Haider Adil H, Efron David T, Haut Elliott R, Chang David C, Paidas Charles N, Cornwell Edward E
Division of Trauma and Critical Care, Department of Surgery, Johns Hopkins School of Medicine, 600 N Wolfe St, Blalock 688, Baltimore, MD 21287, USA.
Arch Surg. 2007 Sep;142(9):875-80; discussion 879-80. doi: 10.1001/archsurg.142.9.875.
Female sex imparts a survival benefit after traumatic injury in children.
DESIGN, SETTING, AND PATIENTS: Review of patients (aged 0-17 years) included in the National Pediatric Trauma Registry between April 1994 and September 2001. Multiple logistic regression was used to analyze the effect of sex on mortality, adjusting for age, severity of injury (New Injury Severity Score and Pediatric Trauma Score), severity of head or extremity injury, injury mechanism, intent, and comorbidities. Subset analysis focused on severely injured children (New Injury Severity Score >or= 16) with shock (systolic blood pressure <or= 90 mm Hg, adjusted for age).
Adjusted odds of mortality between sexes.
Of 46,859 children, 67% were boys. Girls had a higher crude mortality rate than boys (3.1% vs 2.7%, respectively; P < .05), but after adjustment, no significant difference was found in the odds of mortality between sexes (odds ratio, 1.16; 95% confidence interval, 0.89-1.37). Among children meeting the definition of severe injury with shock (n = 697), mortality was 39%. On regression analysis, sex did not predict outcomes in prepubescent children (aged <or= 11 years; n = 532; 95% confidence interval, 0.56-1.22). However, among adolescents (aged 12-17 years), girls demonstrated significantly decreased odds of death when compared with equivalently injured boys (odds ratio, 0.38; 95% confidence interval, 0.14-0.90; n = 165).
Adolescent girls exhibit lower mortality than boys following traumatic shock. This effect is not seen in prepubescent children. These findings suggest that hormonal differences may play a role in the sex-based outcome disparities following traumatic shock in children.
儿童创伤性损伤后女性性别具有生存优势。
设计、背景和患者：回顾1994年4月至2001年9月纳入国家儿科创伤登记处的0至17岁患者。采用多因素逻辑回归分析性别对死亡率的影响，并对年龄、损伤严重程度（新损伤严重程度评分和儿科创伤评分）、头部或四肢损伤严重程度、损伤机制、意图和合并症进行校正。亚组分析聚焦于伴有休克（收缩压≤90mmHg，根据年龄校正）的重伤儿童（新损伤严重程度评分≥16）。
两性之间校正后的死亡几率。
46859名儿童中，67%为男孩。女孩的粗死亡率高于男孩（分别为3.1%和2.7%；P<0.05），但校正后，两性之间的死亡几率无显著差异（优势比，1.16；95%置信区间，0.89-1.37）。在符合重伤伴休克定义的儿童中（n=697），死亡率为39%。回归分析显示，性别不能预测青春期前儿童（年龄≤11岁；n=532；95%置信区间，0.56-1.22）的预后。然而，在青少年（年龄12-17岁）中，与同等受伤的男孩相比，女孩的死亡几率显著降低（优势比，0.38；95%置信区间，0.14-0.90；n=165）。
青少年女孩创伤性休克后的死亡率低于男孩。青春期前儿童未观察到这种效应。这些发现表明，激素差异可能在儿童创伤性休克后基于性别的预后差异中起作用。
