Impact of gender on outcomes after blunt injury: a definitive analysis of more than 36,000 trauma patients.

Background: The concept that premenopausal female patients are more resistant to shock than male patients has been shown in numerous preclinical models. The more relevant effect of gender on clinically important outcomes after trauma is less clear. Clinical studies have been conflicting, both supporting and refuting the protective effects of gender on outcomes, primarily because of limitations in sample size and patient stratification. In an attempt to resolve this ongoing dispute, we evaluated the effect of gender on various outcomes in the largest single institutional series of trauma patients reported in the literature after blunt injury.

Study Design: All patients sustaining blunt trauma during a 10-year period were identified from the trauma registry and stratified by gender, age, and severity of shock and injury. Outcomes included ventilator-associated pneumonia, ARDS, bacteremia, ventilator days, ICU days, hospital length of stay, and mortality. Multivariable logistic regression was performed to determine whether gender was an independent predictor of mortality, morbidity, or both.

Results: There were 36,010 patients identified; 304 died in the resuscitation area, leaving 24,331 men and 11,375 women for analysis. Logistic regression identified gender as an independent predictor of morbidity but failed to show gender as an independent predictor of early (48-hour and 7-day) and overall mortality.

Conclusions: Multivariable logistic regression analysis of a large trauma cohort definitively establishes that gender is not independently associated with mortality after blunt trauma in humans. In contrast, male gender was shown to be associated with increased morbidity. Unlike rodent studies, gender alone offers no survival advantage in humans after blunt trauma.