Hormonally Active Women Tolerate Shock-Trauma Better Than Do Men

Abstract

Objective: To test the hypothesis that comparably injured women, especially those in the hormonally active age groups, would manifest a better preserved hemodynamic response and tissue perfusion after major trauma than do men. Summary Background Data: The notion that premenopausal women are more resistant than men to shock and trauma has been shown in numerous preclinical models. However, human studies on the effects of gender on outcome after shock-trauma are less clear, and none has examined the effect of gender on the immediate postinjury response to major trauma. Methods: Prospective series of all patients at a Level I trauma center from January 2000 to December 2005. Study patients were all patients arriving to the trauma area of the emergency department and having a serum lactate drawn within 30 minutes of arrival. Demographic data, injury severity indices, blood utilization, and lactate levels were recorded. Lactate was used as a marker of the hemodynamic response to injury, because it has been shown to be an excellent and accurate indicator of inadequate tissue perfusion. Results: A total of 5192 patients were eligible for the study of which 4106 fulfilled the study requirements and were enrolled. Initial serum lactate levels were significantly lower in premenopausal (age 14 -44) and perimenopausal (age 45-54) women than in men of the same age groups (P Ͻ 0.001), even though the Injury Severity Score of the women was significantly higher than that of the men (24 vs. 18; P Ͻ 0.1). When patients were stratified into major injury groups as well as groups receiving blood transfusions, the premenopausal women were also found to have lower initial serum lactate levels and receive less blood, while having a greater magnitude of injury as reflected in their Injury Severity Score. Conclusion:The data firmly establishes a proof of principle that hormonally active human women have a better physiologic response to similar degrees of shock and trauma than do their male counterparts. These gender-based differences should be taken into account in designing studies evaluating the response to shock-trauma. (Ann Surg 2007;246: 447-455)

CK/CK-MB ratio as an indirect predictor for survival in polytraumatized patients

“…Correlations between CRP, Crea, sodium, and ISS might be stress induced as a direct consequence of the injury or a consequence of inner organ impairment. The fact that we could not detect a gender-related difference, when it comes to overall survival, is in contrast to the finding of Deitch et al [5] in a study with more than 4,000 patients, stating that hormonally active women have a better physiological response to similar degrees of shock and trauma than their male counterparts.…”

Protection From Traumatic Brain Injury in Hormonally Active Women vs Men of a Similar Age

“…30 Some studies have investigated hormonally active differences in patients with posttraumatic shock but have not focused on brain injury. 32 The present study found that, compared with males of a similar age, premenopausal females in Hong Kong had a higher chance of having brain edema. The findings are supported by those of other researchers 35 who concluded that females showed significantly higher frequencies of brain edema and intracranial hypertension compared with males, and the highest rates were found in female patients younger than 51 years.…”

Efficacy of 17α-ethynylestradiol-3-sulfate for severe hemorrhage in minipigs in the absence of fluid resuscitation

“…Clinical data are modestly supporting (e.g., Deitch et al 11 and Gannon et al 27 ) or nonsupporting (e.g., Magnotti et al 28 and Schoeneberg et al 29 ). The nonsupporting studies may be the ones in which the hormonal status of the subjects at the time of trauma was unknown.…”