Published: 2022-06-27

Female geriatric patients with traumatic brain injury have better odds of survival compared to men-a meta-analysis and review of the literature

Shreya Pandya, Ivan Fedoriv, Timothy N. Le, Jacqueline Liu, Tori Singer, Kaitlyn Kennedy, Kiara Singer, Bryan Lee, Vincent Kaykaty, Kevin Butler, Kailey Singh, Nikhil Patel, Frank DiRoma, Asaf Gave, Ronit Gilad, Duraid Younan


Geriatric trauma patients have worse outcomes compared to younger patients. Differences in trauma outcomes based on gender remain unproven. We sought to investigate the association of gender with outcomes among geriatric patients with traumatic brain injury (TBI) by performing a meta-analysis and review of the literature. A systematic review of published articles on outcomes of geriatric patients with TBI using PubMed was conducted. A total of 363 articles were identified, from these, 74 articles met the inclusion criteria of isolated TBI in geriatric patients. Upon review of the articles, only 5 met the specified criteria of the search which described male and female mortality amongst geriatric patients suffering isolated TBI. The data from these papers were combined into a master file and meta-analysis was performed using random-effect model with Rev Man 5.4 software. The total number of patients in these 5 papers was 23,893, of these 11,971 were men and 11,922 were women. The odds ratio for survival in these patients were 1.40, 2.40, 1.20, 1.28 and 1.15 with a combined final OR of 1.28 favoring women with a p value of less than 0.00001 and CI of 1.21-1.36. Female geriatric trauma patients sustaining TBI have better survival than men.


Trauma, Geriatric, Female, Gender, TBI

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Centers for Disease Control and Prevention. TBI-related emergency department visits, hospitalizations, and deaths (EDHDs). Available at: Accessed on November 11, 2021.

Menon DK, Schwab K, Wright DW, Maas AI. Demographics and Clinical Assessment Working Group of the International and Interagency Initiative toward Common Data Elements for Research on Traumatic Brain Injury and Psychological Health. Position statement: definition of traumatic brain injury. Arch Phys Med Rehabil. 2010;91(11):1637-40.

Späni CB, Braun DJ, Van Eldik LJ. Sex-related responses after traumatic brain injury: Considerations for preclinical modeling. Frontiers in neuroendocrinol. 2018;50:52-66.

Eom KS, Kim JH, Yoon SH, Lee SJ, Park KJ, Ha SK et al. Gender differences in adult traumatic brain injury according to the Glasgow coma scale: A multicenter descriptive study. Chin J Traumatol. 2021;24(6):333-43.

Rauen K, Späni CB, Tartaglia MC, Ferretti MT, Reichelt L, Probst P et al. Quality of life after traumatic brain injury: a cross-sectional analysis uncovers age- and sex-related differences over the adult life span. Gero Sci. 2021;43(1):263-78.

Heydari F, Golban M, Majidinejad S. Traumatic Brain Injury in Older Adults Presenting to the Emergency Department: Epidemiology, Outcomes and Risk Factors Predicting the Prognosis. Adv J Emergency Med. 2019;4(2):e19.

Niemeier JP, Perrin PB, Holcomb MG, Rolston CD, Artman LK, Lu J, Nersessova KS. Gender differences in awareness and outcomes during acute traumatic brain injury recovery. J women's health. 2002;23(7):573-80.

Gross T, Morell S, Amsler F. Gender-Specific Improvements in Outcome 1 and 2 Years After Major Trauma. J Surg Res. 2019;235:459-69.

Bolandparvaz S, Yadollahi M, Abbasi HR, Anvar M. Injury patterns among various age and gender groups of trauma patients in southern Iran: A cross-sectional study. Medicine (Baltimore). 2017;96(41):e7812.

Bösch F, Angele MK, Chaudry IH. Gender differences in trauma, shock and sepsis. Mil Med Res. 2018;5(1):35.

Elkbuli A, Smith Z, Shaikh S, Hai S, McKenney M, Boneva D. Mild and Moderate Traumatic Brain Injury and Gender-Based Critical Care Outcomes. World J Surg. 2020;44(5):1492-7.

Marcolini EG, Albrecht JS, Sethuraman KN, Napolitano LM. Gender Disparities in Trauma Care: How Sex Determines Treatment, Behavior, and Outcome. Anesthesiol Clin. 2019;37(1):107-17.

Giordano KR, Rojas-Valencia LM, Bhargava V, Lifshitz J. Beyond Binary: Influence of Sex and Gender on Outcome after Traumatic Brain Injury. J Neurotrauma. 2020;37(23):2454-9.

Roof RL, Hall ED. Estrogen-related gender difference in survival rate and cortical blood flow after impact-acceleration head injury in rats. J Neurotrauma. 2000;17(12):1155-69.

Hoi-yan YA, Cheng CH, Yeung JHH, Poon WS, Ho HF, Chang A et al. Functional outcome after head injury: comparison of 12–45-year-old male and female hormonally active patients. Injury. 2012;43(5):603-7.

Wright DW, Espinoza TR, Merck LH, Ratcliff JJ, Backster A, Stein DG. Gender differences in neurological emergencies part II: a consensus summary and research agenda on traumatic brain injury Acad Emerg Med. 2014;21(12):1414-20.