Sex Differences in the Outcomes of Mild Traumatic Brain Injury in Children Presenting to the Emergency Department

Abstract

Sex differences after concussion have been studied largely in high school and college athletes, often without reference to comparison groups without concussion. This study sought to evaluate sex differences in outcomes among all children and adolescents presenting to the Emergency Department (ED) for either mild traumatic brain injury (TBI) or orthopedic injury (OI), regardless of mechanism of injury. The study involved a concurrent cohort, prospective study design with longitudinal follow-up. Participants were eight to 16 years old with mild TBI (n = 143) or OI (n = 73). They were recruited and completed an initial assessment at EDs at two children's hospitals. They returned for a post-acute assessment within two weeks of injury and for follow-up assessments at three and six months. Outcomes included child and parent proxy ratings of somatic and cognitive symptoms, and standardized tests of cognitive functioning and balance. Sex did not moderate group differences in balance, fluid or crystallized cognitive ability, or child or parent proxy ratings of somatic or cognitive symptoms. Both parents and children reported more somatic symptoms in girls than boys, but in both groups. Compared with the OI group, the mild TBI group showed significantly lower fluid cognitive ability at the post-acute assessment and significantly higher somatic and cognitive symptoms according to both child and parent proxy ratings across the first two weeks post-injury. The results suggest that sex does not moderate the outcomes of mild TBI in a pediatric ED population. Previous research pointing to sex differences after concussion may reflect the lack of comparison groups, as well as a focus on adolescents and young adults and sport-related concussion. Future research should investigate whether sex moderates the outcomes of pediatric mild TBI in adolescents but not in pre-adolescent children.

Keywords: concussion; outcome; pediatric; sex; traumatic brain injury.

FIG. 1.

Model estimates (M, 95% confidence interval) of performance on the National Institutes of Health Toolbox Cognition Battery fluid cognition composite by group. TBI, traumatic brain injury; OI, orthopedic injury.

FIG. 2.

Model estimates (M, 95% confidence interval) of ratings on the Health and Behavior Inventory Child (HBI-C) and Parent (HBI-P) forms. (a) Child self-ratings of somatic symptoms. (b) Parent proxy ratings of somatic symptoms. (c) Child self-ratings of cognitive symptoms. (d) Parent proxy ratings of cognitive symptoms. OI, orthopedic injury; TBI, traumatic brain injury.