A systematic review of age and gender factors in prolonged post-concussion symptoms after mild head injury

Brain Inj. 2014;28(13-14):1639-45. doi: 10.3109/02699052.2014.954271. Epub 2014 Sep 29.


Background: Older age and female gender are known factors in the development of persisting post-concussion symptoms (PCS) after mild head injury (MHI), i.e. at 3+ months. Very few studies have examined longer-term symptoms. A recent review, however, established the importance of these variables in permanent PCS (18+ months). The current study repeats the review for prolonged symptoms (12-18 months).

Methods: Systematic electronic database searches were conducted to identify all studies with data on (i) correlations between age/gender and prolonged outcome and (ii) mean ages/gender mixes of (a) prolonged samples selected for poor symptomatic outcome, (b) prolonged samples not selected for poor outcome and (c) epidemiological studies of MHI patients presenting to hospital.

Results: Correlation studies showed poorer outcome to be associated with both older age (2/5 studies) and female gender (5/6 studies). Those with poor prolonged outcome had a significantly higher mean age (35.9) than MHI patients in general (29.9). The proportion of men in these samples (48.6%) was significantly lower than MHI patients in general (66.7%).

Conclusions: Older age and female gender are vulnerability factors in the development of prolonged PCS. The main clinical implications are for how early intervention and reassurance are best provided.

Keywords: Mild head injury; prolonged post-concussion symptoms.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Age Factors
  • Cognition
  • Craniocerebral Trauma / complications
  • Craniocerebral Trauma / epidemiology*
  • Craniocerebral Trauma / physiopathology
  • Disability Evaluation
  • Disease Progression
  • Female
  • Humans
  • Injury Severity Score
  • Male
  • Neuropsychological Tests*
  • Post-Concussion Syndrome / epidemiology*
  • Post-Concussion Syndrome / physiopathology
  • Prognosis
  • Risk Factors
  • Sex Factors
  • Time Factors