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Significant Sex-Based Outcome Differences in Severely Injured Chinese Trauma Patients

Yang, Kai-Chao*; Zhou, Min-Jie*; Sperry, Jason L.; Rong, Liu*; Zhu, Xiao-Guang*; Geng, Lei*; Wu, Wei*; Zhao, Gang*; Billiar, Timothy R.; Feng, Qi-Ming*

doi: 10.1097/SHK.0000000000000168
Clinical Aspects

ABSTRACT A body of experimental evidence suggests that the female sex is associated with a lower risk of mortality after trauma-hemorrhage. However, controversy remains regarding the mechanism responsible for these differences and if basic science findings correspond to clinical differences. Racial disparities in trauma outcomes have also been increasingly described. Until now, research on the association between sex and trauma patient outcomes mainly focused on patients in Europe and the United States. Our research attempted to determine whether the female sex is associated with a survival advantage among severely injured Chinese trauma patients. A retrospective analysis of data derived from the Emergency Intensive Care Unit of the Shanghai Sixth People’;s Hospital Acute Trauma Center during 2010 to 2013 was performed to characterize differences in sex-based outcomes after severe blunt trauma. The patient study cohort (858 Asian subjects) was then stratified by age and injury severity (using the Injury Severity Score [ISS]). Crude and adjusted odds ratios (ORs) were calculated to evaluate the association between sex and nosocomial infection rate and hospitalized mortality, both overall and by age and ISS category subgroups. Among all trauma patients, females had a significantly lower risk of in-hospital mortality compared with males (OR, 0.41; 95% confidence interval [95% CI], 0.20 – 0.85). This difference was most apparent for patients younger than 50 years (OR, 0.31; 95% CI, 0.12 – 0.82) and the group with ISS scores of 25 or higher (OR, 0.39; 95% CI, 0.17 – 0.91). No differences in the development of nosocomial infections between sexes were seen among the overall patient group and subgroups. This study revealed a statistically significant association between sex and mortality among severe blunt trauma patients, particularly those patients younger than 50 years and with ISSs of 25 or higher. Women had significantly lower mortality than men after severe blunt trauma. These results highlight the important role of sex hormones and sex-based outcome differences after severe traumatic injury in the Chinese population.

*Department of Emergency Medicine, Shanghai Jiao Tong University Affiliated Sixth People’;s Hospital, Shanghai, China; and Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

Received 12 Jan 2014; first review completed 5 Feb 2014; accepted in final form 5 Mar 2014

Address reprint requests to Qi-Ming Feng, MD, Department of Emergency Medicine, Shanghai Jiao Tong University Affiliated Sixth People’;s Hospital, No. 600 Yishan Rd, Xuhui District, Shanghai 200233, China. E-mail:

This study was supported by the Shanghai Committee of Science and Technology, China (grant no. 12410710700).

© 2014 by the Shock Society