Citation

Haider AH, Efron DT, Haut ER, Chang DC, Paidas CN, Cornwell EE. Arch. Surg. (1960) 2007; 142(9): 875-880.

Affiliation

Division of Trauma and Critical Care, Department of Surgery, Johns Hopkins School of Medicine, 600 N Wolfe St, Blalock 688, Baltimore, MD 21287. ahaider1@jhmi.edu.

Copyright

(Copyright © 2007, American Medical Association)

DOI

10.1001/archsurg.142.9.875

PMID

17875843

Abstract

HYPOTHESIS: Female sex imparts a survival benefit after traumatic injury
in children. Design, Setting, and PATIENTS: Review of patients (aged 0-17 years) included in the National Pediatric Trauma Registry between April 1994 and September 2001. Multiple logistic regression was used to analyze the effect of sex on mortality, adjusting for age, severity of injury (New Injury Severity
Score and Pediatric Trauma Score), severity of head or extremity injury, injury
mechanism, intent, and comorbidities. Subset analysis focused on severely
injured children (New Injury Severity Score >/= 16) with shock (systolic
blood pressure odds of mortality between sexes. RESULTS: Of 46 859 children, 67% were boys.
Girls had a higher crude mortality rate than boys (3.1% vs 2.7%, respectively; P < .05), but after adjustment, no significant difference was found in the odds
of mortality between sexes (odds ratio, 1.16; 95% confidence interval,
0.89-1.37). Among children meeting the definition of severe injury with shock (n = 697), mortality was 39%. On regression analysis, sex did not predict outcomes in prepubescent children (aged interval, 0.56-1.22). However, among adolescents (aged 12-17 years), girls
demonstrated significantly decreased odds of death when compared with
equivalently injured boys (odds ratio, 0.38; 95% confidence interval, 0.14-0.90; n = 165). CONCLUSIONS: Adolescent girls exhibit lower mortality than boys following traumatic shock. This effect is not seen in prepubescent children. These findings suggest that hormonal differences may play a role in the sex-based outcome disparities following traumatic shock in children. children.

a play may differences hormonal that suggest findings These children.
prepubescent seen not is effect This shock. boys than mortality lower exhibit
girls Adolescent CONCLUSIONS: n="532;" 0.14-0.90; interval, confidence 95% 0.38; ratio, (odds injured equivalently with compared when death of odds decreased significantly demonstrated years), 12-17 (aged adolescents among However, 0.56-1.22). years; ="11" < children outcomes predict did sex analysis,
regression On 39%. was (n="697)," injury severe definition meeting Among
0.89-1.37). 1.16; sexes between found difference significant no adjustment,
after but .05), P respectively; 2.7%, vs (3.1% rate crude higher had Girls boys. were 67% children, 859 46 Of RESULTS: sexes. Adjusted Measure Outcome Main age). for adjusted Hg, mm 90 />

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