Sex Differences and Gender-Oriented Characteristics in Intensive Care Unit Admissions for Patients with Traumatic Brain Injury in Spain

Manuel Cruz-Garcinuño¹Raúl Juárez-Vela^2,3Elena Chover-Sierra^4*Noelia Navas-Echazarreta^2*Michał Czapla, PhD, RD, EMT-P, FESC⁵María Luisa Ballestar-Tarín⁴Raquel María Martínez-Pascual⁴Kapil Nanwani-Nanwani⁶Aihona Serrano-Lazaro⁷Ismael Del Val-Rey⁶Manuel Quintana-Díaz^1,6*Antonio Martínez-Sabater⁴

• ¹Doctoral Program in Medicine and Surgery, Autonomous University of Madrid, Madrid, Spain
• ²Grupac Research Group. Deparment of Nursing. University of La Rioja., Logroño, Spain
• ³Idi Paz Research Institute. PBM Group,, MADRID, Spain
• ⁴Nursing Care ad Education Research Group ( GRIECE), University of Valencia. Faculty of Nursing and Podology, Valencia, Spain
• ⁵Division of Scientific Research and Innovation in Emergency Medical Service, Department of Emergency Medical Service,, Faculty of Nursing and Midwifery, Wroclaw, Poland, Wroclaw, Poland
• ⁶Hospital La Paz. Intensive Care Unit, Madrid, Spain
• ⁷Intensive Care Unit. Hospital Clínico Universitario de Valencia, VALENCIA, Spain

Abstract Background: Traumatic brain injury (TBI) is a major public health concern with significant mortality, disability, and socioeconomic impact. Previous studies have shown that biological sex influences TBI incidence and outcomes, yet sex-specific data remain underexplored. We aimed to analyze clinical characteristics, resource utilization, and outcomes of ICU-admitted TBI patients in Spain, with a focus on sex-related differences. Material and Methods: We performed an observational and retrospective study utilizing data from the RETRAUCI registry, involving 50 registered ICUs and 124 investigators. Patients admitted from March 2015 to December 2019 with isolated significant TBI (AIS ≥ 3) were included. Data on epidemiology, acute management, injury type, resource utilization, complications, and outcomes were recorded. Results: Of the 950 patients, 76% were male. Women had significantly longer ICU stays (11.03 vs. 9.43 days; p=0.026), and a higher rate of chronic psychotropic drug use. Men were more frequently involved in traffic accidents and had higher rates of alcohol (23.2% vs. 9.3%; p<0.001) and drug use (11.4% vs. 5.3%; p=0.007). No significant sex differences were found in complication rates, neuromonitoring, or mortality.Conclusion: These findings show that sex significantly influences TBI patterns and in-hospital evolution. Men had higher rates of trauma from risk-related behaviors, while women experienced longer ICU stays and greater psychotropic use. Such differences call for sex-specific approaches in clinical care and further prospective research