• Zhi-Jie Hong, Matthew Firek, Bishoy Zachary, Katharina Mörs, Cora Schindler, Ingo Marzi, Jyh-Cherng Yu, and Raul Coimbra.
• Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System Medical Center, 26520 Cactus Ave., CPC Building, Suite 102-5, Riverside, Moreno Valley, CA, 92555, USA.
• Eur J Trauma Emerg Surg. 2022 Apr 1; 48 (2): 871-880.

PurposeThe impact of female sex on traumatic brain injury (TBI) outcomes remains controversial. The combined impact of age and sex on TBI outcomes must be clarified. We hypothesized that females have better outcomes than males in the premenopausal age group.MethodsData from the 2007-2016 National Trauma Data Bank of the Committee on Trauma-American College of Surgeons were used. Of a total of 686,549 patients with moderate to severe TBI (AIS ≥ 3), 251,491 were female. Comparison analyses of clinical characteristics and outcomes between females and males were conducted at different age groups: < 45 years, 45-55, and > 55 years. Logistic regressions were performed to assess the impact of age and female sex on mortality and complications.ResultsMortality rate between females and males aged < 45 and 45-55 years was similar, but significantly reduced in the > 55 years group. After multivariate logistic regression analysis controlling for multiple confounding factors, we found that females aged > 55 years had markedly decreased risk of mortality (AOR: 0.857, 95% CI 0.835-0.879, p < 0.001) and complications.ConclusionFemale patients in the postmenopausal stage have better outcomes following TBI than males, but pre- and perimenopausal females do not, suggesting that female sexual hormones may not provide a significant protective effect on clinical outcomes following isolated moderate to severe TBI.© 2020. Springer-Verlag GmbH Germany, part of Springer Nature.

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