Research Reports - Are boys and girls that different? An analysis of traumatic brain injury in children

Emerg Med J. 2012 Sep 8

Collins NC, Molcho M, Carney P, McEvoy L, Geoghegan L, Phillips JP, Nicholson AJ

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.

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