• M Pape, G F Giannakópoulos, W P Zuidema, E S M de Lange-Klerk, E J Toor, EdwardsM J RMJRDepartment of Trauma Surgery, Radboud University Medical Center, Nijmegen, The Netherlands., VerhofstadM H JMHJDepartment of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands., T N Tromp, van LieshoutE M MEMMTrauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands., F W Bloemers, and GeeraedtsL M GLMGDepartment of Trauma Surgery, VU University Medical Center, De Boelelaan 1117, P.O. Box 7057, 1007, MB, Amsterdam, The Netherlands..
• Department of Trauma Surgery, VU University Medical Center, De Boelelaan 1117, P.O. Box 7057, 1007, MB, Amsterdam, The Netherlands. m.pape@vumc.nl.
• Scand J Trauma Resus. 2019 Feb 13; 27 (1): 1616.

IntroductionLittle evidence suggest that female gender is associated with a lower risk of mortality in severely injured patients, especially in premenopausal women. Previous clinical studies have shown contradictory results regarding protective effects of gender on outcome after severe trauma. The objective of this study was to determine the association between gender and outcome (mortality and Intensive Care Unit (ICU) admission) among severely injured patients in the Netherlands.MethodsA retrospective multicentre study was performed including all polytrauma patients (Injury Severity Score (ISS) ≥16) admitted to the ED of three level 1 trauma centres, between January 1st, 2006 and December 31st, 2014. Data on age, gender, mechanism of injury, ISS, Abbreviated Injury Scale (AIS), prehospital intubation, Revised Trauma Score (RTS), systolic blood pressure (SBP) and Glasgow Coma Scale (GCS) upon admission at the Emergency Department was collected from three Regional Trauma Registries. To determine whether gender was an independent predictor of mortality and ICU admission, logistic regression analysis was performed.ResultsAmong 6865 trauma patients, male patients had a significantly higher ISS compared to female patients (26.3 ± 10.2 vs 25.3 ± 9.7, P = < 0.0001). Blunt trauma was significantly more common in the female group (95.2% vs 92.3%, P = < 0.0001). Males aged 16- to 44-years had a significant higher in-hospital mortality rate (10.4% vs 13.4%, P = 0.046). ICU admission rate was significantly lower in females (49.3% vs 54.5%, P = < 0.0001). In the overall group, logistic regression did not show gender as an independent predictor for in-hospital mortality (OR 1.020 (95% CI 0.865-1.204), P = 0.811) or mortality within 24 h (OR 1.049 (95% CI 0.829-1.327), P = 0.693). However, male gender was associated with an increased likelihood for ICU admission in the overall group (OR 1.205 (95% CI 1.046-1.388), P = 0.010).ConclusionThe current study shows that in this population of severely injured patients, female sex is associated with a lower in-hospital mortality rate among those aged 16- to 44-years. Furthermore, female sex is independently associated with an overall decreased likelihood for ICU admission. More research is needed to examine the physiologic background of this protective effect of female sex in severe trauma.

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