Holbrook T L, Hoyt D B, Anderson J P
Department of Family and Preventive Medicine, University of California, San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093-0073, USA.
J Trauma. 2001 Feb;50(2):270-3. doi: 10.1097/00005373-200102000-00012.
Outcome after major trauma is an increasingly important focus of injury research. The effect of gender on functional and psychological outcomes has not been examined. The Trauma Recovery Project is a large, prospective, epidemiologic study designed to examine multiple outcomes after major trauma, including quality of life, functional outcome, and psychological sequelae such as depression and early symptoms of acute stress reaction. The specific objectives of the present report are to examine gender differences in short- and long-term functional and psychological outcomes in the Trauma Recovery Project population.
Between December 1, 1993, and September 1, 1996, 1,048 eligible trauma patients triaged to four participating trauma center hospitals in the San Diego Regionalized Trauma System were enrolled in the study. The enrollment criteria for the study included age 18 years and older, admission Glasgow Coma Scale score of 12 or greater, and length of stay greater than 24 hours. Quality of life was measured after injury using the Quality of Well-being scale, a sensitive index to the well end of the functioning continuum (range, 0 = death to 1.000 = optimum functioning). Depression was assessed using the Center for Epidemiologic Studies Depression scale and early symptoms of acute stress reaction were assessed using the Impact of Events scale. Patient outcomes were assessed at discharge and at 6, 12, and 18 months after discharge.
Functional outcome was significantly worse at each follow-up time point in women (n = 313) versus men (n = 735). Quality of Well-being scale scores were markedly and significantly lower at 6-month follow-up in women compared with those in men (0.606 vs. 0.646, p < 0.0001). This association persisted at 12-month (0.637 vs. 0.6685, p < 0.0001) and 18-month (0.646 vs. 0.6696, p < 0.0001) follow-up. Women were also significantly more likely to be depressed at all follow-up time points (discharge odds ratio [OR] = 1.4, p < 0.05; 6-month follow-up OR = 2.2, p < 0.01; 12-month follow-up OR = 2.0, p < 0.01; 18-month follow-up OR = 2.2, p < 0.01) and to have early symptoms of acute stress reaction at discharge (OR = 1.4, p < 0.05). These differences remained significant and independent after adjusting for injury severity, mechanism, age, and sociodemographic factors.
Women are at risk for markedly worse functional and psychological outcomes after major trauma than men, independent of injury severity and mechanism. Gender differences in short- and long-term trauma outcomes have important implications for future studies of recovery from trauma.
重大创伤后的结局是创伤研究中一个日益重要的焦点。性别对功能和心理结局的影响尚未得到研究。创伤恢复项目是一项大型前瞻性流行病学研究，旨在研究重大创伤后的多种结局，包括生活质量、功能结局以及抑郁和急性应激反应早期症状等心理后遗症。本报告的具体目的是研究创伤恢复项目人群中短期和长期功能及心理结局的性别差异。
在1993年12月1日至1996年9月1日期间，1048名符合条件的创伤患者被分诊到圣地亚哥区域创伤系统的四家参与创伤中心医院并纳入研究。该研究的纳入标准包括年龄18岁及以上、入院时格拉斯哥昏迷量表评分12分或更高以及住院时间超过24小时。受伤后使用幸福质量量表测量生活质量，这是功能连续体良好结局的一个敏感指标（范围：0 = 死亡至1.000 = 最佳功能）。使用流行病学研究中心抑郁量表评估抑郁情况，使用事件影响量表评估急性应激反应的早期症状。在出院时以及出院后6个月、12个月和18个月评估患者结局。
在每个随访时间点，女性（n = 313）的功能结局明显比男性（n = 735）差。与男性相比，女性在6个月随访时的幸福质量量表评分显著更低（0.606对0.646，p < 0.0001）。这种关联在12个月随访时（0.637对0.6685，p < 0.0001）和18个月随访时（0.646对0.6696，p < 0.0001）持续存在。在所有随访时间点，女性抑郁的可能性也显著更高（出院时优势比[OR] = 1.4，p < 0.05；6个月随访时OR = 2.2，p < 0.01；12个月随访时OR = 2.0，p < 0.01；18个月随访时OR = 2.2，p < 0.01），并且在出院时出现急性应激反应早期症状的可能性更高（OR = 1.4，p < 0.05）。在调整损伤严重程度、机制、年龄和社会人口学因素后，这些差异仍然显著且独立。
与男性相比，女性在重大创伤后功能和心理结局明显更差的风险更高，且与损伤严重程度和机制无关。短期和长期创伤结局的性别差异对未来创伤恢复研究具有重要意义。
