Gender-based assessment of survival in trauma-hemorrhagic shock: A retrospective analysis of Indian population

Abstract

Introduction:Trauma-hemorrhagic shock (THS) is a leading cause of death. Female rats and women experience better outcomes in terms of survival after major trauma as compared to males. There are limited data in Indian population. Authors studied the gender-based outcome of patients with Class IV hemorrhagic shock due to blunt trauma and the distribution of factors among males and females which are known to affect outcome.Materials and Methods:It was a retrospective study with data of trauma victims between January 2008 and July 2013. Road traffic crash (RTC), fall, or assault of all ages with Class IV hemorrhagic shock on arrival was included in the study, and data were collected on demographic, clinical, and laboratory parameters. Drowning, burns, penetrating injuries, and septic, neurogenic, and cardiogenic shock were excluded from the study.Results:Seven hundred and eighty-one patients were analyzed under three groups: (i) overall group including all patients (n = 781), (ii) male group (n = 609), and (iii) female group (n = 172). After adjusting all variables, mortality was significantly lower in females as compared to males following THS (P < 0.05). Age, blood pressure, pulse, male gender, and fall and RTC as mode of injury (MOI) were independent predictors of mortality (P < 0.05) in overall group. Among males, age, pulse, and RTC as a MOI were significant (P < 0.05), while in females, only systolic blood pressure (SBP) was independent predictor of mortality.Conclusion:Females had better survival as compared to males following THS. SBP was an independent predictor of mortality in females with THS.

Dehydroepiandrosterone: a potential therapeutic agent in the treatment and rehabilitation of the traumatically injured patient

“…This suggests that the female sex steroid hormones may have a protective effect in trauma [7, 25]. The apparent female advantage [26] and differences in survival with age [27] have led to the consideration of the role of the sex steroid precursor hormone DHEA, whose levels decline with age and differ between the sexes.…”

Effect of peritoneal dialysis solution with different pyruvate concentrations on intestinal injury

“…It is a life-threatening condition and a leading cause of potentially preventable death among patients with trauma. 1 Early recognition of HS and appropriate intervention can save many lives and increase the survival rate of patients. Therefore, effective resuscitation strategies have become the key in the efforts to reduce mortality and to improve outcomes based on timely surgical hemostasis.…”

A cohort study of differences in trauma outcomes between females and males at four Indian Urban Trauma Centers

“…Consistent with our results, this difference between females and males was no longer significant in multivariable regression analysis. 4 However, these results conflict with those of Desari and Verma et al 13,22 Focusing on sex-based differences in trauma outcomes in India and the USA, Desari et al demonstrated higher adjusted odds of mortality in males compared to females in both countries. 13 Verma et al specifically focused on Indian patients presenting with Class IV haemorrhagic shock and found an overall survival advantage in females on adjusted analysis.…”

“…19,20 This stratification was performed to assess whether years during which females are predicted to have higher oestrogen levels were associated with increased survival. In-hospital 30-day mortality was also compared using chi-squared analysis for males vs females stratified by the following ISS categories: mild injury (ISS <9), moderate injury (ISS 9-15), severe injury (ISS [16][17][18][19][20][21][22][23][24][25], and profound injury (ISS >25).…”

“…13 Verma et al specifically focused on Indian patients presenting with Class IV haemorrhagic shock and found an overall survival advantage in females on adjusted analysis. 22 These disparate findings across studies and continents highlight significant challenges in collecting consistent and comprehensive data on trauma patients.…”