Association of Sex and Age With Mild Traumatic Brain Injury–Related Symptoms: A TRACK-TBI Study

• DOI: 10.1001/jamanetworkopen.2021.3046
• Publication Date: 2021-04-06T15:37:56Z
• Authors: Harvey S. Levin; Nancy R. Temkin; Jason Barber; Lindsay D. Nelson; Claudia Robertson; Jeffrey Brennan; Murray B. Stein; John K. Yue; Joseph T. Giacino; Michael A. McCrea; Ramon Diaz-Arrastia; Pratik Mukherjee; David O. Okonkwo; Kim Boase; Amy J. Markowitz; Yelena Bodien; Sabrina Taylor; Mary J. Vassar; Geoffrey T. Manley; ; Opeolu Adeoye; Neeraj Badjatia; M. Ross Bullock; Randall Chesnut; John D. Corrigan; Karen Crawford; Sureyya Dikmen; Ann-Christine Duh...; Richard Ellenbogen; V. Ramana Feeser; Adam R. Ferguson; Brandon Foreman; Raquel Gardner; Etienne Gaudette; Luis Gonzalez; Shankar Gopinath; Rao Gullapalli; J. Claude Hemphill; Gillian Hotz; Sonia Jain; C. Dirk Keene; Frederick K. Korley; Joel Kramer; Natalie Kreitzer; Chris Lindsell; Joan Machamer; Christopher Madden; Alastair Martin; Thomas McAllister; Randall Merchant; Amber Nolan; Laura B. Ngwenya; Florence Noel; Eva Palacios; Ava Puccio; Miri Rabinowitz; Jonathan Rosand; Angelle Sander; Gabriella Satris; David Schnyer; Seth Seabury; Xiaoying Sun; Arthur Toga; Alex Valadka; Kevin Wang; Esther Yuh; Ross Zafonte
• Keywords: Post-concussion syndrome; Depression

<h3>Importance</h3> Knowledge of differences in mild traumatic brain injury (mTBI) recovery by sex and age may inform individualized treatment these patients. <h3>Objective</h3> To identify sex-related symptom from mTBI; secondarily, to explore within women, who demonstrate poorer outcomes after TBI. <h3>Design, Setting, Participants</h3> The prospective cohort study Transforming Research Clinical Traumatic Brain Injury (TRACK-TBI) recruited 2000 patients with mTBI February 26, 2014, July 3, 2018, 299 orthopedic trauma (who served as controls) January 2016, 27, 2018. Patients were 18 level I centers followed up for 12 months. Data analyzed August 19, 2020, March 2021. <h3>Exposures</h3> (defined a Glasgow Coma Scale score 13-15) triaged head computed tomography 24 hours or less; controls. <h3>Main Outcomes Measures</h3> Measured included (1) the Rivermead Post Concussion Symptoms Questionnaire (RPQ), 16-item self-report scale that assesses postconcussion severity over past 7 days relative preinjury; (2) Posttraumatic Stress Disorder Checklist the<i>Diagnostic Statistical Manual Mental Disorders</i>(Fifth Edition) (PCL-5), 20-item test measures posttraumatic stress disorder symptoms; (3) Patient Health Questionnaire-9 (PHQ-9), 9-item depression based on frequency 2 weeks; (4) Brief Symptom Inventory-18 (BSI-18), an 18-item psychological distress (split into Depression Anxiety subscales). <h3>Results</h3> A total (1331 men [67%; mean (SD) age, 41.0 (17.3) years; 1026 White (78%)] 669 women [33%; 43.0 (18.5) 505 (76%) White]). After adjustment multiple comparisons, significant TBI × interactions observed cognitive symptoms (B = 0.76; 5% false discovery rate–corrected<i>P</i> .02) somatic RPQ 0.80; .02), worse than men, but no difference control trauma. Within female evaluated, there was interaction symptoms, which aged 35 49 years compared those 17 34 1.65;<i>P</i> older 50 1.66;<i>P</i> .02). <h3>Conclusions Relevance</h3> This found more vulnerable persistent mTBI-related whereas burden seen injury. Postconcussion also younger further investigation is needed corroborate findings mechanisms involved. Results suggest clinical management should consider some are especially predisposed chronic even months