TY - JOUR
T1 - Age and sex-mediated differences in six-month outcomes after mild traumatic brain injury in young adults
T2 - a TRACK-TBI study
AU - the TRACK-TBI Investigators
AU - Yue, John K.
AU - Levin, Harvey S.
AU - Suen, Catherine G.
AU - Morrissey, Molly Rose
AU - Runyon, Sarah J.
AU - Winkler, Ethan A.
AU - Puffer, Ross C.
AU - Deng, Hansen
AU - Robinson, Caitlin K.
AU - Rick, Jonathan W.
AU - Phelps, Ryan R.L.
AU - Sharma, Sourabh
AU - Taylor, Sabrina R.
AU - Vassar, Mary J.
AU - Cnossen, Maryse C.
AU - Lingsma, Hester F.
AU - Gardner, Raquel C.
AU - Temkin, Nancy R.
AU - Barber, Jason
AU - Dikmen, Sureyya S.
AU - Yuh, Esther L.
AU - Mukherjee, Pratik
AU - Stein, Murray B.
AU - Cage, Tene A.
AU - Valadka, Alex B.
AU - Okonkwo, David O.
AU - Manley, Geoffrey T.
N1 - Funding Information:
Dr. Harvey S. Levin, PhD Professor in the Department of Physical Medicine & Rehabilitation, Baylor College of Medicine. He is also a Research Scientist at the Michael E. De Bakey Veterans Affairs Medical Center, Houston. Dr. Levin is a partnering PI on a VA Merit Review grant concerning functional MRI in Veterans who sustained mild TBI which is frequently complicated by post-traumatic stress disorder. Dr. Levin is also a partnering PI on an NIH grant concerning biomarkers and brain imaging in high school athletes who have been cleared to return to play following a concussion. Other relevant experience includes his DoD funded research on the chronic effects of neurotrauma. Dr. Levin is the recipient of a Distinguished Career Award by the International Neuropsychological Society.
Funding Information:
Dr. Raquel C. Gardner, MD is an Assistant Professor at the UCSF. Dr. Gardner received her MD from Harvard Medical School and completed residency in neurology and clinical fellowship in behavioral neurology at UCSF, followed by a postdoctoral fellowship in dementia epidemiology at the San Francisco VA Medical Center and a certificate program in advanced training in clinical research methods and biostatistics at the UCSF Clinical and Translational Science Institute. She is faculty in the UCSF/SFVAMC Center for Population Brain Health and leads the geriatric TBI interest group as part of the TBI Endpoints Development (TED) initiative.
Funding Information:
Mr. Ryan R. L. Phelps, BA is a Medical Student at UCSF, and a current research fellow at the National Institutes of Health (NIH), with focus in neurosurgery.
Funding Information:
This work was supported by the following grants: National Institute of Neurological Disorders and Stroke [1RC 2NS069409-01]; [3RC2NS069409-02S1]; [5RC2NS069409-02]; [1U01NS086090-01]; [3U01NS086090-02S1]; [3U01 NS086090-02S2]; [5U01NS086090-03]; [3U01NS086090-03S1]; [5U01NS086090-02];U.S. Department of Defense [W81XWH-13-1-0441];U.S. Department of Defense [W81XWH-14-2-0176] (to G. T. M.).
Publisher Copyright:
© 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group.
PY - 2019/7/3
Y1 - 2019/7/3
N2 - Introduction: Risk factors for young adults with mTBI are not well understood. Improved understanding of age and sex as risk factors for impaired six-month outcomes in young adults is needed. Methods: Young adult mTBI subjects aged 18–39 years (18-29y; 30-39y) with six-month outcomes were extracted from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot (TRACK-TBI Pilot) study. Multivariable regressions were performed for outcomes with age, sex, and the interaction factor age-group*sex as variables of interest, controlling for demographic and injury variables. Mean-differences (B) and 95% CIs are reported. Results: One hundred mTBI subjects (18-29y, 70%; 30-39y, 30%; male, 71%; female, 29%) met inclusion criteria. On multivariable analysis, age-group*sex was associated with six-month post-traumatic stress disorder (PTSD; PTSD Checklist-Civilian version); compared with female 30-39y, female 18-29y (B= −19.55 [−26.54, −4.45]), male 18-29y (B= −19.70 [−30.07, −9.33]), and male 30-39y (B= −15.49 [−26.54, −4.45]) were associated with decreased PTSD symptomatology. Female sex was associated with decreased six-month functional outcome (Glasgow Outcome Scale-Extended (GOSE): B= −0.6 [1.0, −0.1]). Comparatively, 30-39y scored higher on six-month nonverbal processing speed (Wechsler Adult Intelligence Scale-Processing Speed Index (WAIS-PSI); B= 11.88, 95% CI [1.66, 22.09]). Conclusions: Following mTBI, young adults aged 18-29y and 30-39y may have different risks for impairment. Sex may interact with age for PTSD symptomatology, with females 30-39y at highest risk. These results may be attributable to cortical maturation, biological response, social modifiers, and/or differential self-report. Confirmation in larger samples is needed; however, prevention and rehabilitation/counseling strategies after mTBI should likely be tailored for age and sex.
AB - Introduction: Risk factors for young adults with mTBI are not well understood. Improved understanding of age and sex as risk factors for impaired six-month outcomes in young adults is needed. Methods: Young adult mTBI subjects aged 18–39 years (18-29y; 30-39y) with six-month outcomes were extracted from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot (TRACK-TBI Pilot) study. Multivariable regressions were performed for outcomes with age, sex, and the interaction factor age-group*sex as variables of interest, controlling for demographic and injury variables. Mean-differences (B) and 95% CIs are reported. Results: One hundred mTBI subjects (18-29y, 70%; 30-39y, 30%; male, 71%; female, 29%) met inclusion criteria. On multivariable analysis, age-group*sex was associated with six-month post-traumatic stress disorder (PTSD; PTSD Checklist-Civilian version); compared with female 30-39y, female 18-29y (B= −19.55 [−26.54, −4.45]), male 18-29y (B= −19.70 [−30.07, −9.33]), and male 30-39y (B= −15.49 [−26.54, −4.45]) were associated with decreased PTSD symptomatology. Female sex was associated with decreased six-month functional outcome (Glasgow Outcome Scale-Extended (GOSE): B= −0.6 [1.0, −0.1]). Comparatively, 30-39y scored higher on six-month nonverbal processing speed (Wechsler Adult Intelligence Scale-Processing Speed Index (WAIS-PSI); B= 11.88, 95% CI [1.66, 22.09]). Conclusions: Following mTBI, young adults aged 18-29y and 30-39y may have different risks for impairment. Sex may interact with age for PTSD symptomatology, with females 30-39y at highest risk. These results may be attributable to cortical maturation, biological response, social modifiers, and/or differential self-report. Confirmation in larger samples is needed; however, prevention and rehabilitation/counseling strategies after mTBI should likely be tailored for age and sex.
KW - Age factors
KW - common data elements
KW - functional disability
KW - mild traumatic brain injury (mTBI)
KW - post-traumatic stress disorder (PTSD)
KW - risk factors
KW - sex
KW - young adults
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U2 - 10.1080/01616412.2019.1602312
DO - 10.1080/01616412.2019.1602312
M3 - Article
C2 - 31007155
AN - SCOPUS:85064671731
SN - 0161-6412
VL - 41
SP - 609
EP - 623
JO - Neurological Research
JF - Neurological Research
IS - 7
ER -