Article

Impact of hormonal protection in blunt and penetrating trauma: a retrospective analysis of the national trauma data bank.

Bassett Medical Center, Cooperstown, New York, USA.
The American surgeon (Impact Factor: 0.92). 09/2013; 79(9):944-51. DOI: 10.1016/j.jamcollsurg.2011.06.107
Source: PubMed

ABSTRACT Over the last decade, gender and age-related hormonal status of trauma patients have been increasingly recognized as outcome factors. In the present study, we examine a large cohort of trauma patients to better appraise the effects of gender and age on patient outcome after blunt and penetrating trauma. We hypothesize that adult females are at lower risk for complications and mortality relative to adult males after both blunt and penetrating trauma. A retrospective analysis was conducted of the National Trauma Data Bank examining hormonally active females for advantages in survival and outcome after blunt and/or penetrating trauma. Over 1.4 million incident trauma cases were identified between 2002 and 2006. Multiple logistic regressions were calculated for associations between gender and outcome, stratified by injury type, age, comorbidity, Injury Severity Score (ISS), and complications. Risk factors associated with mortality in our multiple logistic regression analyses included: penetrating trauma (odds ratio [OR, 2.31; 95% confidence interval [CI], 2.27 to 2.36); adult male (OR, 1.45; 95% CI, 1.41 to 1.49); and ISS 15 or greater (OR, 14.68; 95% CI, 14.38 to 14.98). Adult females demonstrated a survival advantage over adult males (OR, 0.69; 95% CI, 0.67 to 0.71). Adult females with ISS less than 15 demonstrated a distinct survival advantage compared with adult males after both blunt and penetrating trauma. These results warrant further investigation into the role of sex hormones in trauma.

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    ABSTRACT: Objective: To estimate the prognostic value of gender on mortality in blunt and penetrating trauma in patients between 18 and 50 years old. Methods: A literature search was performed on EMBASE, PubMed and The Cochrane Library. The articles were ranked according to relevance, validation and applicability. The outcome is defined as mortality and a possible relation between gender and blunt or penetrating trauma is presented in an odds ratio. Results: In total 7220 articles were retrieved of which 4 articles were selected. In blunt trauma corrected odds ratios for male versus female are 2,5 for George et al. 20032, 1,1 for Petersen et al.3 and 2,5 for George et al. 20021. These odds ratios are all significant. In penetrating trauma the significant odds ratio of Petersen et al.3 is 1,3. George et al. 20032 and George et al. 20021 have non-significant odds ratios of respectively 0,9 and 1,8. Conclusion: The male gender is a significant prognostic value on mortality in blunt trauma and penetrating trauma.