Is Sex an Indicator of Prognosis After Mild Traumatic Brain Injury: A Systematic Analysis of the Findings of the World Health Organization Collaborating Centre Task Force on Mild Traumatic Brain Injury and the International Collaboration on Mild Traumatic Brain Injury Prognosis

Carol Cancelliere; James Donovan; J David Cassidy

doi:10.1016/j.apmr.2014.11.028

Is Sex an Indicator of Prognosis After Mild Traumatic Brain Injury: A Systematic Analysis of the Findings of the World Health Organization Collaborating Centre Task Force on Mild Traumatic Brain Injury and the International Collaboration on Mild Traumatic Brain Injury Prognosis

Arch Phys Med Rehabil. 2016 Feb;97(2 Suppl):S5-18. doi: 10.1016/j.apmr.2014.11.028. Epub 2015 Feb 7.

Authors

Carol Cancelliere¹, James Donovan², J David Cassidy³

Affiliations

¹ Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
² Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada. Electronic address: jamesd@uhnresearch.ca.
³ Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Institute of Sports Science and Clinical Biomechanics, Faculty of Health, University of Southern Denmark, Odense, Denmark.

PMID: 25666784
DOI: 10.1016/j.apmr.2014.11.028

Abstract

Objective: To determine sex differences in the recovery and prognosis after mild traumatic brain injury (MTBI) in adults and children.

Data sources: We analyzed all scientifically admissible primary studies in the World Health Organization (WHO) (n=120) and International Collaboration on Mild Traumatic Brain Injury Prognosis (ICoMP) (n=101) systematic reviews regarding prognosis of MTBI for sex-stratified findings. They searched MEDLINE and other databases from 1980 through 2000 (WHO) and 2001 through 2012 (ICoMP) for published, peer-reviewed reports in English and other languages.

Study selection: We selected controlled trials and cohort and case-control studies that assessed the effect of sex on outcomes after MTBI.

Data extraction: Data from the eligible studies from both systematic reviews combined (n=14, 7%) were extracted into evidence tables.

Data synthesis: Prognostic information relating to sex was prioritized according to design as exploratory or confirmatory, and a best-evidence synthesis was conducted. After MTBI, females may have a higher risk of epilepsy (children, young adults) and suicide, and use more health care services; males may be at higher risk for schizophrenia. Most studies did not find a sex difference for postconcussion symptoms in children and adults. No sex difference was found for risk of dementia and primary brain tumor, return to work, or posttraumatic stress syndrome.

Conclusions: Sex is not a well-studied prognostic indicator for recovery after MTBI, but small sex differences were found for some outcomes. More well-designed studies are needed that report outcomes according to sex and control for potential confounders.

Keywords: Brain concussion; Prognosis; Rehabilitation; Sex.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Review

MeSH terms

Adult
Advisory Committees
Age Factors
Brain Injuries / complications*
Brain Injuries / rehabilitation*
Child
Epilepsy / etiology
Female
Humans
Male
Patient Acceptance of Health Care / statistics & numerical data
Prognosis
Risk Factors
Schizophrenia / etiology
Sex Factors*
Suicide / statistics & numerical data
Trauma Severity Indices*
World Health Organization