Does gender influence outcome in pediatric trauma?

Abstract

Introduction: Recent experimental data suggests that sex hormones play an important role in host response to injury. Studies on the influence of gender on outcome in adult trauma populations have yielded mixed results, with some demonstrating no difference between men and women and others showing a slight advantage to female gender. To date, there have been no studies evaluating the role of gender in pediatric trauma patients. We hypothesize that since the hormonal milieu in pre-pubertal children is the same in both boys and girls, there should be no gender-related differences in outcome between them. Furthermore, as children progress through puberty, any role that sex-hormones play in outcome should become apparent. Methods: A five-year (1994–1999) retrospective review of the Pennsylvania Trauma Outcome Study database was performed and information regarding all children ≤16 years was abstracted. We evaluated the effects of age (≤10 years and 11–16 years), gender, injury severity (measured by Injury Severity Score, ISS), and type of injury on mortality. Statistical analysis was performed using chi-square and multivariate logistic regression (Stata, College Station, Texas). P < 0.05 was considered statistically significant. Results: 17,690 children were admitted to Pennsylvania trauma centers during the study period; 67% were male and the overall mortality was 3.8%. There was no gender-related difference in mortality in children ≤ 10 years of age with mild (ISS ≤ 15; p = .4), moderate (ISS 16–24; p = .9), or severe (ISS > 25; p = .5) injuries, head injuries (p = .5), or injury to the trunk (p = .6) or extremities (p = .4). In contrast, girls 11–16 years of age with a head injury had a 3 times higher risk of mortality than boys (OR 3.09, 95% CI 2.63–3.64) despite equivalent admission GCS and ISS. Conclusion: As expected, gender does not influence mortality in children ≤ 10 years of age. On the other hand, adolescent girls appear to have a higher than expected mortality from head injuries. Whether this is a result of hormonal influences or other factors have yet to be determined. TABLE—ABSTRACT P115Head injuryMale (died/total)Female (died/total)P-value≤10 years151/259396/13850.4>10 years118/184762/7120.04