale of psychological distress (split into Depression and Anxiety subscales). <br><br>RESULTS: A total of 2000 patients with mTBI (1331 men [67%; mean (SD) age, 41.0 (17.3) years; 1026 White (78%)] and 669 women [33%; mean (SD) age, 43.0 (18.5) years; 505 (76%) White]). After adjustment of multiple comparisons, significant TBI × sex interactions were observed for cognitive symptoms (B = 0.76; 5% false discovery rate-corrected P = .02) and somatic RPQ symptoms (B = 0.80; 5% false discovery rate-corrected P = .02), with worse symptoms in women with mTBI than men, but no sex difference in symptoms in control patients with orthopedic trauma. Within the female patients evaluated, there was a significant TBI × age interaction for somatic RPQ symptoms, which were worse in female patients with mTBI aged 35 to 49 years compared with those aged 17 to 34 years (B = 1.65; P = .02) or older than 50 years (B = 1.66; P = .02). <br><br>CONCLUSIONS AND RELEVANCE: This study found that women were more vulnerable than men to persistent mTBI-related cognitive and somatic symptoms, whereas no sex difference in symptom burden was seen after orthopedic injury. Postconcussion symptoms were also worse in women aged 35 to 49 years than in younger and older women, but further investigation is needed to corroborate these findings and to identify the mechanisms involved. <br><br>RESULTS suggest that individualized clinical management of mTBI should consider sex and age, as some women are especially predisposed to chronic postconcussion symptoms even 12 months after injury.<p /> <p>Language: en</p>",
language="en",
issn="2574-3805",
doi="10.1001/jamanetworkopen.2021.3046",
url="http://dx.doi.org/10.1001/jamanetworkopen.2021.3046"
}