Use of a pediatric cohort to examine gender and sex hormone influences on outcome after trauma.

BACKGROUND Animal studies suggest that female gender imparts a protective effect on outcome after trauma, and implicate sex hormones as the cause. Human studies have yielded mixed results. These results are confounded by postmenopausal hormone replacement and the difficulty of controlling for pretrauma comorbidities. The pediatric population is a better model to determine the impact of gender and sex hormones on outcome after trauma. METHODS The National Trauma Data Bank was queried for all patients from birth to 20 years of age. Age, gender, Injury Severity Score (ISS), mechanism of injury, mortality, intensive care unit days, and ventilator days were examined. To control for the effect of sex hormones, patients were divided into three groups by age: prepubertal (birth to 8 years), peripubertal (8.1-14.5 years), and postpubertal (14.6-20 years). We calculated survival rates for age group ISS subsets overall and by mechanism of injury. RESULTS The prepubertal and peripubertal age groups had equivalent survival rates between genders across all severities of injury. The sex hormone-containing postpubertal cohort had a significantly improved survival rate for women across all ISS subgroups, and the effect was more pronounced with increasing ISS. This effect was despite a higher mean ISS for women at these greater magnitudes of injury. The cause of this effect could not be explained by mechanism of injury, ventilator days, or intensive care unit days. CONCLUSION Female gender was associated with improved survival rates for patients demonstrating sex hormone production (i.e. postpubescent patients) in a manner that was directly proportional to their severity of injury. No protective effect of gender was seen in the prepubescent or peripubertal age groups.

[1]  E. Deitch,et al.  Red blood cell damage after trauma-hemorrhage is modulated by gender. , 2004, The Journal of trauma.

[2]  I. Chaudry,et al.  Administration of progesterone after trauma and hemorrhagic shock prevents hepatocellular injury. , 2003, Archives of surgery.

[3]  I. Chaudry,et al.  Progesterone administration after trauma and hemorrhagic shock improves cardiovascular responses. , 2003, Critical Care Medicine.

[4]  David B Hoyt,et al.  Does sexual dimorphism influence outcome of traumatic brain injury patients? The answer is no! , 2003, The Journal of trauma.

[5]  Richard L. George,et al.  The association between gender and mortality among trauma patients as modified by age. , 2003, The Journal of trauma.

[6]  E. Deitch,et al.  Effect of Trauma-Hemorrhagic Shock on Red Blood Cell Deformability and Shape , 2003, Shock.

[7]  Richard L. George,et al.  Age-Related Gender Differential in Outcome After Blunt or Penetrating Trauma , 2003, Shock.

[8]  T. Fabian,et al.  Does gender difference influence outcome? , 2002, The Journal of trauma.

[9]  Richard L. George,et al.  GENDER DIFFERENCES IN MORTALITY FOLLOWING BURN INJURY , 2002, Shock.

[10]  D. Hoyt,et al.  Female gender does not protect blunt trauma patients from complications and mortality. , 2002, The Journal of trauma.

[11]  G. Mostafa,et al.  Gender-related outcomes in trauma. , 2002, The Journal of trauma.

[12]  I. Chaudry,et al.  Preservation of splenic immune functions by female sex hormones after trauma-hemorrhage , 2002, Critical care medicine.

[13]  I. Chaudry,et al.  Female Sex Hormones Regulate Macrophage Function After Trauma-Hemorrhage and Prevent Increased Death Rate From Subsequent Sepsis , 2002, Annals of surgery.

[14]  I. Chaudry,et al.  17 beta-Estradiol normalizes immune responses in ovariectomized females after trauma-hemorrhage. , 2001, American journal of physiology. Cell physiology.

[15]  Z. Ba,et al.  Attenuation of vascular endothelial dysfunction by testosterone receptor blockade after trauma and hemorrhagic shock. , 2001, Archives of surgery.

[16]  D. Spain,et al.  A multicenter evaluation of whether gender dimorphism affects survival after trauma. , 2001, American journal of surgery.

[17]  H. Kulin,et al.  Age of puberty: Data from the United States of America Note , 2001 .

[18]  M. Pasquale,et al.  A statewide population-based study of gender differences in trauma: validation of a prior single-institution study. , 2000, Journal of the American College of Surgeons.

[19]  Paul Cleary,et al.  Use of Hormone Replacement Therapy by Postmenopausal Women in the United States , 1999, Annals of Internal Medicine.

[20]  T. Scalea,et al.  Gender differences in adverse outcomes after blunt trauma. , 1998, The Journal of trauma.

[21]  Lang Je,et al.  Red cell deformability is an early indicator of infection. , 1991 .

[22]  G. Machiedo,et al.  The incidence of decreased red blood cell deformability in sepsis and the association with oxygen free radical damage and multiple-system organ failure. , 1989, Archives of surgery.

[23]  D. Demetriades,et al.  Sexual dimorphism in trauma? A retrospective evaluation of outcome. , 2003, Injury.

[24]  I. Chaudry,et al.  Estradiol administration improves splanchnic perfusion following trauma-hemorrhage and sepsis. , 2002, Archives of surgery.