title: Sex-related differences in patients with severe head injury: greater susceptibility to brain swelling in female patients 50 years of age and younger.
abstract: OBJECTIVE
  The goal of this study was to study the influence of sex and age on factors affecting patient outcome in severe head injury.
  
  
  METHODS
  Data from the prospectively conducted international trial of tirilazad mesylate in patients with head injury were analyzed retrospectively. Included were 957 patients, 23% of whom were female and all of whom were between the ages of 15 and 79 years. All patients presented with Glasgow Coma Scale (GCS) scores between 3 and 8 and evidence of structural brain damage and/or subarachnoid hemorrhage (SAH) on the initial CT scan. Frequencies of recognized risk factors, including brain swelling, intracranial hypertension, systemic hypotension, advanced age, SAH, and injury severity (based on GCS scores), as well as dichotomized Glasgow Outcome Scale (GOS) scores (good recovery or moderate disability compared with severe disability, persistent vegetative state, or death) obtained 6 months postinjury were compared between male and female patients.
  
  
  CONCLUSIONS
  Overall significantly greater frequencies of brain swelling and intracranial hypertension were found in female compared with male patients (35% compared with 24% [p < 0.0008] and 39 compared with 31% [p < 0.03], respectively). The highest rates were found in female patients younger than 51 years old (38% compared with 24% [p < 0.002] and 40% compared with 30% [p < 0.02], respectively, in male patients younger than 51 years of age). This effect was independent of injury severity (GCS) scores, which were not different in male and female patients. Female patients younger than 50 years tended to have worse outcomes, but the difference was not statistically significant. Thus, female patients who sustain severe head injury, especially (presumably) premenopausal ones aged 50 years and younger, are significantly more likely to experience brain swelling and intracranial hypertension than male patients with a comparable injury severity, suggesting that younger women may benefit from more aggressive monitoring and treatment of intracranial hypertension.
authors.affiliation: Department of Family and Preventive Medicine, University of California School of Medicine, San Diego, La Jolla, California 92037, USA.
authors.forename: Azadeh
authors.initials: A
authors.lastname: Farin
authors.forename: Reena
authors.initials: R
authors.lastname: Deutsch
authors.forename: Anat
authors.initials: A
authors.lastname: Biegon
authors.forename: Lawrence F
authors.initials: LF
authors.lastname: Marshall
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001929:Brain Edema / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D001930:Brain Injuries / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D019586:Intracranial Hypertension / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012737:Sex Factors; D014057:Tomography, X-Ray Computed; D015599:Trauma Severity Indices