The primary aim of this study was to describe and compare perceived life satisfaction and perceived functional motor and cognitive status 1 year after severe traumatic brain injury (TBI) in males and females, adjusting for demographics and severity of injury.
Methods:
Data of 297 participants were abstracted from the National Institute on Disability Rehabilitation and Research (NIDRR)-funded Traumatic Brain Injury Model Systems (TBIMS). Participants were aged 16–50, enrolled in the TBIMS study between the years 1998 and 2008, diagnosed with severe TBI (defined as having an initial Glasgow Coma Scale [GCS] score between 3 and 8), and with perceived life satisfaction and functional status data available at 1 year postinjury. Multiple linear regression models were used to estimate the association between sex, demographic variables, severity of injury, and the outcome variables.
Results:
Our findings indicate that sex did not significantly influence perceived satisfaction with life or motor function 1 year after severe TBI. However, females had significantly better (p = 0.031) cognitive outcomes compared to males 1 year after severe TBI, after controlling for demographics and severity of injury.
Conclusions:
Findings suggest that females may have better perceived cognitive functional outcomes than males 1 year after severe TBI. Further longitudinal research, including measurement of hormonal levels, is needed to determine if hormones influence outcomes of severe TBI as well as the trajectory of these outcomes. A better understanding of sex differences in outcomes after TBI will help clinicians improve strategies for rehabilitation.
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References
1.
CorriganJD, SelassieAW, OrmanJA. The epidemiology of traumatic brain injury. J Head Trauma Rehabil, 2010; 25:72–80.
2.
BrunsJJr, HauserWA. The epidemiology of traumatic brain injury: A review. Epilepsia, 2003; 44,Suppl 10:2–10.
3.
Center for Disease Control and Prevention. National Center for Injury Prevention and Control, 2009. www.cdc.gov/ncipc/tbi/TBI.htm. 10312.
4.
BrownAW, LeibsonCL, MalecJF, PerkinsPK, DiehlNN, LarsonDR. Long-term survival after traumatic brain injury: A population-based analysis. Neurorehabilitation, 2004; 19:37–43.
5.
TeasdaleG, JennettB. Assessment of coma and impaired consciousness. A practical scale. Lancet, 1974; 2:81–84.
6.
MyburghJA, CooperDJ, FinferSRet al.Epidemiology and 12-month outcomes from traumatic brain injury in Australia and New Zealand. J Trauma Inj Infect Crit Care, 2008; 64:854–862.
7.
Lippert-GrunerM, MaegeleM, HaverkampH, KlugN, WedekindC. Health-related quality of life during the first year after severe brain trauma with and without polytrauma. Brain Inj, 2007; 21:451–455.
8.
LiuR, WenY, PerezEet al.17beta-Estradiol attenuates blood-brain barrier disruption induced by cerebral ischemia-reperfusion injury in female rats. Brain Res, 2005; 1060:55–61.
9.
HurnPD, Littleton-KearneyMT, KirschJR, DharmarajanAM, TraystmanRJ. Postischemic cerebral blood flow recovery in the female: Effect of 17 beta-estradiol. J Cereb Blood Flow Metab, 1995; 15:666–672.
10.
MendelsohnME, KarasRH. Estrogen and the blood vessel wall. Curr Opin Cardiol, 1994; 9:619–626.
11.
Kume-KickJ, FerrisDC, Russo-MennaI, RiceME. Enhanced oxidative stress in female rat brain after gonadectomy. Brain Res, 1996; 738:8–14.
12.
WenY, YangS, LiuRet al.Estrogen attenuates nuclear factor-kappa B activation induced by transient cerebral ischemia. Brain Res, 2004; 1008:147–154.
13.
SuzukiS, GerholdLM, BottnerMet al.Estradiol enhances neurogenesis following ischemic stroke through estrogen receptors alpha and beta. J Comp Neurol, 2007; 500:1064–1075.
14.
GulinelloM, LebesgueD, Jover-MengualT, ZukinRS, EtgenAM. Acute and chronic estradiol treatments reduce memory deficits induced by transient global ischemia in female rats. Horm Behav, 2006; 49:246–260.
15.
SteinDG, WrightDW, KellermannAL. Does progesterone have neuroprotective properties?Ann of Emerg Med, 2008; 51:164–172.
16.
ArvinB, NevilleLF, BaroneFC, FeuersteinGZ. The role of inflammation and cytokines in brain injury. Neurosci Biobehav Rev, 1996; 20:445–452.
17.
GrossmanKJ, GossCW, SteinDG. Effects of progesterone on the inflammatory response to brain injury in the rat. Brain Res, 2004; 1008:29–39.
18.
WrightDW, KellermannAL, HertzbergVSet al.ProTECT: A randomized clinical trial of progesterone for acute traumatic brain injury. Ann Emerg Med, 402; 49:391–402.
19.
XiaoG, WeiJ, YanW, WangW, LuZ. Improved outcomes from the administration of progesterone for patients with acute severe traumatic brain injury: A randomized controlled trial. Crit Care, 2008; 12:R61.
20.
FaraceE, AlvesWM. Do women fare worse? A meta-analysis of gender differences in traumatic brain injury outcome. J Neurosurg, 2000; 93:539–545.
21.
Slewa-YounanS, van den BergS, BaguleyIJ, NottM, CameronID. Towards an understanding of sex differences in functional outcome following moderate to severe traumatic brain injury: A systematic review. J Neurol, Neurosurg Psychiatry, 2008; 79:1197–1201.
22.
KrausJF, Peek-AsaC, McArthurD. The independent effect of gender on outcomes following traumatic brain injury: A preliminary investigation. Neurosurg Focus, 2000; 8:e5.
23.
MerrillSS, SeemanTE, KaslSV, BerkmanLF. Gender differences in the comparison of self-reported disability and performance measures. J Gerontol A Biol Sci Med Sci, 1997; 52:M19–M26.
24.
BealCC. Gender and stroke symptoms: A review of the current literature. J Neurosci Nurs, 2010; 42:80–87.
25.
CainKC, JarrettME, BurrRL, RosenS, HertigVL, HeitkemperMM. Gender differences in gastrointestinal, psychological, and somatic symptoms in irritable bowel syndrome. Digestive Dis Sci, 2009; 54:1542–1549.
26.
Slewa-YounanS, BaguleyIJ, HeriseanuRet al.Do men and women differ in their course following traumatic brain injury? A preliminary prospective investigation of early outcome. Brain Inj, 2008; 22:183–191.
27.
NiemeierJP, MarwitzJH, LesherK, WalkerWC, BushnikT. Gender differences in executive functions following traumatic brain injury. Neuropsychol Rehabil, 2007; 17:293–313.
28.
AndelicN, HammergrenN, Bautz-HolterE, SveenU, BrunborgC, RoeC. Functional outcome and health-related quality of life 10 years after moderate-to-severe traumatic brain injury. Acta Neurol Scand, 2009; 120:16–23.
29.
MailhanL, AzouviP, DazordA. Life satisfaction and disability after severe traumatic brain injury. Brain Inj, 2005; 19:227–238.
30.
Lippert-GrunerM, MaegeleM, HaverkampH, KlugN, WedekindC. Health-related quality of life during the first year after severe brain trauma with and without polytrauma. Brain Inj, 2007; 21:451–455.
31.
Steadman-PareD, ColantonioA, RatcliffG, ChaseS, VernichL. Factors associated with perceived quality of life many years after traumatic brain injury. J Head Trauma Rehabil, 2001; 16:330–342.
32.
LinMR, ChiuWT, ChenYJ, YuWY, HuangSJ, TsaiMD. Longitudinal changes in the health-related quality of life during the first year after traumatic brain injury. Arch Phys Med Rehabil, 2010; 91:474–480.
33.
HawthorneG, GruenRL, KayeAH. Traumatic brain injury and long-term quality of life: Findings from an Australian study. J Neurotrauma, 2009; 26:1623–1633.
34.
DahmerER, ShillingMA, HamiltonBB, BontkeCF. A model systems database for traumatic brain injury. J Head Trauma Rehabil, 1993; 2:12–25.
DienerE, EmmonsRA, LarsenRJ, GriffinS. The Satisfaction with Life Scale. J Pers Assess, 1985; 49:71–75.
37.
LinacreJM, HeinemannAW, WrightBD, GrangerCV, HamiltonBB. The structure and stability of the Functional Independence Measure. Arch Phys Med Rehabil, 1994; 75:127–132.
38.
OttenbacherKJ, HsuY, GrangerCV, FiedlerRC. The reliability of the functional independence measure: A quantitative review. Arch Phys Med Rehabil, 1996; 77:1226–1232.
39.
DiSC, GrantCC, BrookeMM, GansBM. Functional outcome in children with traumatic brain injury. Agreement between clinical judgment and the functional independence measure. Am J Phys Med Rehabil, 1992; 71:145–148.
40.
GrahamJE, Radice-NeumannDM, ReistetterTA, HammondFM, DijkersM, GrangerCV. Influence of sex and age on inpatient rehabilitation outcomes among older adults with traumatic brain injury. Arch Phys Med Rehabil, 2010; 91:43–50.
41.
WhitlockJAJr., HamiltonBB. Functional outcome after rehabilitation for severe traumatic brain injury. Arch Phys Med Rehabil, 1995; 76:1103–1112.
42.
Lippert-GrunerM, WedekindC, KlugN. Outcome of prolonged coma following severe traumatic brain injury. Brain Inj, 2003; 17:49–54.
43.
VonEE, OsterwalderJJ, GraberCet al.Severe traumatic brain injury in Switzerland–-Feasibility and first results of a cohort study. Swiss Med Weekly, 2008; 138:327–334.
44.
CorriganJD, SelassieAW, LineberryLAet al.Comparison of the Traumatic Brain Injury (TBI) Model Systems national dataset to a population-based cohort of TBI hospitalizations. Arch Phys Med Rehabil, 2007; 88:418–426.
45.
Arango-LasprillaJC, KetchumJM, WilliamsKet al.Racial differences in employment outcomes after traumatic brain injury. Arch Phys Med Rehabil, 2008; 89:988–995.
46.
WillerB, RosenthalM, KreutzerJS, GordonWA. Assessment of community integration following rehabilitation for traumatic brain injury. J Head Trauma Rehabil, 1993; 8:75–87.
47.
CiceroneKD, AzulayJ. Perceived self-efficacy and life satisfaction after traumatic brain injury. J Head Trauma Rehabil, 2007; 22:257–266.
48.
ReschJA, VillarrealV, JohnsonCLet al.Trajectories of life satisfaction in the first 5 years following traumatic brain injury. Rehabil Psychol, 2009; 54:51–59.
49.
FrischMB. Manual and treatment guide for the Quality of Life Inventory. San Antonio, TX: Pearson, 1994.
50.
ThomasMD, SkilbeckCE, SlatyerM. Pre-injury estimates of subjective quality of life following traumatic brain injury. Brain Inj, 2009; 23:516–527.
51.
TsaousidesT, WarshowskyA, AshmanTA, CantorJB, SpielmanL, GordonWA. The relationship between employment-related self-efficacy and quality of life following traumatic brain injury. Rehabil Psychol, 2009; 54:299–305.
