Differences between men and women in treatment and outcome following traumatic brain injury.

Traumatic brain injury (TBI) is a significant cause of disability, but little is known about sex and gender differences following TBI. We aimed to analyze the association between sex/gender, and the broad range of care pathways, treatment characteristics, and outcomes following mild and moderate/severe TBI. We performed mixed-effects regression analyses in the prospective multi-center Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study, stratified for injury severity and age, and adjusted for baseline characteristics. Outcomes were various care pathway and treatment variables, and 6-month measures of functional outcome, health-related quality of life (HRQoL), post-concussion (PCS) and mental health symptoms. The study included 2862 adults (36% women) with mild (mTBI) (Glasgow Coma Score (GCS) 13-15), and 1333 adults (26% women) with moderate/severe TBI (GCS 3-12). Women were less likely to be admitted to the Intensive Care Unit (odds ratios [OR] 0.6, 95% confidence interval [CI] [0.4-0.8]) following mTBI. Following moderate/severe TBI, women had a shorter median hospital stay (OR 0.7, [0.5-1.0]). Following mTBI, women had poorer outcomes; lower Glasgow Outcome Scale Extended (GOSE)) (OR 1.4, [1.2-1.6]), lower generic and disease-specific HRQoL, and more severe symptoms of post-concussion, depression and anxiety. Among them, women under 45 and above 65 years showed worse 6- month outcomes compared to men of the same age. Following moderate/severe TBI, there was no difference in GOSE (OR 0.9, CI [0.7-1.2], but women reported more severe post-concussion symptoms (OR 1.7, CI [1.1-2.6]). Men and women differ in care pathways and outcomes following TBI. Women generally report worse 6-month outcomes, but the size of differences depends on TBI severity and age. Future studies should examine factors that explain these differences.