Traumatic brain injury (TBI) is a serious global health concern and is one of the leading causes of death and disability worldwide. In addition to physical and psychological complications, TBI can have massive socioeconomic costs, creating considerable barriers for those in recovery from TBI and their families. However, each person who sustains TBI will experience a different outcome trajectory based on individual factors. For example, gender may play a role in the brain’s response to TBI. The hormones estrogen and progesterone are thought to have neuroprotective effects for women, as they are able to reduce the effects of inflammation after TBI, which decreases intracranial pressure and other adverse complications associated with TBI.
Sex-specific differences in TBI responses have been widely researched, but many studies show conflicting findings on morbidity and mortality between men and women with TBI. To clarify this inconsistency, a team of researchers conducted a large-scale study comparing 11,738 pairs of similar male and female patients with TBI. The researchers’ data analysis found that:
- Women with TBI were less likely to be admitted to the ICU and had shorter average hospital stays than men with TBI.
- The overall mortality of severely injured women with TBI was significantly lower than that of men with equally severe injuries.
- When stratifying patients by age, overall mortality was lower in women than men over 45 years old, but there were no significant differences in mortality between men and women younger than 45 years.
While women generally demonstrated a survival advantage over men during TBI, this advantage was not found in women under 45 years of age, who were generally categorized as premenopausal. These findings suggest that the female endocrine system plays an important role in protection from and vulnerability to TBI. However, further research is necessary to validate the hormonal mechanisms underlying the sex-specific differences in TBI outcomes. Understanding the risk factors regarding age and sex for TBI mortality may help guide clinicians in their development of treatment plans.
Mair O, Greve F, Lefering R, et al. The outcome of severely injured patients following traumatic brain injury is affected by gender—A retrospective, multicenter, matched-pair analysis utilizing data of the TraumaRegister DGU®. Frontiers in Neuroscience. (October 2022).