In Brief | Critical Care & Emergency Medicine | Gerontology
New Study Reviews Gender Differences In Injury Patterns and Clinical Presentation in the Elderly with Mild Traumatic Brain Injury
Time to read: 02:35
Time to listen: 05:21
Originally Published: 19 June 2025
Source: International Journal of Emergency Medicine
Type of article: In Brief
MedED Catalogue Reference: MCCIB018
Category: Critical Care & Emergency Medicine
Cross Reference: Geriatrics, Neurology
Keywords: TBI, Geriatrics, sub-cranial haemorrhage, sub-arachnoid haemorrhage, mortality
This article is a non-commercial summary based on the study: Šechný, P., et al. (2024). “Sex-specific patterns of injury and clinical presentation in older adults with mild traumatic brain injury and intracranial bleeding: a retrospective cohort study.” International Journal of Emergency Medicine. https://doi.org/10.1186/s12245-024-00565-5.Licensed under CC BY-NC-ND 4.0 . No changes were made to the original findings. This article does not represent the original research, nor is it intended to replace the original research. Access the full Disclaimer Information.
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Study Context and Purpose
Mild traumatic brain injury (mTBI) is a common emergency department diagnosis among the elderly, a population with complex physiological changes, increased frailty, and frequent comorbidities.
Age-related factors such as brain atrophy and vascular fragility heighten the risk of complications, including intracranial bleeding, which occurs in approximately 5% of elderly mTBI cases.1
Evidence suggests that sex differences in brain structure, hormonal influences, and psychiatric history may influence injury patterns and outcomes, with older females more prone to persistent symptoms and poorer recovery.2,3
However, findings on sex-related differences in TBI remain inconsistent, and limited data exist on sex-specific presentations of geriatric mTBI complicated by intracranial bleeding. Understanding these differences is crucial for improving diagnosis and personalising care.
The Study in Summary
In this context, this retrospective cohort study conducted at Louis Pasteur University Hospital in Košice, Slovak Republic, investigated how gender influences injury patterns, clinical symptoms, and outcomes in older adults with mild traumatic brain injury (mTBI) complicated by intracranial bleeding.
The study, published in the International Journal of Emergency Medicine, included 117 patients aged 65 years and older (62 males and 55 females), all of whom were admitted within 48 hours of injury.
The researchers found clear gender-related differences across several parameters including:
Notably, clinical symptom presentation varied by sex: males more frequently exhibited amnesia and loss of consciousness, whereas females reported more diffuse or multiple concurrent symptoms, with no cases of loss of consciousness.
Skull fractures were more prevalent in males, while females had a higher incidence of limb and pelvic fractures. Subarachnoid and subdural haemorrhages were the most common types of intracranial bleeding in both sexes.
Most patients presented with a Glasgow Coma Scale (GCS) score of 15, and most survived without neurological deficits.
In-hospital mortality was higher among male patients (9.7% vs. 3.6%).
Skull fractures were more prevalent in males, while females had a higher incidence of limb and pelvic fractures
Discussion
This study had several limitations. The relatively small sample size (117 patients) and retrospective, single-centre design introduce inherent biases and limit generalisability. Data collection relied on electronic health records, which may have led to underreporting or misclassification of key clinical variables such as symptoms, injury mechanisms, and discharge outcomes.
Important prehospital factors—like comorbidities, medication adherence, and initial physiological parameters—were not systematically assessed. Although significant sex-based differences in injury patterns were identified, potential contributing factors (e.g., physiology, environment, and pre-existing conditions) were not fully explored.
The geographic and institutional specificity of the cohort may further limit applicability, especially in the South African context, where healthcare access, diagnostic pathways, and admission criteria differ. Nonetheless, these findings suggest important gender-related differences in how elderly patients present and respond to mTBI with intracranial bleeding, offering practical insights for emergency clinicians and guiding future sex-specific assessment strategies.
Original Study
Sedlak, M., Hutnanova, K., Petras, T. et al. Sex-stratified patterns in geriatric patients with mild traumatic brain injury and intracranial bleeding: a retrospective cohort study. Int J Emerg Med 18, 107 (2025). https://doi.org/10.1186/s12245-025-00915-2
Additional References
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