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Archives of Public Health
Published in: Archives of Public Health 1/2017

Open Access 01-12-2017 | Research

Effect of sex and age on traumatic brain injury: a geographical comparative study

Authors: Raaj Kishore Biswas, Enamul Kabir, Rachel King

Published in: Archives of Public Health | Issue 1/2017

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Abstract

Background

Traumatic brain injury (TBI) is a much researched topic in medical health, which requires additional studies to understand various effects of demographic and geographic factors that can assist in developing the most effective treatments. Thousands of people of different ages are suffering from lifelong disabilities, either mild or severe, from TBI and the number is increasing. This study aims to increase our understanding of the effect of sex and age by applying five different statistical methods to evaluate the effect of these covariates on two independent TBI data sets representing patients from different geographical cohorts. A primary data was collected from Bangladesh and it was compared with CRASH (Corticosteroid Randomisation after Significant Head Injury) data, representing various countries around the world.

Methods

The outcome variable for TBI considered in this paper is Glasgow Outcome Scale, which is a four point scale. It was converted to a binary outcome scale for fitting of Fisher’s exact test, a test of proportions and a binary linear model. For analyzing ordinal outcomes, the proportional odds model and the sliding dichotomy model were fitted. As the sample size of the Bangladeshi data set was small, parametric bootstrapping was applied for the consistency of results.

Results

Females were the worse sufferers of TBI compared to men, according to CRASH data set. The old (aged above 58 years) followed by adults (age 25 to 58) were the most vulnerable victims. Interaction effects concluded that old women tended to endure the worst outcomes of TBI. This conclusion came from the CRASH data set representing the world in general, whereas such effects were not present in the Bangladesh data set. Additional application of parametric bootstrapping for the smaller Bangladesh data set did not result into any significant outcome.

Conclusion

The effect of gender and age could be stronger in some countries than others which is driving the significance in CRASH and was not found in Bangladesh. It reflects the necessity of incorporating geographic patterns as well as demographic features of patients while developing treatments and designing clinical trials.
Literature
1.
McHugh GS, Butcher I, Steyerberg EW, Marmarou A, Lu J, Lingsma HF, Weir J, Maas AI, Murray GD. A simulation study evaluating approaches to the analysis of ordinal outcome data in randomized controlled trials in traumatic brain injury: results from the impact project. Clin Trials. 2010; 7(1):44–57.CrossRefPubMed
2.
Menon DK, Schwab K, Wright DW, Maas AI, et al. Position statement: definition of traumatic brain injury. Arch Phys Med Rehabil. 2010; 91(11):1637–40.CrossRefPubMed
3.
Faul M, Xu L, Wald MM, Coronado VG. Traumatic Brain Injury in the United States. Atlanta: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2010.
4.
Tiesman HM, Konda S, Bell JL. The epidemiology of fatal occupational traumatic brain injury in the us. Am J Prev Med. 2011; 41(1):61–7.CrossRefPubMed
5.
Reeves RH, Beltzman D, Killu K. Implications of traumatic brain injury for survivors of sexual abuse: A preliminary report of findings. Rehabil Psychol. 2000; 45(2):205.CrossRef
6.
Maas AI, Menon DK, Lingsma HF, Pineda JA, Sandel ME, Manley GT. Re-orientation of clinical research in traumatic brain injury: report of an international workshop on comparative effectiveness research. J Neurotrauma. 2012; 29(1):32–46.CrossRefPubMedPubMedCentral
7.
Rutland-Brown W, Langlois JA, Thomas KE, Xi YL, et al. Incidence of traumatic brain injury in the united states, 2003. J Head Trauma Rehabil. 2006; 21(6):544.CrossRefPubMed
8.
National Center for Injury Prevention and Control (US). Report to Congress on Mild Traumatic Brain Injury in the United States: Steps to Prevent a Serious Public Health Problem. Atlanta: Centers for Disease Control and Prevention; 2003.
9.
Maas AI, Marmarou A, Murray GD, Teasdale SGM, Steyerberg EW. Prognosis and clinical trial design in traumatic brain injury: the impact study. J Neurotrauma. 2007; 24(2):232–8.CrossRefPubMed
10.
Varrone A, Dickson JC, Tossici-Bolt L, Sera T, Asenbaum S, Booij J, Kapucu OL, Kluge A, Knudsen GM, Koulibaly PM, et al. European multicentre database of healthy controls for [123i] fp-cit spect (enc-dat): age-related effects, gender differences and evaluation of different methods of analysis. Eur J Nucl Med Mol Imaging. 2013; 40(2):213–27.CrossRefPubMed
11.
Kraus JF, Peek-Asa C, McArthur D. The independent effect of gender on outcomes following traumatic brain injury: a preliminary investigation. Neurosurg Focus. 2000; 8(1):1–7.CrossRef
12.
Klauber MR, Marshall LF, Barrett-Connor E, Bowers SA. Prospective study of patients hospitalized with head injury in san diego county, 1978. Neurosurgery. 1981; 9(3):236–41.PubMed
13.
Rutherford W, Merrett J, McDonald J. Symptoms at one year following concussion from minor head injuries. Injury. 1979; 10(3):225–30.CrossRefPubMed
14.
Bazarian JJ, Atabaki S. Predicting postconcussion syndrome after minor traumatic brain injury. Acad Emerg Med. 2001; 8(8):788–95.CrossRefPubMed
15.
Fenton G, McClelland R, Montgomery A, MacFlynn G, Rutherford W. The postconcussional syndrome: social antecedents and psychological sequelae. Br J Psychiatr. 1993; 162(4):493–7.CrossRef
16.
Ponsford J, WILLMOTT C, Rothwell A, Cameron P, Kelly AM, Nelms R, Curran C, Ng K. Factors influencing outcome following mild traumatic brain injury in adults. J Int Neuropsychol Soc. 2000; 6(05):568–79.CrossRefPubMed
17.
Rimel RW, Giordani B, Barth JT, Boll TJ, Jane JA. Disability caused by minor head injury. Neurosurgery. 1981; 9(3):221–8.PubMed
18.
Marion DW, Penrod LE, Kelsey SF, Obrist WD, Kochanek PM, Palmer AM, Wisniewski SR, DeKosky ST. Treatment of traumatic brain injury with moderate hypothermia. N Engl J Med. 1997; 336(8):540–6.CrossRefPubMed
19.
Pentland B, Jones PA, Roy CW, Miller JD. Head injury in the elderly. Age Ageing. 1986; 15(4):193–202.CrossRefPubMed
20.
Farace E, Alves WM. Do women fare worse: a metaanalysis of gender differences in traumatic brain injury outcome. J Neurosurg. 2000; 93(4):539–45.CrossRefPubMed
21.
Gómez PA, Lobato R, Boto G, De la Lama A, González P, De la Cruz J. Age and outcome after severe head injury. Acta Neurochir. 2000; 142(4):373–81.CrossRefPubMed
22.
Carroll L, Cassidy JD, Peloso P, Borg J, Von Holst H, Holm L, Paniak C, Pépin M. Prognosis for mild traumatic brain injury: results of the who collaborating centre task force on mild traumatic brain injury. J Rehabil Med. 2004; 36(0):84–105.CrossRef
23.
Susman M, DiRusso SM, Sullivan T, Risucci D, Nealon P, Cuff S, Haider A, Benzil D. Traumatic brain injury in the elderly: increased mortality and worse functional outcome at discharge despite lower injury severity. J Trauma Acute Care Surg. 2002; 53(2):219–24.CrossRef
24.
Mosenthal AC, Livingston DH, Lavery RF, Knudson MM, Lee S, Morabito D, Manley GT, Nathens A, Jurkovich G, Hoyt DB, et al. The effect of age on functional outcome in mild traumatic brain injury: 6-month report of a prospective multicenter trial. J Trauma Acute Care Surg. 2004; 56(5):1042–8.CrossRef
25.
Heiskanen O, Sipponen P. Prognosis of severe brain injury. Acta Neurologica Scandinavica. 1970; 46(3):343–8.CrossRefPubMed
26.
27.
Guralnik JM. Assessing the impact of comorbidity in the older population. Ann Epidemiol. 1996; 6(5):376–80.CrossRefPubMed
28.
Lakatta EG. Age-associated cardiovascular changes in health: impact on cardiovascular disease in older persons. Heart Fail Rev. 2002; 7(1):29–49.CrossRefPubMed
29.
Seeman TE, Guralnik JM, Kaplan GA, Knudsen L, Cohen R. The health consequences of multiple morbidity in the elderly the alameda county study. J Aging Health. 1989; 1(1):50–66.CrossRefPubMed
30.
van Reekum R, Simard M, Cohen T. The prediction and prevention of alzheimer’s disease–towards a research agenda. J Psychiatry Neurosci. 1999; 24(5):413.PubMedPubMedCentral
31.
Glenn MB, O’Neil-Pirozzi T, Goldstein R, Burke D, Jacob L. Depression amongst outpatients with traumatic brain injury. Brain Inj. 2001; 15(9):811–8.CrossRefPubMed
32.
Collaborators CT, et al. Final results of mrc crash, a randomised placebo-controlled trial of intravenous corticosteroid in adults with head injury outcomes at 6 months. The Lancet. 2005; 365(9475):1957–9.CrossRef
33.
34.
Jennett B, Bond M. Assessment of outcome after severe brain damage: a practical scale. The Lancet. 1975; 305(7905):480–4.CrossRef
35.
Eisenstadt SN. From Generation to Generation: Age Groups and Social Structure. Piscataway: Transaction Publishers; 1956.
36.
Murray GD, Barer D, Choi S, Fernandes H, Gregson B, Lees KR, Maas AI, Marmarou A, Mendelow AD, Steyerberg EW, et al. Design and analysis of phase iii trials with ordered outcome scales: the concept of the sliding dichotomy. J Neurotrauma. 2005; 22(5):511–7.CrossRefPubMed
37.
Ilodigwe D, Stat M, Murray GD, Kassell NF, Torner J, Kerr RS, Molyneux AJ, Macdonald RL. Sliding dichotomy compared with fixed dichotomization of ordinal outcome scales in subarachnoid hemorrhage trials: Clinical article. J Neurosurg. 2013; 118(1):3–12.CrossRefPubMed
38.
Fisher RA. On the interpretation of χ 2 from contingency tables, and the calculation of p. J R Stat Soc. 1922; 85(1):87–94.CrossRef
39.
Upton GJG. Fisher’s exact test. J R Stat Soc Ser A (Stat Soc). 1992; 155:395–402.CrossRef
40.
Wilson EB. Probable inference, the law of succession, and statistical inference. J Am Stat Assoc. 1927; 22(158):209–12.CrossRef
41.
Cox DR. Regression models and life-tables. J R Stat Soc Ser B (Methodol). 1972; 34:187–220.
42.
Hosmer Jr DW, Lemeshow S. Applied Logistic Regression. Milton: John Wiley & Sons; 2004.
43.
Dobson AJ, Barnett A. An Introduction to Generalized Linear Models. Boca Raton: CRC press; 2008.
44.
45.
Roozenbeek B, Lingsma HF, Perel P, Edwards P, Roberts I, Murray GD, Maas A, Steyerberg EW, et al. The added value of ordinal analysis in clinical trials: an example in traumatic brain injury. Crit Care. 2011; 15(3):127.CrossRef
46.
Price M, Hertzberg V, Wright DW. Does the sliding dichotomy result in higher powered clinical trials for stroke and traumatic brain injury research?Clin Trials. 2013; 10(6):924–34.CrossRefPubMed
Metadata
Title
Effect of sex and age on traumatic brain injury: a geographical comparative study
Authors
Raaj Kishore Biswas
Enamul Kabir
Rachel King
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Archives of Public Health / Issue 1/2017
Electronic ISSN: 2049-3258
DOI
https://doi.org/10.1186/s13690-017-0211-y

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