The relationship between gender and postconcussion symptoms after sport-related mild traumatic brain injury.
The relationship between gender and postconcussion symptoms after sport-related mild traumatic brain injury.
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DOI：
10.1016/j.pmrj.2009.01.011
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发表时间：
2009-03
期刊：
影响因子：
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通讯作者：
Bazarian JJ
中科院分区：
文献类型：
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作者：
Preiss-Farzanegan SJ;Chapman B;Wong TM;Wu J;Bazarian JJ
作者试图确定运动相关轻度创伤性脑损伤（mTBI）3个月后性别与脑震荡后症状（PCSx）之间的关系，并进一步检验年龄（未成年人与成年人）、PCSx报告来源（自我报告与代理报告）、既往头部损伤或意识丧失，以及发生mTBI的运动类型是否能解释PCSx中观察到的性别差异。
前瞻性嵌套队列研究。
地区创伤中心急诊科。
共有260名符合美国康复医学大会标准定义的运动相关mTBI患者开始参与研究。无mTBI相关诉讼且参与了随访评估的参与者完成了研究（n = 215）。
年龄、性别、既往头部损伤或意识丧失以及受伤运动项目的自我报告、代理报告和访谈者报告。
Rivermead脑震荡后症状问卷（RPQ）。
与男性受试者相比，成年女性RPQ评分升高的风险更大（优势比[OR] = 2.89，95%置信区间[95%CI] = 1.25 - 6.71；P = 0.013），但未成年女性并非如此（OR = 0.87，95%CI = 0.45 - 1.71；P = 0.695）。对每个年龄组中经实证确定的混杂因素进行调整后，发现成年女性的风险仍然升高（OR = 2.57，95%CI = 1.09 - 6.08；P = 0.031），但未成年女性并非如此（OR = 1.07，95%CI = 0.52 - 2.19，P = 0.852）。成年女性的性别相关风险无法用运动项目的特征来解释，比如女性发生mTBI时是否戴头盔，是接触性还是非接触性运动。没有运动特征与mTBI后PCSx风险增加相关。
与男性患者相比，成年女性（而非未成年女性）在运动相关mTBI后患PCSx的风险增加。这种风险增加不能用症状的自我报告（而非代理报告）、既往头部损伤或意识丧失、年龄或运动特征来解释。需要进一步研究以阐明女性轻度脑损伤的年龄差异恢复过程，以及如何在急诊科评估后最有效地进行适当的随访。
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.