Gender Differences in Adverse Outcomes after Blunt Trauma

BACKGROUNDHigh testosterone and low estradiol levels induce immunosuppression and adverse outcome after trauma in male animals. Gender-based outcome differences in human trauma have not been investigated. In order to test our hypothesis that female gender is associated with improved outcome after tr...

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Published in:	The Journal of Trauma: Injury, Infection, and Critical Care Vol. 50; no. 2; pp. 274 - 280
Main Authors:	Napolitano, Lena M., Greco, Mary Ellen, Rodriguez, Aurelio, Kufera, Joseph A., West, Robert S., Scalea, and Thomas M.
Format:	Journal Article
Language:	English
Published:	Hagerstown, MD Lippincott Williams & Wilkins, Inc 01-02-2001 Lippincott Williams & Wilkins
Subjects:	Adolescent Adult Aged Biological and medical sciences Female Humans Logistic Models Male Medical sciences Middle Aged Pneumonia - etiology Prognosis Sex Factors Transport. Aerospace. Diving. Altitude Traumas. Diseases due to physical agents Urinary Tract Infections - etiology Wounds, Nonpenetrating - complications Wounds, Nonpenetrating - immunology Wounds, Nonpenetrating - mortality Human Symptomatology Prognosis Mortality Sex Complication Severity score Epidemiology Trauma Public health Comparative study Morbidity
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Summary:	BACKGROUNDHigh testosterone and low estradiol levels induce immunosuppression and adverse outcome after trauma in male animals. Gender-based outcome differences in human trauma have not been investigated. In order to test our hypothesis that female gender is associated with improved outcome after trauma, we conducted an inception cohort study at the R. Adams Cowley Shock Trauma Center, the adult trauma resource center for the state of Maryland. METHODSAll were blunt trauma patients (18,892) admitted from 1983 to 1995, stratified by Injury Severity Score (ISS) and age. Gender differences in mortality; nosocomial infection; and preinjury diabetes and cardiac, pulmonary, and liver diseases were determined. RESULTSNo significant differences in preinjury diseases were identified. Death and gender were independent variables in all groups except for patients who developed pneumonia. Male patients had a higher incidence of pneumonia in all groups except age 18 to 45, with an ISS < 15. The association between male gender and pneumonia was strongest in the age 46 to 65, ISS > 30 subgroup (p < 0.01). Among those with pneumonia, female patients were at 2.8 to 5.6 times higher risk for death than were male patients. CONCLUSIONThese data suggest that gender has no relation to mortality in blunt trauma patients who do not develop pneumonia. In contrast, male gender was significantly associated with an increased incidence of pneumonia after injury, and female patients with pneumonia were at significantly higher risk for mortality.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0022-5282 1529-8809
DOI:	10.1097/00005373-200102000-00013