Study Reveals Significant Gender Disparities in Traumatic Brain Injury Outcomes

Women who experience a traumatic brain injury (TBI) fare worse than men, according to a new Houston Methodist study that will be featured at the upcoming American Association of Neurological Surgeons' annual meeting.

Among patients undergoing craniectomy procedures for TBI, women had higher complication rates and more systemic sepsis, prolonged ventilator use, urinary tract infections and blood transfusions than their male counterparts, Houston Methodist researchers found.

The study found no significant gender differences in mortality rates.

"We aren't sure why women are more susceptible to complications following a traumatic brain injury than men — if it's the result of the injury itself or the surgery to fix the injury — but the good news is that women appear to be able to overcome these challenges and still survive," said Dr. Amir Faraji, director of Functional Neurosurgery at Houston Methodist and a co-author of the study. "The question then becomes: does it affect their longer-term outcomes and quality of life, and how can we prevent the complications from occurring in the first place?"

Dr. Faraji and co-author Dr. Monique Mitchell, a Houston Methodist research fellow, will co-present the study at AANS, which is being held in Chicago April 25 to 28.

The Houston Methodist team examined national surgical data, taken from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), for over 2,500 patients who underwent craniectomy procedures for TBI between 2016 and 2021.

Dr. Faraji says the results indicate a need for health care providers to consider gender differences in TBI management. He noted that female patients exhibited higher frailty levels, with 42% experiencing moderate frailty compared to 37% of males.

Other differences included female patients experiencing higher rates of complications within 30 days after surgery. Approximately 44.9% of female patients suffered increased morbidity, compared to 38.7% of male patients.

Male patients had a slightly higher incidence of pneumonia.

Recognizing these differences could help clinicians better assess risks and improve treatment outcomes for TBI patients.

The research is part of a broader initiative at Houston Methodist aimed at using machine learning to develop predictive models for TBI patient outcomes. By leveraging extensive national datasets, the team hopes to create tailored and proactive treatment strategies for patients based on individualized risk factors and predictive analytics.

The study also aligns with broader national efforts, such as the NIH-funded Track TBI initiative, aimed at improving understanding and treatment strategies for patients affected by TBI.

Dr. Faraji believes predictive analytics developed from these studies could lead to significant improvements in patient care, including earlier and more aggressive interventions for high-risk patients.

"Traumatic brain injury research over the past 10 to 20 years has come a long way, to the point where we now have a blood test that can tell us whether an emergency room patient needs to be imaged for a brain bleed or not," Dr. Faraji noted. "An effective risk prediction algorithm could similarly revolutionize current treatment practices by ensuring that higher risk patients get routed down the correct rehabilitation paths while lower risk patients avoid unnecessary procedures and associated risks and health care costs."