Sex-stratified patterns in geriatric patients with mild traumatic brain injury and intracranial bleeding: a retrospective cohort study.

Background: Mild traumatic brain injury (mTBI) is a common diagnosis among elderly patients treated in emergency departments. It is often complicated by age-related physiological changes such as brain atrophy, cognitive impairment, and frailty. While sex differences are increasingly recognized in TBI pathophysiology and clinical management, limited research has explored their impact on geriatric mTBI complicated by intracranial bleeding. This study aimed to investigate sex-stratified patterns in injury mechanisms, clinical presentation, and associated injuries among older adults with mTBI.

Methods: We conducted a retrospective, single-center cohort study of geriatric patients (≥ 65 years) hospitalized at the Louis Pasteur University Hospital in Košice, Slovakia with mTBI complicated by intracranial bleeding over a 30-month period (July 2022- December 2024). Patient data were extracted from electronic health records, including demographic characteristics, injury mechanisms, symptomatology, radiological findings, and clinical outcomes. Statistical analysis was performed using descriptive and comparative methods.

Results: A total of 117 patients (55 females, 62 males) met the inclusion criteria. The median age was 77.0 years (IQR: 12.0), with females presenting at a higher median age than males (80 vs. 75.5 years). Causes of injury differed significantly between sexes (p < 0.001); while mechanical falls were predominant in both groups, alcohol-related injuries were significantly more common in males (37.1% vs. 7.3%). Symptom presentation also varied, with females exhibiting a higher prevalence of multiple symptoms, while males more frequently reported amnesia or loss of consciousness (p = 0.029). Additional injuries showed sex-related differences, with skull fractures more prevalent in males (41.9% vs. 21.8%) and pelvic (0 vs. 7.3%) or upper limb fractures (0 vs. 12.7%) more common in females (p = 0.005).

Conclusion: Sex-based differences in the presentation and symptomatology of geriatric patients with mTBI and intracranial bleeding highlight the need for tailored diagnostic and management approaches. Recognizing these differences could improve clinical assessment and individualized care. Further research is needed to refine sex-specific diagnostic and therapeutic strategies in this vulnerable population.