Female Trauma Patients Research Articles

The Consequences of High-Risk Behaviors: Trauma During Pregnancy

Trauma during pregnancy places two lives at risk. Knowledge of risk factors for trauma during pregnancy may improve outcomes. We reviewed the charts of 188 such patients admitted to a Level I trauma center from 1996 to 2004. A comparison was made of injury severity and outcome from a cohort of nonpregnant female trauma patients selected with a similar temporal occurrence and age range. Motor vehicle collisions comprised 160 cases, 67 using a restraint device. Of 84 patients tested, 45 tested positive for intoxicants, 16 positive for 2 or more intoxicants. A significant trend toward less testing through the study period was observed (p = 0.0002). Injury severity was assessed by Revised Trauma Score (RTS). RTS <11 or admission to operating room or intensive care units (OR/ICU) classified patients as severely injured. The six maternal fatalities had an RTS <11 or OR/ICU disposition. Fetal outcomes included 155 live in utero, 18 live births, and 15 fatalities correlating with injury severity by either criteria (p < 0.0001). Of the fetal fatalities, 7 occurred with RTS = 12, but only 3 fatalities occurred in the 147 cases not admitted to OR/ICU. Gestational age correlated (p < 0.0001) with fetal outcomes. The 18 live births had mean gestational ages of 35 +/- 4 weeks as compared with fetal fatalities at 20 +/- 9 weeks, and fetuses alive in utero at 22 +/- 9 weeks gestation. Coagulation tests prothrombin time (PT), international normalized ratio (INR) (both p < 0.008), and partial thromboplastin time (PTT) (p < 0.0001) correlated with maternal outcome. A matched cohort of nonpregnancy trauma cases during the same time frame indicated that, despite a significantly higher percentage of severely injured patients, fewer fatalities occurred. This might reflect a greater risk for the pregnant trauma patient. This study of trauma in pregnancy cases revealed a high percentage with risk behaviors. There was a significant trend toward less intoxicant testing in recent years. Coagulation tests were the most predictive of outcomes. Lower gestational age correlated with fetal demise.

Asymptomatic Lumbar Vertebral Erosion from Inferior Vena Cava Filter Perforation

In 2002, a 24-year-old female trauma patient underwent prophylactic inferior vena cava filter placement. Recurrent bouts of renal stones prompted serial CT imaging in 2004. In this brief report, we describe erosion and ossification of the L3 vertebral body by a Greenfield filter strut.

Gender, infection, critical illness, and death: superior survival for female trauma patients admitted to the intensive care unit treated for infection in a dedicated, prospective, multicenter study

Gender, infection, critical illness, and death: superior survival for female trauma patients admitted to the intensive care unit treated for infection in a dedicated, prospective, multicenter study

Rhythmic Premature Ventricular Contractions

Scenario: This is a bedside ECG strip of lead I and the accompanying arterial waveform in a 24-year-old female trauma patient. She presented 24 hours earlier to the emergency department after an all-terrain vehicle accident in which she sustained multiple injuries to her head, neck, torso, abdomen, and limbs. ECG PUZZLER A regular feature of the American Journal of Critical Care, the ECG Puzzler addresses ECG interpretation for clinical practice. We welcome letters to the Editors regarding this feature.

Recovery after Musculoskeletal Trauma in Men and Women

Recent work has suggested that women are more at risk of impaired outcome after traumatic injuries. This would suggest that resources should be targeted at female trauma patients to optimize their outcomes. We wished to explore the physical and psychological outcomes of women treated in our trauma unit. The Grampian Trauma Outcomes Study recruited patients aged 16 to 70 years with musculoskeletal injuries. Patients with significant head injuries, alcohol intoxication, or low-energy osteoporotic fractures were excluded. Of 227 patients approached, 200 were recruited to the study. Patients were asked to complete physical and psychosocial (Short Form-36 and Musculoskeletal Function Assessment) and psychological (General Health Questionnaire) outcomes measures at initial assessment and at 2- and 6-month follow-up. Of the 200 patients, 79% completed 2-month follow-up and 75% completed 6-month follow-up. There were no significant differences in the outcomes scores between male and female patients at either of the follow-up points. From our study, women do not appear to have impaired recovery after trauma as compared with men. Larger scale studies are required to assess the need to target specific resources toward the treatment of female trauma victims.

Severe Intimate Partner Violence and Alcohol Use among Female Trauma Patients

The lifetime prevalence of intimate partner violence (IPV) among women in the United States is reported to be between 18 and 50%. One-third of female homicide victims are killed by an intimate partner and alcohol is often involved. Despite these figures, 77% of women have never been screened for IPV. Substance abuse in male partners is known to place women at risk. We examined the role of female alcohol use on rates of severe IPV. Our hypotheses were: (1) the prevalence of IPV among women seen in trauma centers is greater than that found in national surveys; (2) alcohol problems among abused women and their partners are greater than those among non-abused women; (3) females and their partners alcohol problems are each independently associated with IPV; and (4) female trauma center patients support domestic violence screening. An in-person survey was administered to 95 consecutive adult female trauma patients admitted to a Level I Trauma Center. The survey included questions about past-year and lifetime severe IPV, female and male partner alcohol use, and willingness to participate in IPV screening and referral. The multivariate associations of female and partner alcohol use with past-year severe IPV were assessed with logistic regression. Nearly one-half (46.3%) of women reported a lifetime history of severe IPV, with 26% experiencing severe IPV in the past year. Past-year IPV was identified in 59.1% of women screening positive for drinking problems, but in only 12.7% of those screening negative for drinking problems (p = 0.001). Similarly, past-year IPV prevalence was 55.2% when the partner was a problem drinker versus 8.3% when he was not (p = 0.001). Multivariate analysis showed that female problem drinking (odds ratio [OR] = 5.8) and partner problem drinking (OR=8.9) were independent predictors of past-year severe IPV. The majority of women (90.5%) felt that it was appropriate for health care professionals to screen for IPV; 90% of women with a history of IPV thought screening was important and 71% wished a previous healthcare provider had asked them about it. Female trauma patients demonstrate a higher prevalence of severe IPV than the general population. IPV rates appear to be related to both female and partner alcohol misuse. Female trauma patients endorsed IPV screening and thus should be screened for alcohol use and IPV in a way that minimizes future violence risk. Further research is needed to elucidate whether intervention for alcohol misuse has an impact on rates of IPV in this population.

Age-Related Changes in Cerebral Blood Flow May Explain Worse Outcome in Female Head Trauma Patients

Age-Related Changes in Cerebral Blood Flow May Explain Worse Outcome in Female Head Trauma Patients

Injury patterns among female trauma patients: recognizing intentional injury.

Intimate partner violence and interpersonal violence are a major source of morbidity and mortality among women. Our objective was to identify patterns of injury consistent with intentional injury in female trauma patients admitted to the hospital. Subjects were women aged 16 to 65 years discharged from acute care hospitals in a single year with a primary diagnosis of injury. Data were collected from 14 states across the United States. Analysis was performed using multivariate logistic regression. Women who suffered blunt intentional trauma exhibited very different injury patterns than those hospitalized for motor vehicle collisions or falls. The risk of facial injury with blunt intentional trauma was much higher than for other mechanisms (odds ratio, 4.9; 95% confidence interval, 4.20-5.74). Head injury was also more common in these women (odds ratio, 1.4, 95% confidence interval, 1.15-1.70). Physicians can potentially improve identification of cases of intimate partner violence and interpersonal violence by understanding common injuries associated with interpersonal violence.

Male gender is associated with increased risk for postinjury pneumonia.

Nosocomial pneumonia in trauma patients is a significant source of resource utilization and mortality. We have previously described increased rates of pneumonia in male trauma patients in a single institution study. In that study, female trauma patients had a lower incidence of postinjury pneumonia but a higher relative risk for mortality when they did develop pneumonia. We sought to investigate the hypothesis that male trauma patients have an increased incidence of postinjury pneumonia in a separate population-based dataset. Prospective data were collected on 30,288 trauma patients (26,231 blunt injuries, 4057 penetrating injuries) admitted to all trauma centers (n = 26) in Pennsylvania over 24 months (January 1996 to December 1997). Gender differences in pneumonia were determined for the entire dataset. A second analysis examined all blunt injury patients and excluded all patients with a hospital length of stay less than 24 h, eliminating patients who expired early after admission. In trauma patients with minor injury (ISS < 15), there was no significant difference between male and female patients in the rate of postinjury pneumonia (male 1.37%, female 1.11%). In the moderate-injury group (ISS > 15), male trauma patients had a significantly increased incidence of postinjury pneumonia (ISS 15-30, male 8.85%, female 6.45%; ISS > 30, male 24.35%, female 17.30%). Logistic regression analysis of blunt trauma patients revealed that gender, ISS, injury type, admission Revised Trauma Score (RTS), admission respiratory rate, history of cardiac disease, and history of cancer were all independent predictors of pneumonia. Trauma patients with nosocomial pneumonia had a significantly higher mortality rate (P < 0.001) than patients without pneumonia. There was no gender-specific difference in mortality among pneumonia patients. Male gender is significantly associated with an increased incidence of postinjury pneumonia. In contrast to our initial study, there was no gender difference in postinjury pneumonia mortality rates identified in this population-based study.

Female Trauma Patients in the Emergency Department: Should their Injury Prevention Programme be Different?

Background(1) To compare the characteristics of female and male trauma patients seen in the Emergency Department (ED) and (2) to determine if injury prevention programmes for women should be different.MethodsA prospective survey was conducted for 11544 trauma patients, aged 15 years and above, who presented to the ED of an urban public hospital in Singapore over 6 months. The following data were collected: demography, place, type and mechanism of injury and subsequent disposition from the ED.ResultsAlmost half (49.5%) the injuries sustained by females occurred at home, with low falls of less than 2 metres being the most common mechanism of injury (52.7%). Victims of domestic violence were predominantly female at p&lt;0.0001.ConclusionInjury prevention programs for women should focus on home safety and low falls. Special assistance programs for the victims of domestic violence should be available in the ED as the latter may be their only access to safety.

Gender-related outcomes in trauma.

Recent data suggest that sex hormones may play a role in regulating posttraumatic immunosuppression, leading to gender-based differences in outcome after injuries. This study examined gender-related outcomes in trauma patients. We conducted a retrospective review of trauma registry data from our Level I trauma center over a 4-year period. Patients > 15 years of age, with Injury Severity Scores > 15, who survived and received mechanical ventilation for > 48 hours were included. Patients were divided into two groups on the basis of age (15-45 years and > 45 years) and the groups were further stratified by gender. Groups were matched by Injury Severity Scores, Glasgow Coma Scale score, Abbreviated Injury Score for the head, and transfusion requirement. Gender-based outcomes consisted of ventilator days, intensive care unit length of stay (LOS), hospital LOS, pneumonia, and death. Data were reported as mean +/- SD. There were 612 patients. In the younger age group, male patients had a higher incidence of multiple organ failure (10.5% vs. 1.5%), longer intensive care unit (13.5 +/- 9.2 days vs. 9.2 +/- 7.2 days) and hospital LOS (30.2 +/- 37.7 days vs. 18.9 +/- 13.0 days), and higher mortality (13.4% vs. 6.8%) compared with female patients (p < 0.05 for all). These differences did not exist in the older age group. The incidence of pneumonia did not differ by gender. Age > 45 years was associated with higher mortality (odds ratio, 2.0; 95% confidence interval, 1.1-3.5). Although the incidence of pneumonia was not influenced by gender, female trauma patients had better outcomes than male patients in the younger age group. Outcome in the older age group was not gender-related. Our data support a gender-based difference in outcome after traumatic injuries in younger patients.

Prevalence of Domestic Violence and Associated Factors among Women on a Trauma Service

Despite the increasing recognition of the problem of domestic violence (DV), it has not been studied in surgical populations. Eligible patients underwent screening for a recent history of DV and alcohol abuse (AA). Other demographic, health, and injury-related data were also collected. Of 127 subjects entered into the study, 18% screened positive for DV and 21% screened positive for AA. Of those screening positive for DV, 65% screened positive for AA compared with 12% of those screening negative for DV (p < 0.001.) Screening for DV was recommended by a vast majority of subjects, with only 6% of subjects responding that it was not appropriate. Both DV and AA have a high prevalence among female trauma patients admitted to trauma centers. Nearly all subjects recommended screening for DV. Screening for DV should be incorporated into the routine care of female trauma patients.

A statewide population-based study of gender differences in trauma: validation of a prior single-institution study.

Women usually have lower mortality rates than men do at any age. This pattern is observed for most causes of death from chronic diseases. Significant controversy still exists about gender differences in outcomes in trauma. We previously reported no differences in in-hospital mortality based on gender in a large single-institution study (n= 18,892) that had a significant limitation in that it was not population based. This current study was performed to validate our earlier findings in a separate, statewide, population-based dataset of trauma victims. Prospective data were collected on 22,332 trauma patients (18,432 blunt, 3,900 penetrating) admitted to all trauma centers (n = 26) in Pennsylvania over 24 months (January 1996 to December 1997). Gender differences in in-hospital mortality were determined for the entire dataset and for the subsets of blunt and penetrating injury patients. A second analysis examined all blunt injury patients and excluded all patients with a hospital length of stay of less than 24 hours, eliminating patients who expired soon after admission. The null hypothesis was that female gender is protective in trauma outcomes. Multiple logistic regression analysis identified age (odds ratio [OR] 1.03, confidence interval [CI] 1.02 to 1.03), Injury Severity Score (OR 1.06, CI 1.05 to 1.06), non-Caucasian race (OR 1.72, CI 1.39 to 2.15), blunt injury type (OR 0.327, CI 0.26 to 0.41), and Revised Trauma Score (OR 0.44, CI 0.41 to 0.47) as independent predictors of in-hospital mortality in trauma. Preexisting diseases, including cardiac disease (OR 1.53, CI 1.12 to 2.09) and malignancy (OR 4.08, CI 1.64 to 10.17), were also identified as independent predictors of in-hospital mortality in trauma. Female gender was not associated with decreased mortality (OR 0.83, CI 0.67 to 1.03, p = 0.093). A second multiple regression analysis in blunt trauma patients admitted for longer than 24 hours (which eliminated early deaths and patients with minor injuries) determined that in-hospital mortality was not significantly different in male or female blunt trauma patients stratified by Injury Severity Score and age. The same factors that were predictive of in-hospital mortality in the total dataset were also significant in this secondary analysis. These population-based data confirm that female gender does not adversely affect in-hospital mortality in trauma when patients are appropriately stratified for other variables, including Injury Severity Score and age, that do significantly affect outcomes.

Surgeon-performed focused assessment with sonography for trauma as an early screening tool for pregnancy after trauma.

Incidental pregnancy in trauma patients is associated with a high fetal mortality. Because of quality assurance reasons, many trauma centers have eliminated the rapid urine pregnancy screen. We sought to determine the utility and impact of the initial ultrasound examination in the diagnosis of pregnancy in female trauma patients. Data were analyzed for all female trauma patients in whom pregnancy was diagnosed during a 5-year period. One hundred one (70%) of 144 pregnant women had an initial ultrasound examination. Eighteen patents had newly diagnosed pregnancies, of whom 8 of 9 patients (89%) at > or = 8 weeks' gestation were diagnosed by the initial ultrasound. This directly contributed to a significant decrease in the amount of radiation exposure (p < 0.001) compared with patients diagnosed by serum beta-human chorionic gonadotropin. An initial ultrasound examination should be considered in all female trauma patients of reproductive age. This may help to promote a reduction in fetal radiation exposure.

Sexual dimorphism in trauma? A retrospective evaluation of outcome

Purpose: Multiple studies have demonstrated a heightened immune response in female animals subjected to trauma–hemorrhage models and have implied a subsequent survival advantage.Procedures: A retrospective review of outcome in 15,170 trauma admissions over a 5-year-period (1993–1997) at a level 1-trauma center was performed. A comparison of outcome by gender, age, injury severity score (ISS), mechanism of injury, location of injury (AIS), and length of hospitalization (intensive care unit and total hospitalization) was performed.Findings: There were 12,456 male and 2714 female patients included in the study. Overall survival rates (male=90.2%, female=90.8%) and survival of serious (ISS≥15) trauma (male=63.5%, female=60.5%) were not statistically different. Logistic regression analysis identified age, mechanism and ISS as factors associated with survival.Conclusion: Retrospective evaluation of our trauma population failed to show a difference in outcome between male and female trauma patients. Age, mechanism and severity of injury—but not gender—were identified as factors influencing survival.

X-Rays and the Female Trauma Patient: Is She Pregnant?

There are few data on the incidence of pregnancy in female trauma patients. These authors retrospectively analyzed pregnancy rates in 3976 female

Epidemiology of facial injury in female blunt assault trauma cases.

Etiology of trauma in the female population differs from that of the male population. To date, domestic violence has been researched extensively, but little has been published about the epidemiology of facial injury in the female population. To analyze the differences in the circumstances under which males and females are injured, to identify gender-specific patterns of injury, and to assess whether differences in the demographics, health status, and drug-use profile exist between female and male assault cases and whether these factors lead to a difference in outcome. A cohort of 91 female assault cases was compared with a control group of 706 males with similar injuries resulting from blunt assault trauma. Information was gathered by retrospective review of 797 consecutive cases requiring admission for facial injuries resulting from blunt assault trauma. Fisher exact, chi 2, and t tests were used to assess statistically significant differences between the male and female cohorts. The female cohort comprised 12% of all cases admitted for blunt assault facial trauma. One third of female blunt assault facial trauma patients were subjects of domestic violence. Statistically significant differences were found between males and females for the type of assault (rape, domestic violence, altercation, etc) with P < .0001. Females were more likely to be admitted with soft tissue injury only but no fracture (P < .05), less likely to be assaulted with a weapon, and unlikely to be involved in an altercation, gang violence, arrest, or robbery. Females were also less likely than males to be injured while intoxicated (P < .05). Incidence of specific injury patterns and outcomes, however, were similar between the 2 groups. The present data support the hypothesis that the female blunt assault facial trauma population represents a distinct epidemiological entity, with significant differences in the circumstances of injury, mechanism of assault, and role of intoxication in the incidence of injury. The prevalence of facial trauma in female assault cases makes it critical for the facial plastic surgeon to be vigilant in the evaluation and treatment of these patients.

Head, neck, and facial injuries as markers of domestic violence in women

Purpose: The diagnosis of domestic violence (DV) is difficult because of a lack of clearly defined signs and symptoms. The goal of this study was to confirm and refine the role of head, neck, and face (HNF) injuries as markers of DV. Patients and Methods: A cross-sectional study design and a sample of female trauma patients treated in an inner-city hospital emergency room (Grady Memorial Hospital, Atlanta, GA) were used. The predictor study variable was injury location (HNF or other location). The outcome variable was traumatic origin (DV or other cause). A victim of DV was defined as a patient who gave a history of being injured by her spouse or sexual partner. Other data included age, nature of the injury (blunt or penetrating), and injury severity score (ISS). Descriptive, bivariate, and logistic regression statistical analyses were performed. Results: The sample consisted of 100 injured women, with a mean age of 40 ± 16.3 years and a mean ISS of 3.3 ± 3.0. Thirty-four women were victims of DV. The mean age of the DV victims was 32.5 ± 7.3 years, compared with a mean age of 43.9 ± 18.2 year in the other-causes group ( P = .001). The mean ISS for the DV victims was 3.4 ± 3.0, and the mean ISS for the other-causes group was 3.2 ± 3.0 ( P = .65). DV victims were 7.5 (2.5 < RR < 22.9) times more likely to have HNF injuries than other trauma patients ( P < .001), Age was associated with cause and location of injury. After controlling for age, location remained statistically associated with cause ( P = .0002). Sensitivity and specificity of HNF injuries and DV were 91% and 59%, respectively. Conclusions: The data suggest that although HNF injuries and age were sensitive predictors of DV, they remain poor in their specificity as markers.

Project SAFE: Domestic violence education for practicing physicians

F or more than a decade, domestic violence advocates and health care providers have recognized that education of physicians about domestic violence is a key to the development of a comprehensive health care response to battered women. Every surgeon general since Dr. C. Everett Koop has identified family violence as a major health problem and has called upon researchers and clinicians alike to become a part of the solution. With the growth of the National Center for Injury Prevention and Control at the Centers for Disease Control and an emerging emphasis upon research in family violence, there has been a virtual explosion in knowledge regarding the epidemiology and health consequences of domestic violence. Initial prevalence estimates suggest that at least one adult woman in five will be physically assaulted by her partner. In clinical settings, 22%-35% of injured women presenting to emergency services are abused by partners, 23% of women seen in a family practice clinic and 14% of those in a university internal medicine clinic are in violent relationships, and 17% of obstetrical patients are assaulted during their pregnancy.i” Such figures stand in sharp contrast to rates of domestic violence identified routinely by physicians in these settings. The consistent failure to identify domestic violence in clinical practice has led to an emphasis on protocols and education as tools to help physicians address domestic violence in clinical evaluations. Nevertheless, the task of educating practicing physicians has proved difficult. In one of the first evaluations of a domestic violence protocol, McLeer et al successfully increased the rate of identification of abuse in an emergency department from 5.6% to 30% of female trauma patients. However, upon follow-up evaluation at the same site, rates of identification had dropped back to 7.7%, not significantly different than the baseline rate of identification.4 Kurz and Stark provide a more descriptive evaluation in their study of encounters between battered women and medical staff in a Philadelphia emergency department. They found that in the absence of an onsite advocate, clinicians tended to dismiss abused women as “evasive” and “repeaters” who will “just return home anyway.“5 Q 1995 by The Jacobs Institute of

Ectopic pregnancy in a blunt trauma patient

Trauma during pregnancy is a frequent occurrence, and early pregnancies are likely to be unrecognized in the routine evaluation of female trauma patients. We present the case of a 16-year-old woman injured in a motor vehicle crash who sustained a closed head injury and was found to have a right ectopic tubal pregnancy. Since several physiologic responses and pathologic conditions occur during pregnancy, which complicate the diagnosis and treatment of a pregnant patient, it is important to detect pregnancy early in the patient's evaluation. This case report demonstrates an unusual presentation of ectopic pregnancy and illustrates the merits of routine pregnancy testing of female trauma patients.