The Association of Gender and Mortality in Geriatric Trauma Patients
Abstract
:1. Introduction
2. Materials and Methods
2.1. Procedures, Patient Selection, and Variable Definition
2.2. Measures, Inclusion Criteria, and Exclusion Criteria
2.3. Statistical Methods
3. Results
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
- Gioffrè-Florio, M.; Murabito, L.M.; Visalli, C.; Pergolizzi, F.P.; Famà, F. Trauma in elderly patients: A study of prevalence, comorbidities, and gender differences. G Chir. 2018, 39, 35–40. [Google Scholar] [CrossRef] [Green Version]
- Stawicki, S.P.; Kalra, S.; Jones, C.; Justiniano, C.F.; Papadimos, T.J.; Galwankar, S.C.; Pappada, S.M.; Feeney, J.; Evans, D.C. Comorbidity polypharmacy score and ts clinical utility: A pragmatic practitioner’s perspective. J. Emerg. Trauma Shock 2015, 8, 224–231. Available online: https://pubmed.ncbi.nlm.nih.gov/26604529 (accessed on 1 July 2021). [CrossRef]
- Llompart-Pou, J.A.; Pérez-Bárcena, J.; Chico-Fernández, M.; Sánchez-Casado, M.; Raurich, J.M. Severe trauma in the geriatric population. World J. Crit. Care Med. 2017, 6, 99. [Google Scholar] [CrossRef] [PubMed]
- El-Menyar, A.; Tilley, E.; Al-Thani, H.; Latifi, R. Females fall more from heights but males survive less among a geriatric population: Insights from an American level 1 trauma center. BMC Geriatr. 2019, 19, 1–8. [Google Scholar] [CrossRef] [Green Version]
- Choudhry, M.A.; Schwacha, M.G.; Hubbard, W.J.; Kerby, J.D.; Rue, L.W.; Bland, K.I.; Chaudry, I.H. Gender differences in acute response to trauma-hemorrhage. Shock 2005, 24 (Suppl. S1), 101–106. [Google Scholar] [CrossRef] [PubMed]
- Choudhry, M.A.; Bland, K.I.; Chaudry, I.H. Gender and susceptibility to sepsis following trauma. Endocr. Metab. Immune Disord. Drug Targets 2006, 6, 127–135. [Google Scholar] [CrossRef] [PubMed]
- Phelan, H.A.; Shafi, S.; Parks, J.; Maxson, R.T.; Ahmad, N.; Murphy, J.T.; Minei, J.P. Use of a pediatric cohort to examine gender and sex hormone influences on outcome after trauma. J. Trauma 2007, 63, 1127–1131. [Google Scholar] [CrossRef] [PubMed]
- Raju, R.; Chaudry, I.H. Sex steroids/receptor antagonist: Their use as adjuncts after trauma-hemorrhage for improving immune/cardiovascular responses and for decreasing mortality from subsequent sepsis. Anesth. Analg. 2008, 70, 159–166. [Google Scholar] [CrossRef] [PubMed]
- Angele, M.K.; Frantz, M.C.; Chaudry, I.H. Gender and sex hormones influence the response to trauma and sepsis: Potential therapeutic approaches. Clinics 2006, 61, 479–488. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Kawasaki, T.; Chaudry, I.H. The effects of estrogen on various organs: Therapeutic approach for sepsis, trauma, and reperfusion injury. Part 1: Central nervous system, lung, and heart. J. Anesth. 2012, 26, 883–891. [Google Scholar] [CrossRef] [PubMed]
- Kawasaki, T.; Chaudry, I.H. The effects of estrogen on various organs: Therapeutic approach for sepsis, trauma, and reperfusion injury. Part 2: Liver, intestine, spleen, and kidney. J. Anesth. 2012, 26, 892–899. [Google Scholar] [CrossRef] [PubMed]
- Raju, R.; Bland, K.I.; Chaudry, I.H. Estrogen: A novel therapeutic adjunct for the treatment of trauma-hemorrhage-induced immunological alterations. Mol. Med. 2008, 14, 213–221. [Google Scholar] [CrossRef]
- Napolitano, L.M.; Greco, M.E.; Rodriguez, A.; Kufera, J.A.; West, R.S.; Scalea, T.M. Gender differences in adverse outcomes after blunt trauma. J. Trauma 2001, 50, 274–280. [Google Scholar] [CrossRef] [PubMed]
- Al-Tarrah, K.; Moiemen, N.; Lord, J.M. The influence of sex steroid hormones on the response to trauma and burn injury. Burn. Trauma 2017, 5. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Vespa, J.; Medina, L.; Armstrong, D. Demographic Turning Points for the United States: Population Projections for 2020 to 2060. Current Population Reports, P25-1144; US Census Bureau: Washington, DC, USA, 2018; pp. 1–13. Available online: https://census.gov/programs-surveys/popproj.html (accessed on 1 July 2021).
- Kay, S.; Pisani, M.A. An Overview of Sex and Gender in Pulmonary and Critical Care Medicine. Clin. Chest Med. 2021, 42, 385–390. [Google Scholar] [CrossRef] [PubMed]
- Filipescu, D.; Ştefan, M. Sex and gender differences in anesthesia: Relevant also for perioperative safety? Best Pract. Res. Clin. Anaesthesiol. 2021, 35, 141–153. [Google Scholar] [CrossRef] [PubMed]
- Westerman, S.; Wenger, N. Gender Differences in Atrial Fibrillation: A Review of Epidemiology, Management, and Outcomes. Curr. Cardiol. Rev. 2019, 15, 136–144. [Google Scholar] [CrossRef]
All | Dead | Alive | p | |
---|---|---|---|---|
Demographic | ||||
Sex, n (%) | ||||
Male | 1635 (36.9) | 89 | 1546 | <0.01 |
Race, n (%) | ||||
White | 3859 (87.2) | 148 | 3711 | 0.01 |
Black | 106 (2.4) | 4 | 102 | |
Other | 460 (10.4) | 13 | 447 | |
Age (mean ± SD) | 81 ± 9 | 84.5 ± 7 | 80.8 ± 9 | <0.01 |
Injury | ||||
ISS, median (IQR) | 5 (7) | 9 (12.5) | 5 (7) | <0.01 |
Head, n (%) | 1041 (23.5) | 65 | 976 | <0.01 |
Chest, n (%) | 669 (15.09) | 36 | 633 | 0.02 |
Abdomen, n (%) | 146 (3.29) | 10 | 136 | 0.07 |
Extremity, n (%) | 2537 (57.24) | 82 | 2455 | 0.05 |
Clinical | ||||
ED SBP, mean ± SD | 150 ± 32 | 138 ± 46 | 151 ± 31 | <0.01 |
ED Heart rate, mean ± SD | 81 ± 17 | 85 ± 26 | 81 ± 16 | 0.11 |
ED Respiratory rate, mean ± SD | 19 ± 3 | 18 ± 7 | 19 ± 3 | 0.6 |
Hematocrit, mean ± SD | 37.3 ± 8.8 | 36 ± 7 | 37 ± 9 | 0.02 |
INR, median (IQR) | 1.1 (0.3) | 1.2 (0.3) | 1.1 (0.3) | <0.01 |
Lactate, median (IQR) | 1.7 (1.2) | 2.2 (3.3) | 1.6 (1.2) | <0.01 |
>1 co-morbidity, n (%) | 721 (16.27) | 48 | 673 | <0.01 |
Smoking, n (%) | 244 (5.51) | 10 | 234 | 0.42 |
VAP, n (%) | 13 (0.29) | 4 | 9 | <0.01 |
PE, n (%) | 5 (0.11) | 1 | 4 | 0.17 |
DVT—deep venous thrombosis, n (%) | 45 (1.0) | 6 | 39 | <0.01 |
AKI—acute kidney injury, n (%) | 33 (0.74) | 14 | 19 | <0.01 |
Outcome | ||||
Length of stay, median (IQR) | 5 (5) | 6 (8) | 5 (5) | <0.01 |
Men n = 1635 | Women n = 2797 | p | |
---|---|---|---|
Demographic | |||
Race, n (%) | |||
White | 1398 (85.6) | 2461 (88.1) | 0.02 |
Black | 51 (3.1) | 55 (2.0) | |
Other | 184 (11.3) | 276 (9.9) | |
Age, Mean ± SD | 79.3 ± 8.4 | 81.9 ± 8.5 | <0.01 |
Injury | |||
Severity (ISS), median (IQR) | 5 (7) | 6 (5) | <0.01 |
Head, n (%) | 459 (28.1) | 582 (20.8) | <0.01 |
Chest, n (%) | 287 (17.6) | 382 (13.7) | <0.01 |
Abdomen, n (%) | 71 (4.3) | 75 (2.7) | <0.01 |
Extremity, n (%) | 781 (47.8) | 1756 (62.8) | <0.01 |
Clinical | |||
ED SBP, mean ± SD | 146 ± 32 | 153 ± 41 | <0.01 |
ED Heart rate, mean ± SD | 81 ± 18 | 82 ± 16 | 0.10 |
ED Respiratory rate, mean ± SD | 19 ± 3 | 19 ± 3 | 0.41 |
Hematocrit, mean ± SD | 38.1 ± 12.3 | 36.7 ± 5.8 | <0.01 |
INR, median (IQR) | 1.1 (0.3) | 1.1 (0.3) | <0.01 |
Lactate, median (IQR) | 1.8 (1.3) | 1.6 (1) | <0.01 |
>1 morbidity, n (%) | 322 (19.7) | 399 (14.3) | <0.01 |
Smoking, n (%) | 99 (6.1) | 145 (5.2) | 0.03 |
VAP—ventilator-associated pneumonia, n (%) | 7 (0.4) | 6 (0.2) | 0.10 |
PE—pulmonary embolism, n (%) | 2 (0.1) | 3 (0.1 | 0.34 |
DVT—deep venous thrombosis, n (%) | 18 (1.1) | 27 (0.9) | 0.11 |
AKI—acute kidney injury, n (%) | 13 (0.8) | 20 (0.7) | 0.14 |
Outcome | |||
LOS (days), median (IQR) | 5 (6) | 5 (4) | 0.68 |
Died, n (%) | 89 (5.4) | 76 (2.7) | <0.01 |
OR | 95% CI | p | |
---|---|---|---|
Gender, male vs. female ED SBP < 90 vs. >90 | 1.94 6.17 | 1.38–2.73 3.17–12.01 | <0.0001 <0.0001 |
ISS (injury severity score) | 1.12 | 1.09–1.14 | <0.0001 |
≥2 comorbidity compared to ≤1 | 2.28 | 1.55–3.35 | <0.0001 |
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Pandya, S.; Le, T.; Demissie, S.; Zaky, A.; Arjmand, S.; Patel, N.; Moko, L.; Garces, J.; Rivera, P.; Singer, K.; et al. The Association of Gender and Mortality in Geriatric Trauma Patients. Healthcare 2022, 10, 1472. https://doi.org/10.3390/healthcare10081472
Pandya S, Le T, Demissie S, Zaky A, Arjmand S, Patel N, Moko L, Garces J, Rivera P, Singer K, et al. The Association of Gender and Mortality in Geriatric Trauma Patients. Healthcare. 2022; 10(8):1472. https://doi.org/10.3390/healthcare10081472
Chicago/Turabian StylePandya, Shreya, Timothy Le, Seleshi Demissie, Ahmed Zaky, Shadi Arjmand, Nikhil Patel, Lilamarie Moko, Juan Garces, Paula Rivera, Kiara Singer, and et al. 2022. "The Association of Gender and Mortality in Geriatric Trauma Patients" Healthcare 10, no. 8: 1472. https://doi.org/10.3390/healthcare10081472