Holbrook Troy L, Hoyt David B
Department of Family and Preventive Medicine, University of California San Diego, San Diego, California 92103-8896, USA.
J Trauma. 2004 Feb;56(2):284-90. doi: 10.1097/01.TA.0000109758.75406.F8.
The importance of gender differences in quality of life and psychologic morbidity after major trauma is a newly recognized focus of trauma outcomes research. The Trauma Recovery Project is a large, prospective, epidemiologic study designed to examine multiple outcomes after major trauma, including quality of life (QoL), and psychologic sequelae such as depression and early symptoms of acute stress reaction (SASR). The specific objectives of the present report are to examine gender differences in QoL outcomes and the early incidence of combined depression and SASR after injury, controlling for injury severity, specific body area injured, and mechanism.
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. QoL outcome after trauma 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 scale. SASR was assessed using the Impact of Events scale. Patient outcomes were assessed at discharge and at 6, 12, and 18 months after discharge.
Women (n = 313) were significantly more likely to have poor QoL outcomes at follow-up than men (n = 735) (women vs. men: 12-month follow-up odds ratio [OR] = 2.2, p < 0.001; 18-month follow-up OR = 2.0, p < 0.001). Quality of Well-being scores at each of the 6-, 12-, and 18-month follow-up time points were markedly and significantly lower in women compared with men, independent of injury severity, serious and moderate injury status, lower extremity injury, intentional or unintentional injury type, and blunt or penetrating injury. Women were also significantly more likely to develop early combined depression and SASR at discharge (OR = 1.7, p < 0.01) and to have continuous depression throughout the 18-month follow-up period (OR = 2.3, p < 0.001).
These analyses provide further important and more detailed evidence that women are at risk of worse QoL outcomes and early psychologic morbidity after major trauma than men, independent of mechanism and injury severity. A better understanding of the impact of major trauma in men and women will be an important component of efforts to improve trauma care and long-term outcome in mature trauma systems.
重大创伤后生活质量和心理疾病方面的性别差异的重要性是创伤结局研究中一个新认识到的重点。创伤恢复项目是一项大型的前瞻性流行病学研究，旨在检查重大创伤后的多种结局，包括生活质量（QoL）以及诸如抑郁和急性应激反应（SASR）早期症状等心理后遗症。本报告的具体目标是检查生活质量结局方面的性别差异以及受伤后抑郁和SASR合并症的早期发生率，并对损伤严重程度、特定受伤身体部位和损伤机制进行控制。
在1993年12月1日至1996年9月1日期间，对圣地亚哥区域创伤系统中四家参与研究的创伤中心医院分诊的1048名符合条件的创伤患者进行了研究。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。创伤后生活质量结局在受伤后使用幸福感量表进行测量，该量表是功能连续体良好结局的敏感指标（范围：0 = 死亡至1.000 = 最佳功能）。使用流行病学研究中心量表评估抑郁情况。使用事件影响量表评估SASR。在出院时以及出院后6、12和18个月对患者结局进行评估。
女性（n = 313）在随访时生活质量结局较差的可能性显著高于男性（n = 735）（女性与男性相比：12个月随访时优势比[OR] = 2.2，p < 0.001；18个月随访时OR = 2.0，p < 0.001）。在6个月、12个月和18个月随访时间点的每一个，女性的幸福感得分均显著低于男性，且与损伤严重程度、重度和中度损伤状态、下肢损伤、有意或无意损伤类型以及钝性或穿透性损伤无关。女性在出院时发生早期抑郁和SASR合并症的可能性也显著更高（OR = 1.7，p < 0.01），并且在整个18个月随访期间持续存在抑郁的可能性也更高（OR = 2.3，p < 0.001）。
这些分析提供了进一步重要且更详细的证据，表明与男性相比，女性在重大创伤后生活质量结局更差以及早期出现心理疾病的风险更高，且与损伤机制和严重程度无关。更好地理解重大创伤对男性和女性的影响将是成熟创伤系统中改善创伤护理和长期结局努力的重要组成部分。
