Sex differences in symptom presentation and functional outcomes: a pilot study in a matched sample of veterans with mild TBI

ABSTRACT

Primary Objective: Research focused on mild traumatic brain injury in active military and veteran populations details the psychological, neurological and functional outcomes of mTBI, in a primarily male (~95%) cohort. This may misrepresent female symptoms and outcomes. Here we assess for genuine sex differences in symptom presentation and functional outcomes.

Research Design: We used matched pairs to preclude potential sex bias in outcome data.

Methods and Procedures: We matched 49 female/male pairs on; 1) mechanism of injury, 2) time from injury to assessment and 3) age at assessment. Statistics were t-tests, chi-square, correlations and post hoc linear regression.

Main outcomes and results: Outcome assessment revealed four significant (p < .05) sex differences; Living situation, Marital status, Vocation and Branch of service. Only the Neurobehavioral Symptom Inventory (NSI) composite cognitive domain factor was significantly different between females (mean: 10.26) and males (mean: 7.58). Linear regression confirmed a significant effect of sex for the cognitive composite (p = .002).

Conclusion: We conclude that sex has a moderate effect on mTBI post-concussive symptom presentation. The significant sex difference in the NSI cognitive domain characterizes sex-related symptomology profiles providers can focus on for better rehabilitation management. Replication in the larger cohort would improve generalizability.

Abbreviation: TBI: Traumatic Brain Injuries; mTBI: mild Traumatic Brain Injuries; OIF: Operation Iraqi Freedom; OEF: Operation Enduring Freedom; VA: Veterans Affairs Health Care System; PSC: Polytrauma System of Care; PRC: Polytrauma Rehabilitation Center; PTRP: Polytrauma Transitional Rehabilitation Program; PNS: Polytrauma Network Site; PTSD: Post Traumatic Stress Disorder; DoD: Department of Defense; NSI: Neurobehavioral Symptom Inventory; LOC: loss of consciousness; AOC: alteration of consciousness; PTA: posttraumatic amnesia; CPRS: computerized patient record system; CTBIE: Comprehensive TBI Evaluation; OCD: obsessive compulsive disorder; ETOH: alcohol abuse

KEYWORDS:

• Sex
• Traumatic Brain Injury
• Veterans
• Symptoms
• Living Situation

Disclaimers

There are no disclaimers

Conflict of Interest Declaration

No conflicts of interest exist for any of the authors. This work was funded by the Clayman Institute for Gender Research at Stanford University awarded to Dr. Odette Harris. We acknowledge the support of Defense and Veterans Brain Injury Center (DVBIC), VA Palo Alto Health Care System Polytrauma Department and Department of Neurosurgery at Stanford School of Medicine.

Additional information

Funding

This work was funded by the Clayman Institute for Gender Research at Stanford University awarded to Dr. Odette Harris. We acknowledge the support of Defense and Veterans Brain Injury Center (DVBIC), VA Palo Alto Health Care System Polytrauma Department and Department of Neurosurgery at Stanford School of Medicine.