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Are boys and girls that different? An analysis of traumatic brain injury in children
Niamh C Collins1, Michal Molcho, Peter Carney
1Department of Emergency Medicine, Connolly Hospital, Dublin, Ireland. nievoc@yahoo.co.uk
Insights
Gender differences in traumatic brain injury (TBI) emerge in infancy. Boys experience more severe injuries and higher mortality rates from TBI compared to girls, despite similar overall injury severity.
Area of Science:
- Pediatrics
- Neuroscience
- Public Health
Background:
- Traumatic brain injury (TBI) disproportionately affects males, with gender differences noted in childhood.
- Previous research indicated a higher incidence of TBI in males.
Purpose of the Study:
- To determine the age of emergence for gender differences in pediatric TBI.
- To analyze the impact of gender on TBI mechanisms, injury types, severity, and outcomes.
Main Methods:
- A 2-year prospective, observational national study included all pediatric patients (<17 years) referred for TBI.
- Data collected included demographics, injury circumstances, type, severity, management, and outcomes from neurosurgical records.
Main Results:
- Falls were the most common cause of TBI for both genders.
- Boys sustained higher-energy injuries, engaged in riskier behaviors, and had higher rates of associated non-brain injuries and mortality (4.3% vs. 1.8% in girls).
- Intentional injuries occurred only in boys; extradural hematomas were more common in boys (p=0.014), subdural hematomas in girls (p=0.011).
Conclusions:
- Gender differences in TBI are evident from infancy.
- Boys face higher risks due to greater energy transfer, less protective device use, and deliberate injury, leading to varied injury patterns and increased mortality.
- Falls at home are the primary cause of TBI in children.
Introduction:
The Phillips Report on traumatic brain injury (TBI) in Ireland found that injury was more frequent in men and that gender differences were present in childhood. This study determined when gender differences emerge and examined the effect of gender on the mechanism of injury, injury type and severity and outcome.
Methods:
A national prospective, observational study was conducted over a 2-year period. All patients under 17 years of age referred to a neurosurgical service following TBI were included. Data on patient demographics, events surrounding injury, injury type and severity, patient management and outcome were collected from 'on-call' logbooks and neurosurgical admissions records.
Results:
342 patients were included. Falls were the leading cause of injury for both sexes. Boys' injuries tended to involve greater energy transfer and involved more risk-prone behaviour resulting in a higher rate of other (non-brain) injury and a higher mortality rate. Intentional injury occurred only in boys. While injury severity was similar for boys and girls, significant gender differences in injury type were present; extradural haematomas were significantly higher in boys (p=0.014) and subdural haematomas were significantly higher in girls (p=0.011). Mortality was 1.8% for girls and 4.3% for boys.
Conclusions:
Falls were responsible for most TBI, the home is the most common place of injury and non-operable TBI was common. These findings relate to all children. Significant gender differences exist from infancy. Boys sustained injuries associated with a greater energy transfer, were less likely to use protective devices and more likely to be injured deliberately. This results in a different pattern of injury, higher levels of associated injury and a higher mortality rate.