From the Division of Trauma and Critical Care (E.J.L., S.S.S., D.Z.L., M.B.S., N.M., M.B., A.S.), Department of Surgery, and Division of Biostatistics (J.M.), Cedars-Sinai Medical Center, Los Angeles, California.
J Trauma Acute Care Surg. 2013 Oct;75(4):682-6. doi: 10.1097/TA.0b013e31829d024f.
Gender may influence outcomes following traumatic brain injury (TBI) although the mechanism is unknown. Animal TBI studies suggest that gender differences in endogenous hormone production may be the source. Limited retrospective clinical studies on gender present varied conclusions. Pediatric patients represent a unique population as pubescent children experience up-regulation of endogenous hormones that varies dramatically by gender. Younger children do not have these hormonal differences. The aim of this study was to compare pubescent and prepubescent females with males after isolated TBI to identify independent predictors of mortality.
We performed a retrospective review of the National Trauma Data Bank Research Data Sets from 2007 and 2008 looking at all blunt trauma patients 18 years or younger who required hospital admission after isolated, moderate-to-severe TBI, defined as head Abbreviated Injury Scale (AIS) score 3 or greater. We excluded all individuals with AIS score of 3 or greater for any other region to limit the confounding effect of comorbidities. Based on the median age of menarche, we defined two age groups as follows: prepubescent (0-12 years) and pubescent (>12 years). Analysis was performed to compare trauma profiles and outcomes between groups. Our primary outcome measure was in-hospital mortality.
A total of 20,280 patients met inclusion criteria; 10,135 were prepubescent, and 10,145 were pubescent. Overall mortality was 6.9%, and lower mortality was noted among prepubescent patients compared with pubescent (5.2% vs. 8.6%, p < 0.0001). Although female gender did not predict reduced mortality in the prepubescent cohort (adjusted odds ratio, 1.05; 95% confidence interval, 0.85-1.30; p = 0.63), female gender was associated with reduced mortality in the pubescent (adjusted odds ratio, 0.78; 95% confidence interval, 0.65-0.93; p = 0.007).
In contrast to prepubescent female gender, pubescent female gender predicts reduced mortality following isolated, moderate-to-severe TBI. Endogenous hormonal differences may be a contributing factor and require further investigation.
Prognostic study, level III.
性别可能会影响创伤性脑损伤（TBI）的结果，尽管其机制尚不清楚。动物 TBI 研究表明，内源性激素产生的性别差异可能是其来源。关于性别的有限回顾性临床研究得出了不同的结论。儿科患者是一个独特的群体，因为青春期的儿童经历了内源性激素的上调，这种上调因性别而异，差异很大。较小的儿童则没有这些激素差异。本研究的目的是比较孤立性 TBI 后青春期和青春期前女性与男性的差异，以确定死亡率的独立预测因素。
我们对 2007 年和 2008 年国家创伤数据银行研究数据集进行了回顾性分析，研究了所有因中度至重度 TBI 而需要住院治疗的 18 岁以下的钝器伤患者，TBI 的定义为头部简明损伤量表（AIS）评分 3 或更高。我们排除了所有 AIS 评分大于等于 3 的任何其他区域的患者，以限制合并症的混杂影响。根据初潮的中位数年龄，我们将两个年龄组定义如下：青春期前（0-12 岁）和青春期（>12 岁）。对两组之间的创伤特征和结果进行了分析。我们的主要观察指标是院内死亡率。
共有 20280 名患者符合纳入标准，其中 10135 名患者为青春期前，10145 名患者为青春期。总体死亡率为 6.9%，青春期前患者的死亡率较低，与青春期患者相比（5.2%对 8.6%，p<0.0001）。尽管女性性别并未预测青春期前患者死亡率降低（校正比值比，1.05；95%置信区间，0.85-1.30；p=0.63），但女性性别与青春期患者死亡率降低相关（校正比值比，0.78；95%置信区间，0.65-0.93；p=0.007）。
与青春期前女性不同，青春期女性性别预测孤立性中度至重度 TBI 后的死亡率降低。内源性激素差异可能是一个促成因素，需要进一步研究。
预后研究，III 级。
