Citation

Anto-Ocrah M, Mannix R, Bazarian JJ. JAMA Netw. Open 2021; 4(4): e213068.

Copyright

(Copyright © 2021, American Medical Association)

DOI

10.1001/jamanetworkopen.2021.3068

PMID

unavailable

Abstract

Age and sex are among the most frequently studied preinjury health and demographic factors thought to be related to outcome after mild traumatic brain injury (mTBI).1 Indeed, the current body of literature supports the observation that women have more postconcussive symptoms and take longer to recover than men.2 Moreover, a reasonable amount of evidence substantiates the notion that women of reproductive age have worse outcomes after mTBI compared with premenarchal or postmenopausal women.3,4 An emerging hypothesis is that hormonal fluctuations during the reproductive years underlie this age and sex interaction,5 leading to a burgeoning line of investigation into whether the observed age-sex interaction could provide clues not only to the pathophysiology of mTBI but also to putative therapeutics to hasten recovery. However, the literature to date has been hampered by the lack of appropriate control groups in these studies, leaving considerable room for speculation that age and sex differences in these prior studies reflected a nonspecific response to injury in general, and not mTBI specifically, reducing enthusiasm for this line of research investigation as a path forward.

The current study by Levin et al6 in JAMA Network Open has gone a long way to put that speculation to rest. Among 2000 adult emergency department patients with mTBI accrued from 16 level 1 trauma centers in the US and followed prospectively for 12 months, women were found to have worse cognitive and somatic postconcussion symptoms than men, and somatic symptoms were worse in women aged 35 to 49 years compared with those between the ages of 17 and 34 years and women aged 50 years and older. The key methodologic innovation of this study was the inclusion of 299 patients with orthopedic trauma who served as a comparison control group. This large and well-chosen control group allowed the authors to demonstrate 2 important points...

Language: en