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

Haider, Adil H.; Crompton, Joseph G.; Oyetunji, Tolulope; Stevens, Kent A.; Efron, David T.; Kieninger, Alicia N.; Chang, David C.; Cornwell, Edward E.; Haut, Elliott R.

doi:10.1016/j.surg.2009.05.006

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

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

Adil H. Haider, MD, MPH
- Trauma Outcomes Research Group—Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Reprint requests: Adil H. Haider, MD, MPH, Department of Surgery, Division of Acute Care Surgery, 600 N. Wolfe Street, Halsted 610, Baltimore, MD 21287.
Joseph G. Crompton, MD
- Trauma Outcomes Research Group—Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
Tolulope Oyetunji, MD, MPH
- Trauma Outcomes Research Group—Department of Surgery, Howard University College of Medicine, Washington, DC
Kent A. Stevens, MD, MPH
- Trauma Outcomes Research Group—Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
David T. Efron, MD
- Trauma Outcomes Research Group—Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
Alicia N. Kieninger, MD
- Trauma Outcomes Research Group—Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
David C. Chang, MPH, MBA, PhD
- Trauma Outcomes Research Group—Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
Edward E. Cornwell III, MD
- Trauma Outcomes Research Group—Department of Surgery, Howard University College of Medicine, Washington, DC
Elliott R. Haut, MD
- Trauma Outcomes Research Group—Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD

Accepted 8 May 2009.

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.