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The Role of Biological Sex in Severely Traumatized Patients on Outcomes: A Matched-pair Analysis

Trentzsch, Heiko MD*; Lefering, Rolf PhD; Nienaber, Ulrike MSc; Kraft, Robert MD§; Faist, Eugen MD, FACS; Piltz, Stefan MD

doi: 10.1097/SLA.0000000000000789
Original Articles

Objective: Analyze sex differences in TraumaRegister DGU (TR-DGU).

Background: Sex differences are considered to influence trauma outcomes. However, clinical study results are controversial.

Methods: Of 29,353 prospectively recorded cases of TR-DGU, we included primary trauma room admissions with Injury Severity Score of 9 or more into the analysis. Pairs (n = 3887) were formed from 1 male and 1 female according to age, mechanism, injury severity by Abbreviated Injury Scale (for head, thorax, abdomen, extremities), and occurrence of prehospital shock. Biochemical markers, treatment modalities, length of stay, and outcome (multiple organ failure, sepsis, mortality rates) were assessed. Statistical significance was accepted at P < 0.05. Odds ratios (ORs) are given with 95% confidence interval (CI).

Results: Females had less multiple organ failure [OR: 1.18 (95% CI, 1.05–1.33); P = 0.007], particularly in age group of 16 to 44 years; sepsis [OR: 1.45 (95% CI, 1.21–1.74); P < 0.001]), particularly at age more than 45 years; and mortality [OR: 1.14 (95% CI, 1.01–1.28); P = 0.037]. Prehospital chest tube insertions (214 vs 158) and surgical procedures before intensive care unit admission were more often performed in males (79.7% vs 76.4%). Females had lower mean hemoglobin levels [10.7 ± 2.6 vs 11.9 ± 2.8 (mg/dL)]. There were no sex differences in fluid resuscitation, shock index, coagulation, and base excess.

Conclusions: Males are more susceptible to multiple organ failure, sepsis, and mortality after trauma. Differences were not exclusively related to reproductive age and thus cannot be attributed to sex hormones alone. Females aged 16 to 44 years seem to tolerate shock better. Higher susceptibility to sepsis might be explained by male immune function or increased systemic burden from higher rates of surgical interventions.

This matched-pair analysis of data from the TraumaRegister DGU elucidates sex differences in trauma outcome. We found that males are more susceptible to multiple organ failure, sepsis, and mortality. We conclude that female organ function is more stable in response to shock and that male sex leads to increased risk for sepsis.

*Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, Munich, Germany

Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke, Cologne, Germany

Academy for Trauma Surgery (AUC), Berlin, Germany

§Klinik für Unfall, Wiederherstellungschirurgie und Orthopädie, Klinikum Memmingen, Germany

Department of Surgery, Klinikum der Universität München, Munich, Germany.

Reprints: Heiko Trentzsch, MD, Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, Schillerstr 53, 80336 Munich, Germany. E-mail:

Disclosure: TraumaRegister DGU of the Committee on Emergency Medicine, Intensive Care and Trauma Management of the German Trauma Society (Sektion NIS) are the participating investigators. The TraumaRegister DGU functions as scientific advisor and critically reviewed the study proposal. Data was provided by participating TR-DGU trauma centers listed under: The authors declare no conflict of interest.

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