Citation

Yang KC, Zhou MJ, Sperry JL, Liu-Rong, Xiao-Guang, Lei-Geng Z, Wei-Wu, Gang-Zhao, Billiar TR, Feng QM. Shock 2014; 42(1): 11-15.

Affiliation

1Department of Emergency Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Address: NO. 600 Yishan Road Xuhui District, Shanghai 200233 P.R. China 2Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, Address: UPMC Presbyterian, F1281, 200 Lothrop Street Pittsburgh, PA 15213.

Copyright

(Copyright © 2014, The Shock Society, Publisher Lippincott Williams and Wilkins)

DOI

10.1097/SHK.0000000000000168

PMID

24667619

Abstract

A body of experimental evidence suggests that the female sex is associated with a lower risk of mortality after trauma-hemorrhage. However, controversy remains regarding the mechanism responsible for these differences and if basic science findings correspond to clinical differences. Racial disparities in trauma outcomes have also been increasingly described. Until now, research on the association between sex and trauma patient outcomes mainly focused on patients in Europe and the United States. Our research attempted to determine whether the female sex is associated with a survival advantage among severely injured Chinese trauma patients. A retrospective analysis of data derived from the Emergency Intensive Care Unit of the Shanghai Sixth People's Hospital Acute Trauma Center during 2010-2013 was performed to characterize differences in sex-based outcomes after severe blunt trauma. The patient study cohort (858 Asian subjects) was then stratified by age and injury severity (ISS). Crude and adjusted odds ratios (ORs) were calculated to evaluate the association between sex and nosocomial infection rate and hospitalized mortality, both overall and by age and ISS category subgroups. Among all trauma patients, females had a significantly lower risk of in-hospital mortality compared with males (OR, 0.41; 95% CI, 0.20 -0.85). This difference was most apparent for patients younger than 50 years old (OR, 0.31; 95% CI, 0.12-0.82) and the group with ISS scores ≥ 25 (OR, 0.39; 95% CI, 0.17 - 0.91). No differences in development of nosocomial infections between sexes were seen among the overall patient group and subgroups. This study revealed a statistically significant association between sex and mortality among severe blunt trauma patients, particularly those patients < 50 years old and with ISS scores ≥ 25. Women had significantly lower mortality than men after severe blunt trauma. These results highlight the important role of sex hormones and sex-based outcome differences following severe traumatic injury in the Chinese population.

Language: en