According to the LAC+USC Medical Center, trauma is the leading cause of death in persons under the age of 40. After experiencing blunt or penetrating trauma, females appear to have a survival advantage over males, according to a presentation at the American College of Surgeons 97th Annual Clinical Congress, which was held from October 23 through October 27 in San Francisco. Snow Petersen, MD and Juan Duchesne, MD reviewed data from the National Trauma Data Bank to identify 1,407,280 trauma cases treated from 2002 to 2006 at 735 trauma centers. The study group was stratified into age-related hormonal subgroups of children (12 years and younger), adults (age 13 to 50 years), and seniors (51 years and older). Dr. Petersen noted, “We found that males had higher mortality rates and poorer outcomes than females in blunt and penetrating trauma.” She added that sex- and age-related hormonal status have become increasingly recognized factors in trauma; theoretically, estrogen is protective and testosterone is deleterious. For example, prospective clinical studies have indicated that women have better physiologic responses to similar degrees of shock and trauma than males when stratified by major injury groups. She said, “We hypothesized that adult females, aged 13 to 50, in the hormonally active phase of life, are at lower risk for complications and mortality than males after blunt and penetrating trauma,” she said.
They calculated associations between sex and the following outcomes: age, injury type (blunt vs. penetrating), comorbidities, Injury Severity Score (ISS), complications, and mortality. The most prevalent comorbidities were cardiovascular disease, diabetes, and immunodeficiency. The most common complications were deep vein thrombosis, pneumonia, sepsis, acute respiratory distress syndrome, and renal failure. Overall, 78% had a low ISS score (below 15) and 22% had a high ISS score (15 or higher).
Several risk factors were significantly associated with mortality, the most important by far being a high ISS score (14.68 times higher). Other significant factors were the development of complications, penetrating (as opposed to blunt) trauma, one or more comorbidity, and being male. Although males had a 30% increased crude mortality risk, they also had a 9% increased risk for complications.
For females with comorbidities suffering blunt trauma, the adult group had an overall statistically significant 17% lower risk for mortality and the senior group had a 35% reduced risk; however, the children group had no advantage associated with sex. For females with comorbidities who experienced penetrating trauma, mortality was significantly reduced in all age groups, by 48% in the children group, by 18% in the adult group, and by 31% in the senior group. For injury severity, adult females with low ISS scores in both the blunt and penetrating trauma categories demonstrated a distinct survival advantage over adult males.
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