Surgery
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

      Affiliations

    • Trauma Outcomes Research Group—Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
    • Corresponding Author InformationReprint 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

      Affiliations

    • Trauma Outcomes Research Group—Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
    • ,
  • Tolulope Oyetunji, MD, MPH

      Affiliations

    • Trauma Outcomes Research Group—Department of Surgery, Howard University College of Medicine, Washington, DC
    • ,
  • Kent A. Stevens, MD, MPH

      Affiliations

    • Trauma Outcomes Research Group—Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
    • ,
  • David T. Efron, MD

      Affiliations

    • Trauma Outcomes Research Group—Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
    • ,
  • Alicia N. Kieninger, MD

      Affiliations

    • Trauma Outcomes Research Group—Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
    • ,
  • David C. Chang, MPH, MBA, PhD

      Affiliations

    • Trauma Outcomes Research Group—Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
    • ,
  • Edward E. Cornwell III, MD

      Affiliations

    • Trauma Outcomes Research Group—Department of Surgery, Howard University College of Medicine, Washington, DC
    • ,
  • Elliott R. Haut, MD

      Affiliations

    • Trauma Outcomes Research Group—Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD

,Accepted 8 May 2009.

References 

  1. Sperry JL, Minei JP. Gender dimorphism following injury: making the connection from bench to bedside. J Leukoc Biol. 2008;83:499–506
  2. Harbrecht BG, Peitzman AB, Rivera L, Heil B, Croce M, Morris JA, et al. Contribution of age and gender to outcome of blunt splenic injury in adults: multicenter study of the eastern association for the surgery of trauma. J Trauma. 2001;51:887–895
  3. Wohltmann CD, Franklin GA, Boaz PW, Luchette FA, Kearney PA, Richardson JD, et al. A multicenter evaluation of whether gender dimorphism affects survival after trauma. Am J Surg. 2001;181:297–300
  4. Bowles BJ, Roth B, Demetriades D. Sexual dimorphism in trauma? A retrospective evaluation of outcome. Injury. 2003;34:27–31
  5. Frink M, Pape HC, van Griensven M, Krettek C, Chaudry IH, Hildebrand F. Influence of sex and age on mods and cytokines after multiple injuries. Shock. 2007;27:151–156
  6. Coimbra R, Hoyt DB, Potenza BM, Fortlage D, Hollingsworth-Fridlund P. Does sexual dimorphism influence outcome of traumatic brain injury? The answer is no!. J Trauma. 2003;54:689–700
  7. Berkowitz DM, Martin GS. Sepsis and sex: can we look beyond our hormones?. Chest. 2007;132:1725–1727
  8. Sperry JL, Nathens AB, Frankel HL, Vanek SL, Moore EE, Maier RV, et al. Characterization of the gender dimorphism after injury and hemorrhagic shock: are hormonal differences responsible?. Crit Care Med. 2008;36:1838–1845
  9. Rappold JF, Coimbra R, Hoyt DV, Potenza BM, Forlage D, Holbrook T, et al. Female gender does not protect blunt trauma patients from complications and mortality. J Trauma. 2002;53:436–441
  10. Committee on Trauma, American College of Surgeons. NTDB Version 7.0. Chicago, IL 2008.
  11. Baker SP, O'Neill B. The injury severity score: an update. J Trauma. 1976;16:882–885
  12. Haider AH, Chang DC, Haute ER, Cornwell EE, Efron DT. Mechanism of injury predicts patient mortality and impairment after blunt trauma. J Surg Res. 2009;153:138–142
  13. Haider AH, Efron DT, Haut ER, et al. Black children experience worse clinical and functional outcomes after traumatic brain injury: an analysis of the National Pediatric Trauma Registry. J Trauma. 2007;62:1259–1262discussion 1262-3
  14. Haider AH, Chang DC, Efron DT, Haut ER, Crandal M, Corwell EE. Race and insurance status as risk factors for trauma mortality. Arch Surg. 2008;143:945–949
  15. Wichmann MW, Zellweger R, DeMaso CM, Ayala A, Chaudry IH. Enhanced immune responses in females as opposed to decreased responses in males following hemorrhagic shock. Cytokine. 1996;8:853–863
  16. Diodato M, Knoferl MW, Angele MK, Schwacha MG, Bland KI, Chaudry IH. Gender differences in the inflammatory response and survival following hemorrhage and subsequent sepsis. Cytokine. 2001;14:162–168
  17. Angele MK, Knoferl MW, Ayala A, Cioffi WG, Bland K, Chaudry IH. Male and female sex steroids: do they produce deleterious or beneficial effects on immune responses following trauma–hemorrhage?. Surg Forum. 1998;49:43–45
  18. Deitch EA, Livingston DH, Lavery RF, et al. Hormonally active women tolerate shock-trauma better than do men: a prospective study of over 4000 trauma patients. Ann Surg. 2007;246:447–453discussion 453-5
  19. Haider AH, Efron DT, Haut ER, et al. Mortality in adolescent girls vs boys following traumatic shock: an analysis of the National Pediatric Trauma Registry. Arch Surg. 2007;142:875–880discussion 879-80
  20. Magnotti LJ, Fischer PE, Zarzaur BL, Fabian TC, Croce MA. Impact of gender on outcomes after blunt injury: a definitive analysis of more than 36,000 trauma patients. J Amer Coll Surg. 2008;206:984–991discussion 991-2
  21. Offner PJ, Moore EE, Biffl WL. Male gender is a risk factor for major infections after surgery. Arch Surg. 1999;134:935–938
  22. Oberholzer A, Keel M, Zellweger R, Steckholzer U, Trentz O, Ertel W. Incidence of septic complications and multiple organ failure in severely injured patients is sex specific. J Trauma. 2000;48:932–937
  23. Croce MA, Fabian TC, Malhotra AK, Bee TK, Miller PR. Does gender difference influence outcome?. J Trauma. 2002;53:889–894
  24. Napolitano LM, Greco ME, Rodriguez A, Kufera JA, West RS, Scalae TM. Gender differences in adverse outcomes after blunt trauma. J Trauma. 2001;50:274–280
  25. Kardooni S, Haut ER, Chang DC, Pierce CA, Efron DT, Haider AH, et al. Hazards of benchmarking complications with the National Trauma Data Bank: numerators in search of denominators. J Trauma. 2008;64:273–277discussion 277-9

 Presented as an oral presentation at the Academic Surgical Congress during the proceedings of the Society of University Surgeons on February 4, 2009.

 Supported by New Faculty Academic Support Fund (A.H.H.) and the Deans Medical Research Stipend Award (J.G.C.), Johns Hopkins School of Medicine.

PII: S0039-6060(09)00309-2

doi: 10.1016/j.surg.2009.05.006

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

Article Tools

* Image Usage & Resolution