John K Yue1,2, Harvey S Levin3, Catherine G Suen4, Molly Rose Morrissey1,2, Sarah J Runyon1,2, Ethan A Winkler1,2, Ross C Puffer5,6, Hansen Deng1,2, Caitlin K Robinson1,2, Jonathan W Rick1,2, Ryan R L Phelps1,2, Sourabh Sharma1,2, Sabrina R Taylor1,2, Mary J Vassar1,2, Maryse C Cnossen7, Hester F Lingsma7, Raquel C Gardner8,9, Nancy R Temkin10, Jason Barber10, Sureyya S Dikmen11, Esther L Yuh2,12, Pratik Mukherjee2,12, Murray B Stein13, Tene A Cage1,2, Alex B Valadka14, David O Okonkwo6, Geoffrey T Manley1,2. 1. a Department of Neurological Surgery , University of California San Francisco , San Francisco , CA , USA. 2. b Brain and Spinal Injury Center , Zuckerberg San Francisco General Hospital , San Francisco , CA , USA. 3. c Departments of Neurology and Neurosurgery , Baylor College of Medicine , Houston , TX , USA. 4. d Department of Neurology , University of Utah , Salt Lake City , UT , USA. 5. e Department of Neurological Surgery , Mayo Clinic , Rochester , MN , USA. 6. f Department of Neurological Surgery , University of Pittsburgh Medical Center , Pittsburgh , PA , USA. 7. g Department of Public Health , Erasmus Medical Center , Rotterdam , The Netherlands. 8. h Department of Neurology , University of California San Francisco , San Francisco , CA , USA. 9. i Department of Neurology , Veterans Affairs Medical Center , San Francisco , CA , USA. 10. j Departments of Neurological Surgery and Biostatistics , University of Washington , Seattle , WA , USA. 11. k Department of Rehabilitation Medicine , University of Washington , Seattle , WA , USA. 12. l Department of Radiology , University of California San Francisco , San Francisco , CA , USA. 13. m Departments of Psychiatry and Family Medicine , University of California San Diego , San Diego , CA , USA. 14. n Department of Neurological Surgery , Virginia Commonwealth University , Richmond , VA , USA.
Abstract
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.
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.
Entities:
Keywords:
Age factors; common data elements; functional disability; mild traumatic brain injury (mTBI); post-traumatic stress disorder (PTSD); risk factors; sex; young adults
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