Aims, Objectives and Background Female patients are consistently outnumbered by males in trauma studies. This introduces bias towards male physiology when developing treatments and protocols and may result in females receiving less efficacious care. Recent studies have looked at sex based differences in injury patterns and outcomes following motor vehicle collisions1 as well as TXA administration following severe injury2. In this study we aimed to describe differences between male and female patients with equivalent injury severities (as assessed by ISS), specifically looking at acute physiological responses to injury and subsequent clinical outcomes.
Method and Design We have sex disaggregated data from over 2000 patients enrolled in the Activation of Coagulation and Inflammation in Trauma (ACIT-II) prospective cohort study (REC: 07/Q0603/29) at the Royal London Hospital. Patients are eligible for inclusion into ACIT-II if they arrive in the Emergency Department within 2 hours of injury and meet the local criteria for a trauma team activation. Blood samples are taken on admission, and physiological parameters and outcome data are collected daily for up to 28 days or until death or discharge. Injury Severity Scores (ISS) were grouped into ‘control’ (ISS 0-3), ‘mild’ (ISS 4-8), ‘moderate’ (ISS 9-15), ‘severe’ (ISS 16-25), ‘critical’ (ISS 25-35) and ‘super critical’ (ISS ≥36).
Results and Conclusion Our data showed a number of variations in physiological response between females and males of the same injury severity categories, notably in terms of depth of shock and coagulation. We also demonstrated worse 28-day survival for females compared to males in the higher injury severity groups (severe p = 0.006, critical p = <0.001). This work shows a definite requirement for further study into how sex based differences can affect presentations and outcomes in trauma.
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