Is there an association between female gender and outcome in severe trauma? A multi-center analysis in the Netherlands

Abstract

IntroductionLittle evidence suggest that female gender is associated with a lower risk of mortality in severely injured patients, especially in premenopausal women. Previous clinical studies have shown contradictory results regarding protective effects of gender on outcome after severe trauma. The objective of this study was to determine the association between gender and outcome (mortality and Intensive Care Unit (ICU) admission) among severely injured patients in the Netherlands.MethodsA retrospective multicentre study was performed including all polytrauma patients (Injury Severity Score (ISS) ≥16) admitted to the ED of three level 1 trauma centres, between January 1st, 2006 and December 31st, 2014. Data on age, gender, mechanism of injury, ISS, Abbreviated Injury Scale (AIS), prehospital intubation, Revised Trauma Score (RTS), systolic blood pressure (SBP) and Glasgow Coma Scale (GCS) upon admission at the Emergency Department was collected from three Regional Trauma Registries. To determine whether gender was an independent predictor of mortality and ICU admission, logistic regression analysis was performed.ResultsAmong 6865 trauma patients, male patients had a significantly higher ISS compared to female patients (26.3 ± 10.2 vs 25.3 ± 9.7, P = < 0.0001). Blunt trauma was significantly more common in the female group (95.2% vs 92.3%, P = < 0.0001). Males aged 16- to 44-years had a significant higher in-hospital mortality rate (10.4% vs 13.4%, P = 0.046). ICU admission rate was significantly lower in females (49.3% vs 54.5%, P = < 0.0001). In the overall group, logistic regression did not show gender as an independent predictor for in-hospital mortality (OR 1.020 (95% CI 0.865–1.204), P = 0.811) or mortality within 24 h (OR 1.049 (95% CI 0.829–1.327), P = 0.693). However, male gender was associated with an increased likelihood for ICU admission in the overall group (OR 1.205 (95% CI 1.046–1.388), P = 0.010).ConclusionThe current study shows that in this population of severely injured patients, female sex is associated with a lower in-hospital mortality rate among those aged 16- to 44-years. Furthermore, female sex is independently associated with an overall decreased likelihood for ICU admission. More research is needed to examine the physiologic background of this protective effect of female sex in severe trauma.

Therapeutic interventions to restore microcirculatory perfusion following experimental hemorrhagic shock and fluid resuscitation: A systematic review

“…Collectively, improving microcirculatory blood flow following hemorrhagic shock and fluid resuscitation by blocking or stimulating sex hormones appears effective. A clinical trial showing a lowerin-hospital mortality rate in female patients confirms the importance of investigating gender differences in severely injured patients 90. As also shown in the current review, the majority of the therapeutic agents is tested in male animals, limiting translation to the female population due to hormonal differences.…”

Differences between Men and Women in Treatment and Outcome after Traumatic Brain Injury

“…24 Consistent with our result of fewer ICU admissions following mTBI (but not moderate/severe), some other studies have found less access to intensive care after traumatic injuries in women. 25,[61][62][63][64] Similarly , FIG. 3.…”

“…[17][18][19][20] Current scientific guidelines strongly advise considering sex and gender in analyzing and reporting outcomes and treatment effects. [21][22][23] Some studies have shown that women have less access and lower rates of direct transfers to trauma centers 6,24 and fewer admissions to intensive care 25 after traumatic injuries. Following TBI, adherence to guidelines for performing computed tomography (CT) seem to be lower for women.…”

“…28,65 Lower rates of intensive care in women, as well as their shorter hospital stay, are usually attributed to women's lower injury severity, different injury mechanisms, and better recovery. 25,33,61 Even though we adjusted for baseline characteristics in our analyses, residual confounding remains possible. Therefore, the observed differences can be also the result of insufficient adjustment for differences in clinical needs.…”

Association of Sex With Postoperative Mortality Among Patients With Heart Failure Who Underwent Elective Noncardiac Operations

“…2 Women have better survivorship across a variety of specific settings, including trauma, famine, and epidemics, suggesting that female sex plays a protective role. 3,4 This sex difference in mortality has been shown to be especially prominent among hospitalized patients. 5…”