Pathak Priya, Laredo Jonathan, Swain Sonal, Gallagher Scott F, Freeman Jennifer, Agarwal Suresh M, Haines Krista L
The Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Surgery, Duke University School of Medicine, Durham, North Carolina.
Department of Surgery, Duke University School of Medicine, Durham, North Carolina; The University of Tennessee Health Science Center, Memphis, Tennessee.
J Surg Res. 2025 Jul;311:43-53. doi: 10.1016/j.jss.2025.04.003. Epub 2025 May 17.
Men are known to have more severe injuries at younger ages compared to women. However, the relationship between gender and other sociodemographic factors in the context of end-of-life care after traumatic injuries is not well understood.
This retrospective observational cohort study utilized data from the American College of Surgeons Trauma Quality Programs in 2022 and included all patients who were 18 y or older while those with missing information on withdrawal of life-sustaining treatment (WLST) were excluded. Descriptive analysis and multiple logistic regression, following propensity score nearest neighbor matching, were performed to determine the association between WLST and gender after traumatic injury.
Among the 843,135 patients who met the inclusion criteria, 43.6% were female. Compared to females, males were younger. A higher proportion of females had Medicare than males (56.7% versus 31.1%). In contrast, other insurance such as private, Medicaid, self-pay, and others were comparatively more frequently utilized by males. Among injury characteristics, assault was more common among males compared to females (11.0% versus 3.0%). Not surprisingly, initial Glasgow Coma Scale and injury severity were comparatively severe among males. WLST was reported in 2.5% of males and 1.9% of females. After propensity score matching, compared to males of age 18-35 y, males of increasing age had higher odds of WLST. Similar trends were seen among females of increasing age compared to males aged 18-35 y. However, the magnitude of the estimates was higher among males. Of note, compared to private insurance, those with Medicare were likelier to have WLST.
One in every two patients who died after traumatic injury had WLST, whereas males have an increased likelihood of WLST despite matching and adjusting for injury site and severity. These findings suggest a need for policies addressing demographic and insurance-related disparities to ensure equitable end-of-life care across diverse patient populations.
众所周知，与女性相比，男性在年轻时受伤更严重。然而，在创伤性损伤后的临终关怀背景下，性别与其他社会人口学因素之间的关系尚未得到充分理解。
这项回顾性观察队列研究利用了2022年美国外科医师学会创伤质量项目的数据，纳入了所有18岁及以上的患者，排除了在维持生命治疗撤除（WLST）方面信息缺失的患者。在倾向得分最近邻匹配后，进行描述性分析和多重逻辑回归，以确定创伤性损伤后WLST与性别的关联。
在符合纳入标准的843135例患者中，43.6%为女性。与女性相比，男性更年轻。女性拥有医疗保险的比例高于男性（56.7%对31.1%）。相比之下，男性使用私人保险、医疗补助、自费保险等其他保险的频率相对更高。在损伤特征方面，男性遭受袭击的情况比女性更常见（11.0%对3.0%）。不出所料，男性的初始格拉斯哥昏迷量表评分和损伤严重程度相对更严重。2.5%的男性和1.9%的女性报告了WLST。在倾向得分匹配后，与18至35岁的男性相比，年龄较大的男性接受WLST的几率更高。与18至当岁的男性相比，年龄较大的女性也呈现出类似趋势。然而，男性的估计值幅度更高。值得注意的是，与私人保险相比，拥有医疗保险的患者更有可能接受WLST。
每两名创伤性损伤后死亡的患者中就有一名接受了WLST，尽管对损伤部位和严重程度进行了匹配和调整，但男性接受WLST的可能性增加。这些发现表明需要制定政策来解决人口统计学和保险相关的差异，以确保不同患者群体都能获得公平的临终关怀。
