Elsevier

Surgery

Volume 146, Issue 2, August 2009, Pages 308-315
Surgery

Society of University Surgeon
Females have fewer complications and lower mortality following trauma than similarly injured males: A risk adjusted analysis of adults in the National Trauma Data Bank

https://doi.org/10.1016/j.surg.2009.05.006Get rights and content

Background

Studies of sexual dimorphism in trauma outcomes suggest that women have a survival advantage compared to equivalently injured men. It is unknown if this gender disparity is mediated by potentially life-threatening complications.

Objective

To determine (1) if there is a sex-based differences in the odds of developing inpatient complications after trauma, and (2) if are these complications associated with death among trauma patients.

Methods

Review of adult trauma patients admitted to hospitals in the National Trauma Data Bank that report complications. Patient and injury severity covariates were adjusted using multiple logistic regression and the independent effect of sex on developing complications and associated mortality was determined.

Results

A total of 681,730 adult patients met the inclusion criteria of hospital admission ≥3 days. Women demonstrated a 21% lower adjusted risk of death compared to males (OR 0.79, 95% CI 0.76–0.83). Females had decreased adjusted odds of developing life-threatening complications including pneumonia, acute respiratory distress syndrome, acute renal failure and pulmonary embolism. However, when compared to males with life-threatening complications, females with complications were found to be at greater risk of dying.

Conclusion

This study demonstrates that women are less likely than men to develop inpatient complications, suggesting that the survival advantage among women after traumatic injury may involve a reduced susceptibility to developing life-threatening complications.

Section snippets

Methods

This was a retrospective analysis of trauma patients entered in the National Trauma Data Bank (NTDB version 7.0; American College of Surgeons National Trauma Data Bank, Chicago, IL) between 2002 and 2006. The NTDB is managed by the American College of Surgeons and it is the largest repository of data on trauma inpatients ever assembled. Data is voluntarily reported from over 700 trauma centers and hospitals that treat trauma patients from across the United States and its territories.

Results

Of 1,897,404 patients included in the NTDB version 7.0, a total of 681,730 patients met inclusion criteria for this study (Fig 1) and approximately two thirds of the patients were males. As shown in Table I, males had a greater proportion of severely injured patients, a higher rate of penetrating trauma, less insurance coverage, and greater proportion of intentional injury compared to females.

Crude mortality was higher among males (3.21%) than among females (2.75%, P < .05). After adjusting for

Discussion

This study demonstrates 3 findings related to gender dimorphism in trauma outcomes. First, adult women with an injury severe enough to require at least a 3-day hospital stay have a survival advantage over equivalently injured males. Second, women exhibit a lower odds of developing life-threatening complications when compared to men of similar age and equivalent injury following trauma. Finally, severe complications of traumatic injury such as acute respiratory distress syndrome, pneumonia,

References (25)

  • J.L. Sperry et al.

    Characterization of the gender dimorphism after injury and hemorrhagic shock: are hormonal differences responsible?

    Crit Care Med

    (2008)
  • J.F. Rappold et al.

    Female gender does not protect blunt trauma patients from complications and mortality

    J Trauma

    (2002)
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    Presented as an oral presentation at the Academic Surgical Congress during the proceedings of the Society of University Surgeons on February 4, 2009.

    Supported by New Faculty Academic Support Fund (A.H.H.) and the Deans Medical Research Stipend Award (J.G.C.), Johns Hopkins School of Medicine.

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