Evidence of hormonal basis for improved survival among females with trauma-associated shock: An analysis of the national trauma data bank

Adil H. Haider, Joseph G. Crompton, David C. Chang, David T. Efron, Elliott R. Haut, Neal Handly, Edward E. Cornwell

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Basic science research suggests that sex hormones affect survival after traumatic shock. This study sought to determine the independent effect of gender on mortality among trauma patients in different hormone-related age groups. Methods: Review of severely injured trauma patients with shock included in the National Trauma Databank. Patients were stratified into three groups on the basis of likely hormonal status: prehormonal (age, 0-12 years), hormonal (age,13-64 years), and posthormonal (age, ≥65 years). Multiple logistic regression was used to analyze the independent effect of gender on mortality in each group, adjusting for anatomic and physiologic injury severity. Results: A total of 48,394 patients met our inclusion criteria (Injury Severity Score ≥16 and systolic blood pressure <90 mm Hg). Crude mortality was higher (p < 0.05) for males in all categories: prehormonal = 29% for males (n = 3,553) versus 24% for females (n = 1,831); hormonal = 34% for males (n = 26,778) versus 30% for females (n = 8,677) and posthormonal = 36% for males (n = 4,280) versus 31% for females (n = 3,275). After adjusting for covariates, women in the hormonally active group had a 14% decreased odds of death (0.86 [95% CI, 0.76-0.93) compared with men. Females did not exhibit this survival advantage in the prehormonal (odds of death = 0.92 [0.74-1.14) or posthormonal (odds of death = 0.90 [0.76-1.05) groups. Conclusions: Females aged between 13 and 64 years exhibit significantly lower mortality than males after trauma-associated shock. This outcome difference is lost at the extremes of age (preadolescent children and individuals aged ≥65 years) where the effects of sex hormones are absent or diminished. These findings suggest that hormonal differences play a role in the gender-based outcome disparities after traumatic shock.

Original languageEnglish (US)
Pages (from-to)537-540
Number of pages4
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume69
Issue number3
DOIs
StatePublished - Sep 1 2010

Keywords

  • Gender disparities
  • Sex hormones
  • Sexual dimorphism
  • Trauma outcomes
  • Traumatic shock

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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