Sex Differences in Outcome after Mild Traumatic Brain Injury
Sex Differences in Outcome after Mild Traumatic Brain Injury
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DOI：
10.1089/neu.2009.1068
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发表时间：
2010-03-01
影响因子：
4.2
通讯作者：
McDermott, Michael P.
中科院分区：
文献类型：
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作者：
Bazarian, Jeffrey J.;Blyth, Brian;McDermott, Michael P.
本研究的目的是评估性别与轻度创伤性脑损伤（mTBI）后结局的独立相关性。我们对一个已建立的队列的一个子集进行了分析，该队列涉及1425例到学术急诊科（艾德）就诊的mTBI患者。在初次艾德访视3个月后，研究性别与三个结果之间的关系：脑震荡后症状（PCS）评分（0、1-5、6-16和>16），恢复正常活动的天数（0、1-7和>7），以及缺勤天数（0、1-7和>7）。在控制了12个相关的受试者水平变量后，使用逻辑回归分析来确定性别与每个结果之间的关系。在1425例受试者中，643例（45.1%）为女性，782例（54.9%）为男性。mTBI后3个月，男性处于较高PCS评分类别的几率显著较低（比值比[ OR] 0.62，95%置信区间[CI]：0.50，0.78）;这种关联在女性生育年龄期间似乎更为突出。男性和女性在恢复正常活动的天数或错过工作的天数所定义的较差结果的几率方面没有显著差异。在控制适当的混杂因素后，通过PCS评分测量，女性与mTBI后不良结局的几率显著较高相关。观察到的生育年龄女性残疾高峰模式表明内源性雌激素或孕激素产生中断。试图更好地了解mTBI如何影响这些激素的生产急性损伤后，在恢复期可能揭示了女性和推定的治疗干预的不良后果背后的机制。
The objective of this study was to estimate the independent association of sex with outcome after mild traumatic brain injury (mTBI). We performed an analysis of a subset of an established cohort involving 1425 mTBI patients presenting to an academic emergency department (ED). The associations between sex and three outcomes determined 3 months after the initial ED visit were examined: post-concussive symptom (PCS) score ( 0, 1-5, 6-16, and >16), the number of days to return of normal activities (0, 1-7, and >7), and the number of days of work missed (0, 1-7, and >7). Logistic regression analyses were used to determine the relationship between sex and each outcome after controlling for 12 relevant subject-level variables. Of the 1425 subjects, 643 (45.1%) were female and 782 (54.9%) were male. Three months after mTBI, males had significantly lower odds of being in a higher PCS score category (odds ratio [ OR] 0.62, 95% confidence interval [CI]: 0.50, 0.78); this association appeared to be more prominent during child-bearing years for females. Males and females did not significantly differ with respect to the odds of poorer outcome as defined by the number of days to return of normal activities or the number of days of work missed. Female sex is associated with significantly higher odds of poor outcome after mTBI, as measured by PCS score, after control for appropriate confounders. The observed pattern of peak disability for females during the child-bearing years suggests disruption of endogenous estrogen or progesterone production. Attempts to better understand how mTBI affects production of these hormones acutely after injury and during the recovery period may shed light on the mechanism behind poorer outcome among females and putative therapeutic interventions.