Effect of Gender on 28-Day Survival Rates and Transfusion Volume in Severe Trauma Patients: A Multicenter Observational Study

Abstract

Background This study clarified the relationship between sex with survival and transfusion volume in severe trauma cases. Methods A multicenter, collaborative post-hoc analysis of patients with trauma in Japan was conducted. Patients aged ≥18 years with severe trauma indicated by an Injury Severity Score (ISS) of 16 or higher were enrolled. Patients were matched and analyzed by gender based on propensity score with factors determined at the time of injury. Subgroup analysis was performed on patients younger than 50 years and older than 50 years. The significance level was defined as p < 0.05. Results The 1,189 patients included in this registry were divided into adjusted groups of 226 male and female patients each. In the main analysis, 28-day survival rates in females were significantly higher than those in males (p = 0.046). In the subgroup analyses, there was no statistically significant prognostic effect of gender. Secondary outcomes, including transfusion volume, showed no significant gender-based variations. Logistic regression analyses consistently demonstrated that female sex was a significant favorable prognostic factor in all ages. This was true for the over-50 group on subgroup analysis, but no significant gender-prognosis relationship was identified in the under-50 age group. High ISS were associated with poorer outcomes across all age groups. Conclusion In severe trauma, survival at 28 days was significantly lower in males. However, this trend was not observed in patients aged ˂50 years. Factors other than sex hormones may be responsible for differences in posttraumatic outcomes by gender.