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Title: Gender differences in outcome in patients with hypotension and severe traumatic brain injury.
Authors: Ponsford, Jennie
Other Authors: Cooper, James
Mcdermott, Francis
Murray, Lynette
Laidlaw, John
Cooper, Gregory
Tremayne, Ann
Bernard, Stephen
Myles, Paul
Keywords: Traumatic Brain Injury
Glasgow Outcome Scale-Extended version
Glasgow Coma Scale
Injury Severity Score
Brain Injuries
Intracranial Pressure
Saline Solution, Hypertonic
Survival Rate
Treatment Outcome
Wounds, Nonpenetrating
Gender Differences
Monash-Epworth Rehabilitation Research Centre , Epworth HealthCare, VIC , Australia
Issue Date: Jan-2008
Publisher: Elsevier
Citation: Injury. 2008 Jan;39(1):67-76
Abstract: BACKGROUND: Animal studies have identified hormonal influences on responses to injury and recovery, creating a potential gender effect on outcome. Progesterone and oestrogen are thought to afford protection in the immediate post-injury period, suggesting females have an advantage, although there has been limited evidence of this in human outcome studies. METHODS: This study examined the influence of gender on outcome in 229 adults (151 males), aged >17 years, with severe blunt head trauma, initial GCS <9 and hypotension, recruited into a randomised controlled trial of pre-hospital hypertonic saline resuscitation versus conventional fluid management. Outcome was measured by survival and Glasgow Outcome Scale-Extended version (GOS-E) scores at 6 months post-injury. RESULTS: Females recruited into the study had a higher mean age. Females were more likely to be injured as passengers and pedestrians and males as drivers or motorcyclists. There were no gender differences in GCS or injury severity scores, ICP, cerebral perfusion pressure, gas exchange (PaO2/FiO2 ratio), or duration of mechanical ventilation. After controlling for GCS, age and cause of injury, females had a lower rate of survival. They also showed a lower rate of good outcome (GOS-E score >4) at 6 months, but this appeared to reflect the lower rate of initial survival. Those females surviving had similar outcomes to males. CONCLUSIONS: The study provides no evidence that females fare better than males following severe TBI, suggesting rather that females may fare worse.
DOI: 10.1016/j.injury.2007.08.028
PubMed URL:
ISSN: 0020-1383
Journal Title: Injury
Type: Journal Article
Affiliated Organisations: Department of Psychology, Monash University, Australia
National Trauma Research Institute, Australia
Department of Anaesthesia, Alfred Hospital and Monash University, Australia
Department of Intensive Care, Alfred Hospital and Monash University, Australia
Consultative Committee on Road Traffic Fatalities Victoria, Australia
Neurosurgery Department, Royal Melbourne Hospital, Australia
Metropolitan Ambulance Service, Australia
Type of Clinical Study or Trial: Randomized Controlled Clinical Trial
Appears in Collections:Neurosciences

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