2001 WHRG Grant Program

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Symposia

Gender Differences in
Traumatic Brain Injury

Lena M. Napolitano, MD
School of Medicine, University of Maryland, Baltimore

Injury is the fifth leading cause of death among all age groups in the United States and is the leading cause of death of persons ages 1 through 44. Although it is well-known that outcome after trauma is related to severity of shock, hemorrhage and development of organ failure, little is known of the effects of gender on trauma outcomes. Pre-clinical studies in animal models of trauma have documented that female gender is associated with improved survival. Improved outcome after trauma was also evident in male animals who underwent castration or the administration of testosterone receptor blocking agents.

In contrast, we have previously documented that gender has no relation to mortality in blunt trauma patients (n = 18,892) stratified for age (18-65) and injury severity. Male trauma patients had a higher incidence of pneumonia, but females with pneumonia after injury were 2.8 to 5.6 times at higher risk for death than males. Furthermore, our preliminary studies have determined that female gender was associated with a significant increase in mortality in patients (n = 13,770) with blunt traumatic brain injury (TBI). Logistic regression analysis confirmed female gender as an independent predictor of increased mortality (odds ratio 1.27) after adjusting for age and TBI classification. The primary hypothesis for this study proposal is that female gender does not confer a survival advantage in outcome in blunt TBI patients.

Therefore, the objective of these studies is three-fold: (1) to further investigate the gender-based differences in mortality in TBI patients stratified for anatomic injury and treatment rendered, (2) to determine gender-based differences in mortality in geriatric (age >65) TBI patients, and (3) to investigate gender-based differences in TBI mortality and morbidity in a more recent trauma database (1995-1999) at our institution, and validate these findings in a separate state-wide database (Pennsylvania State Trauma Registry, n = 31,253). In addition to the determination of the epidemiology of gender-based differences in TBI outcome, this investigation will also provide valuable information for accurate and early identification of female patients at risk for poor outcome following trauma. These data will potentially spur the future development of appropriate therapeutic strategies for the prevention of gender-related adverse outcomes after trauma.