Do women fare worse: a metaanalysis of gender differences in traumatic brain injury outcome

Elana Farace Department of Neurological Surgery, University of Virginia; and INC Research, Charlottesville, Virginia

Search for other papers by Elana Farace in
Current site
Google Scholar
PubMed
Close
 Ph.D.
and
Wayne M. Alves Department of Neurological Surgery, University of Virginia; and INC Research, Charlottesville, Virginia

Search for other papers by Wayne M. Alves in
Current site
Google Scholar
PubMed
Close
 Ph.D.
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $525.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $624.00
USD  $45.00
USD  $525.00
USD  $624.00
Print or Print + Online Sign in

Object. The purpose of this metaanalysis was to investigate possible gender differences in traumatic brain injury (TBI) sequelae. The case fatality rates in patients after TBI have previously been shown to be significantly higher in women as compared with men.

Methods. A quantitative review of published studies of TBI outcome revealed eight studies (20 outcome variables) of TBI, in which outcome was reported separately for men and women.

Conclusions. Outcome was worse in women than in men for 85% of the measured variables, with an average effect size of −0.15. Although clinical opinion is often that women tend to experience better outcomes than men after TBI, the opposite pattern was suggested in the results of this metaanalysis. However, this conclusion is limited by the fact that, in only a small percentage of the total published reports on TBI outcome, was outcome described separately for each sex. A careful, prospective study of sex differences in TBI outcome is clearly needed.

  • Collapse
  • Expand
  • 1.

    Alkayed NJ, , Harukami I, & Kimes AS, et al: Gender-linked brain injury in experimental stroke. Stroke 29:159166, 1998 Alkayed NJ, Harukami I, Kimes AS, et al: Gender-linked brain injury in experimental stroke. Stroke 29:159–166, 1998

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2.

    Anonymous: Guidelines for the Management of Severe Head Injury. A Joint Initiative of the Brain Trauma Foundation, The American Association of Neurological Surgeons, The Joint Section on Neurotrauma and Critical Care. Washington, DC: Brain Injury Association, 1995 Anonymous: Guidelines for the Management of Severe Head Injury. A Joint Initiative of the Brain Trauma Foundation, The American Association of Neurological Surgeons, The Joint Section on Neurotrauma and Critical Care. Washington, DC: Brain Injury Association, 1995

    • Search Google Scholar
    • Export Citation
  • 3.

    Apfel RJ: How are women sicker than men? An overview of psychosomatic problems in women. Psychother Psychom 37:106118, 1982 Apfel RJ: How are women sicker than men? An overview of psychosomatic problems in women. Psychother Psychom 37:106–118, 1982

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Bazarian JJ, , Wong T, & Harris M, et al: Epidemiology and predictors of post-concussive syndrome after minor head injury in an emergency population. Brain Inj 13:173189, 1999 Bazarian JJ, Wong T, Harris M, et al: Epidemiology and predictors of post-concussive syndrome after minor head injury in an emergency population. Brain Inj 13:173–189, 1999

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5.

    Cifu DX, , Keyser-Marcus L, & Lopez E, et al: Acute predictors of successful return to work 1 year after traumatic brain injury: a multicenter analysis. Arch Phys Med Rehabil 78:125131, 1997 Cifu DX, Keyser-Marcus L, Lopez E, et al: Acute predictors of successful return to work 1 year after traumatic brain injury: a multicenter analysis. Arch Phys Med Rehabil 78:125–131, 1997

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6.

    Cohen J: Statistical Power Analysis for the Behavioral Sciences, ed 2. Hillsdale, NJ: L. Erlbaum Associates, 1988 Cohen J: Statistical Power Analysis for the Behavioral Sciences, ed 2. Hillsdale, NJ: L. Erlbaum Associates, 1988

    • Search Google Scholar
    • Export Citation
  • 7.

    Edna TH, & Cappelen J: Late post-concussional symptoms in traumatic brain injury. An analysis of frequency of risk factors. Acta Neurochir 86:1217, 1987 Edna TH, Cappelen J: Late post-concussional symptoms in traumatic brain injury. An analysis of frequency of risk factors. Acta Neurochir 86:12–17, 1987

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    Emerson CS, , Headrick JP, & Vink R: Estrogen improves biochemical and neurologic outcome following traumatic brain injury in male rats, but not in females. Brain Res 608:95100, 1993 Emerson CS, Headrick JP, Vink R: Estrogen improves biochemical and neurologic outcome following traumatic brain injury in male rats, but not in females. Brain Res 608:95–100, 1993

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9.

    Farace E, & Turkheimer E: Gender differences in brain morphometry and function, in Bigler ED (ed): Neuroimaging. Handbook of Brain Function. New York: Plenum, 1996, pp 127151 Farace E, Turkheimer E: Gender differences in brain morphometry and function, in Bigler ED (ed): Neuroimaging. Handbook of Brain Function. New York: Plenum, 1996, pp 127–151

    • Search Google Scholar
    • Export Citation
  • 10.

    Gennarelli TA, , Spielman GM, & Langfitt TW, et al: Influence of the type of intracranial lesion on outcome from severe head injury. J Neurosurg 56:2632, 1982 Gennarelli TA, Spielman GM, Langfitt TW, et al: Influence of the type of intracranial lesion on outcome from severe head injury. J Neurosurg 56:26–32, 1982

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11.

    Girard D, , Brown J, & Burnett-Stolnack M, et al: The relationship of neuropsychological status and productive outcomes following traumatic brain injury. Brain Inj 10:663676, 1996 Girard D, Brown J, Burnett-Stolnack M, et al: The relationship of neuropsychological status and productive outcomes following traumatic brain injury. Brain Inj 10:663–676, 1996

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12.

    Glass GV, , McGaw B, & Smith ML: Meta-Analysis in Social Research. Beverly Hills: Sage Publications, 1981 Glass GV, McGaw B, Smith ML: Meta-Analysis in Social Research. Beverly Hills: Sage Publications, 1981

    • Search Google Scholar
    • Export Citation
  • 13.

    Grafman J, , Salazar A, & Weingartner H, et al: The relationship of brain-tissue loss volume and lesion location to cognitive deficit. J Neurosci 6:301307, 1986 Grafman J, Salazar A, Weingartner H, et al: The relationship of brain-tissue loss volume and lesion location to cognitive deficit. J Neurosci 6:301–307, 1986

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14.

    Hahn YS, , Fuchs S, & Flannery AM, et al: Factors influencing posttraumatic seizures in children. Neurosurgery 22:864867, 1988 Hahn YS, Fuchs S, Flannery AM, et al: Factors influencing posttraumatic seizures in children. Neurosurgery 22:864–867, 1988

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15.

    Harrison-Felix C, , Zafonte R, & Mann N, et al: Brain injury as a result of violence: preliminary findings from the traumatic brain injury model system. Arch Phys Med Rehabil 79:730737, 1998 Harrison-Felix C, Zafonte R, Mann N, et al: Brain injury as a result of violence: preliminary findings from the traumatic brain injury model system. Arch Phys Med Rehabil 79:730–737, 1998

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16.

    Henry PC, , Hauber RP, & Rice M: Factors associated with closed head injury in a pediatric population. J Neurosci Nurs 24:311316, 1992 Henry PC, Hauber RP, Rice M: Factors associated with closed head injury in a pediatric population. J Neurosci Nurs 24:311–316, 1992

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17.

    Howell DC: Statistical Methods for Psychology, ed 4. Belmont, CA: Duxbury Press, 1997, pp 306314 Howell DC: Statistical Methods for Psychology, ed 4. Belmont, CA: Duxbury Press, 1997, pp 306–314

    • Search Google Scholar
    • Export Citation
  • 18.

    Hulst LK, , Fleishaker JC, & Peters GR, et al: Effect of age and gender on tirilazad pharmacokinetics in humans. Clin Pharmacol Ther 55:378384, 1994 Hulst LK, Fleishaker JC, Peters GR, et al: Effect of age and gender on tirilazad pharmacokinetics in humans. Clin Pharmacol Ther 55:378–384, 1994

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19.

    Hyde JS, & Linn MC: Gender differences in verbal ability: a metaanalysis. Psychol Bull 104:5369, 1988 Hyde JS, Linn MC: Gender differences in verbal ability: a metaanalysis. Psychol Bull 104:53–69, 1988

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20.

    Jensen OK, & Nielsen FF: The influence of sex and pre-traumatic headache on the incidence and severity of headache after head injury. Cephalgia 10:285293, 1990 Jensen OK, Nielsen FF: The influence of sex and pre-traumatic headache on the incidence and severity of headache after head injury. Cephalgia 10:285–293, 1990

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21.

    Kaplan CP, & Corrigan JD: Effect of blood alcohol level on recovery from severe closed head injury. Brain Inj 6:337349, 1992 Kaplan CP, Corrigan JD: Effect of blood alcohol level on recovery from severe closed head injury. Brain Inj 6:337–349, 1992

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22.

    Klauber MR, , Marshall LF, & Barrett-Connor E, et al: Prospective study of patients hospitalized with head injury in San Diego County, 1978. Neurosurgery 9:236241, 1981 Klauber MR, Marshall LF, Barrett-Connor E, et al: Prospective study of patients hospitalized with head injury in San Diego County, 1978. Neurosurgery 9:236–241, 1981

    • Search Google Scholar
    • Export Citation
  • 23.

    Kraus JF, , McArthur DL, & Silberman TA: Epidemiology of mild brain injury. Semin Neurol 14:17, 1994 Kraus JF, McArthur DL, Silberman TA: Epidemiology of mild brain injury. Semin Neurol 14:1–7, 1994

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24.

    Kraus JF, & Nourjah P: The epidemiology of mild, uncomplicated brain injury. J Trauma 28:16371643, 1988 Kraus JF, Nourjah P: The epidemiology of mild, uncomplicated brain injury. J Trauma 28:1637–1643, 1988

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25.

    Kraus JF, , Peek-Asa C, & McArthur D: The independent effect of gender on outcomes following traumatic brain injury: a preliminary investigation. Neurosurg Focus 8 (1):Article 5, 2000 Kraus JF, Peek-Asa C, McArthur D: The independent effect of gender on outcomes following traumatic brain injury: a preliminary investigation. Neurosurg Focus 8 (1):Article 5, 2000

    • Search Google Scholar
    • Export Citation
  • 26.

    Kraus JF, & Sorenson SB: Epidemiology, in Silver JM, , Yudofsky SC, & Hales RE (eds): Neuropsychiatry of Traumatic Brain Injury. Washington, DC: American Psychiatric Press, 1994 Kraus JF, Sorenson SB: Epidemiology, in Silver JM, Yudofsky SC, Hales RE (eds): Neuropsychiatry of Traumatic Brain Injury. Washington, DC: American Psychiatric Press, 1994

    • Search Google Scholar
    • Export Citation
  • 27.

    Levin HS, , Mattis S, & Ruff RM, et al: Neurobehavioral outcome following minor head injury: a three-center study. J Neurosurg 66:234243, 1987 Levin HS, Mattis S, Ruff RM, et al: Neurobehavioral outcome following minor head injury: a three-center study. J Neurosurg 66:234–243, 1987

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 28.

    Marshall LF, , Maas AI, & Marshall SB, et al: A multicenter trial on the efficacy of using tirilazad mesylate in cases of head injury. J Neurosurg 89:519525, 1998 Marshall LF, Maas AI, Marshall SB, et al: A multicenter trial on the efficacy of using tirilazad mesylate in cases of head injury. J Neurosurg 89:519–525, 1998

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29.

    Marshall LF, , Marshall SB, & Musch B, et al: Outcome of moderate and severe head injury in patients treated with tirilazad mesylate. J Neurosurg 84:342A, 1996 (Abstract) Marshall LF, Marshall SB, Musch B, et al: Outcome of moderate and severe head injury in patients treated with tirilazad mesylate. J Neurosurg 84:342A, 1996 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 30.

    McMordie WR, , Barker SL, & Paolo TM: Return to work (RTW) after head injury. Brain Inj 4:5769, 1990 McMordie WR, Barker SL, Paolo TM: Return to work (RTW) after head injury. Brain Inj 4:57–69, 1990

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 31.

    Morrongiello BA, & Rennie H: Why do boys engage in more risk taking than girls? The role of attributions, beliefs, and risk appraisals. J Pediatr Psychol 23:3343, 1998 Morrongiello BA, Rennie H: Why do boys engage in more risk taking than girls? The role of attributions, beliefs, and risk appraisals. J Pediatr Psychol 23:33–43, 1998

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 32.

    National Highway Traffic Safety Administration: National Occupant Safety Use Survey (NOPUS). Controlled Intersection Study. Washington, DC: Department of Transportation, 1997 National Highway Traffic Safety Administration: National Occupant Safety Use Survey (NOPUS). Controlled Intersection Study. Washington, DC: Department of Transportation, 1997

    • Search Google Scholar
    • Export Citation
  • 33.

    Pentland B, , Jones PA, & Roy CW, et al: Head injury in the elderly. Age Ageing 15:193202, 1986 Pentland B, Jones PA, Roy CW, et al: Head injury in the elderly. Age Ageing 15:193–202, 1986

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 34.

    Rimel RW, , Giordani B, & Barth JT, et al: Disability caused by minor head injury. Neurosurgery 9:221228, 1981 Rimel RW, Giordani B, Barth JT, et al: Disability caused by minor head injury. Neurosurgery 9:221–228, 1981

    • Search Google Scholar
    • Export Citation
  • 35.

    Rivara JM, , Jaffe KM, & Polissar NL, et al: Predictors of family functioning and change 3 years after traumatic brain injury in children. Arch Phys Med Rehabil 77:754764, 1996 Rivara JM, Jaffe KM, Polissar NL, et al: Predictors of family functioning and change 3 years after traumatic brain injury in children. Arch Phys Med Rehabil 77:754–764, 1996

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 36.

    Roof RL, , Duvdevani R, & Braswell L, et al: Progesterone facilitates cognitive recovery and reduces secondary neuronal loss caused by cortical contusion injury in male rats. Exp Neurol 129:6469, 1994 Roof RL, Duvdevani R, Braswell L, et al: Progesterone facilitates cognitive recovery and reduces secondary neuronal loss caused by cortical contusion injury in male rats. Exp Neurol 129:64–69, 1994

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 37.

    Roof RL, , Duvdevani R, & Stein DG: Gender influences outcome of brain injury: progesterone plays a protective role. Brain Res 607:333336, 1993 Roof RL, Duvdevani R, Stein DG: Gender influences outcome of brain injury: progesterone plays a protective role. Brain Res 607:333–336, 1993

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 38.

    Rutherford WH: Sequelae of concussion caused by minor head injuries. Lancet 1:14, 1977 Rutherford WH: Sequelae of concussion caused by minor head injuries. Lancet 1:1–4, 1977

    • Search Google Scholar
    • Export Citation
  • 39.

    Sabhesan S, & Natarajan M: Sexual behavior after head injury in Indian men and woman. Arch Phys Med Rehabil 18:349356, 1989 Sabhesan S, Natarajan M: Sexual behavior after head injury in Indian men and woman. Arch Phys Med Rehabil 18:349–356, 1989

    • Search Google Scholar
    • Export Citation
  • 40.

    Schmidt ME, , Matochik JA, & Goldstein DS, et al: Gender differences in brain metabolic and plasma catecholamine responses to α2-adrenoreceptor blockade. Neuropsychopharmacology 16:298310, 1997 Schmidt ME, Matochik JA, Goldstein DS, et al: Gender differences in brain metabolic and plasma catecholamine responses to α2-adrenoreceptor blockade. Neuropsychopharmacology 16:298–310, 1997

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 41.

    Shaywitz BA, , Shaywitz SE, & Pugh KR, et al: Sex differences in the functional organization of the brain for language. Nature 373:607609, 1995 Shaywitz BA, Shaywitz SE, Pugh KR, et al: Sex differences in the functional organization of the brain for language. Nature 373:607–609, 1995

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 42.

    Turkheimer E, & Farace E: A reanalysis of gender differences in IQ scores following unilateral brain lesions. Psychol Assess 4:498501, 1992 Turkheimer E, Farace E: A reanalysis of gender differences in IQ scores following unilateral brain lesions. Psychol Assess 4:498–501, 1992

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 43.

    Turkheimer E, , Farace E, & Yeo RA, et al: Quantitative analysis of gender differences in the effects of lateralized lesions on verbal and performance IQ. Intelligence 17:461474, 1993 Turkheimer E, Farace E, Yeo RA, et al: Quantitative analysis of gender differences in the effects of lateralized lesions on verbal and performance IQ. Intelligence 17:461–474, 1993

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 44.

    Webb CR, , Wrigley M, & Yoels W, et al: Explaining quality of life for persons with traumatic brain injuries 2 years after injury. Arch Phys Med Rehabil 76:11131119, 1995 Webb CR, Wrigley M, Yoels W, et al: Explaining quality of life for persons with traumatic brain injuries 2 years after injury. Arch Phys Med Rehabil 76:1113–1119, 1995

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 45.

    Wilberger JE Jr, , Harris M, & Diamond DL: Acute subdural hematoma: morbidity and mortality related to timing of operative intervention. J Trauma 30:733736, 1990 Wilberger JE Jr, Harris M, Diamond DL: Acute subdural hematoma: morbidity and mortality related to timing of operative intervention. J Trauma 30:733–736, 1990

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 46.

    Williams JM, , Gomes F, & Drudge OW, et al: Predicting outcome from closed head injury by early assessment of trauma severity. J Neurosurg 61:581585, 1984 Williams JM, Gomes F, Drudge OW, et al: Predicting outcome from closed head injury by early assessment of trauma severity. J Neurosurg 61:581–585, 1984

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 47.

    Wingard DL: The sex differential in morbidity, mortality, and lifestye. Ann Rev Publ Health 5:433458, 1984 Wingard DL: The sex differential in morbidity, mortality, and lifestye. Ann Rev Publ Health 5:433–458, 1984

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 48.

    Zimbardo PG, , Keough KA, & Boyd KN: Present time perspective as a predictor of risky driving. Personal Indiv Differ 23:10071023, 1997 Zimbardo PG, Keough KA, Boyd KN: Present time perspective as a predictor of risky driving. Personal Indiv Differ 23:1007–1023, 1997

    • Crossref
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 4997 961 78
Full Text Views 1054 98 10
PDF Downloads 620 105 10
EPUB Downloads 0 0 0