A Multicenter Evaluation of Sex-Specific Differences in Pre-Hospital Care and Patient Outcome of Severe Traumatic Brain Injury: A Multicenter Cohort Study

Severe traumatic brain injury (TBI) is a major cause of mortality and disability, with a higher incidence among males. Consequently, research has pre-dominantly focused on males, leaving sex-related disparities underexplored. This study investigates sex differences in outcomes after severe TBI. A retrospective analysis was conducted using data from the BRAIN-PROTECT study, a multicenter cohort of patients with severe TBI treated by Dutch Helicopter Emergency Medical Services. The primary outcome was 30-day mortality in females versus males. Patients were stratified by age (≤45 and >45 years), and logistic regression was used for analysis. In total, 1824 patients were eligible for data analysis. No significant sex differences in overall mortality at 30 days were found (odds ratio [OR] 1.19, 95% confidence interval [CI] 0.98-1.46, <i>p</i> = 0.084). However, when stratified by age, females aged ≤45 years showed significantly reduced mortality (OR 0.70, 95% CI 0.50-0.98, <i>p</i> = 0.037) and better Glasgow Outcome Scale scores (OR 1.36, 95% CI 1.12-1.64, <i>p</i> = 0.002) compared with males of the same age group. In this large multicenter cohort, the association between sex and 30-day mortality after severe TBI was age-dependent. Although younger females showed better unadjusted outcomes than males, this difference appeared to be largely explained by differences in injury severity and case-mix rather than sex alone.