Sex-based differences in outcomes for adult patients presenting to the emergency department with a concussion

Brian H. Rowe MD, MSc, CCFP(EM)1,5, Esther H. Yang MSc1, Lindsay A. Gaudet MSc2, Leeor Eliyahu MD, CCFP3, Daniela R. Junqueira PharmD, MSc, PhD1, Jeremy Beach MBBS, MD, FRCP(C)4,7, Martin Mrazik PhD6, Garnet Cummings MD, FRCPC1, and Donald Voaklander PhD5
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  • 1 Departments of Emergency Medicine,
  • | 2 Pediatrics, and
  • | 3 Family Medicine, and
  • | 4 Division of Preventive Medicine, Faculty of Medicine & Dentistry;
  • | 5 School of Public Health; and
  • | 6 Department of Educational Psychology, Faculty of Education, University of Alberta; and
  • | 7 College of Physicians and Surgeons of Alberta, Edmonton, Alberta, Canada
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OBJECTIVE

Patients with concussion frequently present to the emergency department (ED). Studies of athletes and children indicate that concussion symptoms are often more severe and prolonged in females compared with males. Given infrequent study of concussion symptoms in the general adult population, the authors conducted a sex-based comparison of patients with concussion.

METHODS

Adults (≥ 17 years of age) presenting with concussion to one of three urban Canadian EDs were recruited. Discharged patients were contacted by telephone 30 and 90 days later to capture the extent of persistent postconcussion symptoms using the Rivermead Post Concussion Symptoms Questionnaire (RPQ). A multivariate logistic regression model for persistent symptoms that included biological sex was developed.

RESULTS

Overall, 250 patients were included; 131 (52%) were women, and the median age of women was significantly higher than that of men (40 vs 32 years). Women had higher RPQ scores at baseline (p < 0.001) and the 30-day follow-up (p = 0.001); this difference resolved by 90 days. The multivariate logistic regression identified that women, patients having a history of sleep disorder, and those presenting to the ED with concussions after a motor vehicle collision were more likely to experience persistent symptoms.

CONCLUSIONS

In a community concussion sample, inconsequential demographic differences existed between adult women and men on ED presentation. Based on self-reported and objective outcomes, work and daily activities may be more affected by concussion and persistent postconcussion symptoms for women than men. Further analysis of these differences is required to identify different treatment options and ensure adequate care and management of injury.

ABBREVIATIONS

CTAS = Canadian Triage Acuity Scale; eCPG = electronic clinical practice guideline; ED = emergency department; GCS = Glasgow Coma Scale; LOC = loss of consciousness; LOS = length of stay; MVC = motor vehicle collision; PCS = postconcussion syndrome; RHFUQ = Rivermead head injury follow-up questionnaire; RPQ = Rivermead Post Concussion Symptoms Questionnaire; RTW = return to work.

Supplementary Materials

    • Supplemental Tables 1–3 (PDF 429 KB)

Illustration from Schneider et al. (pp 205–214). Copyright Elyssa Siegel. Published with permission.

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