Sex Differences in Outcome of Trauma Patients Presented with Severe Traumatic Brain Injury: A Multicenter Cohort Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Population
2.2. Data Collection and Parameter Outcome
2.3. Statistical Analyses
3. Results
3.1. Patient Characteristics—Severe TBI
3.2. Clinical Outcomes—Severe TBI
3.3. Logistic Regression Analysis—Severe TBI
3.4. Patient Characteristics—Severe TBI—Stratified for Age
3.5. Clinical Outcomes—Severe TBI—Stratified for Age
3.6. Logistic Regression Analysis—Severe TBI—Stratified for Age
3.7. Patient Characteristics—Isolated Severe TBI
3.8. Clinical Outcomes—Isolated Severe TBI
3.9. Logistic Regression Analysis—Isolated Severe TBI
3.10. Patient Characteristics—Isolated Severe TBI—Stratified for Age
3.11. Clinical Outcomes—Isolated Severe TBI—Stratified for Age
3.12. Logistic Regression Analysis—Isolated Severe TBI—Stratified for Age
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Acknowledgments
Data Availability Statement
Conflicts of Interest
Appendix A
In-Hospital Mortality | ||||||||
---|---|---|---|---|---|---|---|---|
B | S.E. | Wald | df | Sig. | Exp(B) | 95% C.I. for EXP(B) | ||
Lower | Upper | |||||||
Sex | 0.072 | 0.137 | 0.274 | 1 | 0.600 | 1.074 | 0.822 | 1.405 |
Age | 0.045 | 0.004 | 136.489 | 1 | <0.001 | 1.046 | 1.038 | 1.054 |
MOI | 1.037 | 0.477 | 4.723 | 1 | 0.030 | 2.822 | 1.107 | 7.192 |
ISS | 0.056 | 0.007 | 59.276 | 1 | <0.001 | 1.058 | 1.043 | 1.073 |
RTS < 4 | 0.537 | 0.265 | 4.115 | 1 | 0.043 | 1.711 | 1.018 | 2.876 |
GCS ≤ 8 | 1.774 | 0.149 | 141.624 | 1 | <0.001 | 5.897 | 4.403 | 7.898 |
SI | 1.027 | 0.246 | 17.479 | 1 | <0.001 | 2.793 | 1.726 | 4.522 |
ASA ≥ III | 0.270 | 0.170 | 2.529 | 1 | 0.112 | 1.310 | 0.939 | 1.826 |
ICP | −0.132 | 0.199 | 0.441 | 1 | 0.506 | 0.876 | 0.593 | 1.294 |
Craniotomy | 0.239 | 0.165 | 2.100 | 1 | 0.147 | 1.270 | 0.919 | 1.753 |
Constant | −6.870 | 0.415 | 274.263 | 1 | <0.001 | 0.001 |
GOS ≤ 3 at Discharge | ||||||||
---|---|---|---|---|---|---|---|---|
B | S.E. | Wald | df | Sig. | Exp(B) | 95% C.I. for EXP(B) | ||
Lower | Upper | |||||||
Sex | 0.119 | 0.140 | 0.728 | 1 | 0.394 | 1.127 | 0.857 | 1.481 |
Age | −0.035 | 0.004 | 92.288 | 1 | <0.001 | 0.966 | 0.959 | 0.973 |
MOI | −0.938 | 0.513 | 3.340 | 1 | 0.068 | 0.391 | 0.143 | 1.070 |
ISS | −0.067 | 0.009 | 61.050 | 1 | <0.001 | 0.936 | 0.920 | 0.951 |
RTS < 4 | 0.045 | 0.327 | 0.019 | 1 | 0.891 | 1.046 | 0.551 | 1.986 |
GCS ≤ 8 | −2.071 | 0.149 | 193.604 | 1 | <0.001 | 0.126 | 0.094 | 0.169 |
SI | −1.026 | 0.295 | 12.060 | 1 | <0.001 | 0.358 | 0.201 | 0.640 |
ASA ≥ III | −0.741 | 0.178 | 17.388 | 1 | <0.001 | 0.476 | 0.336 | 0.675 |
ICP | −0.827 | 0.228 | 13.104 | 1 | <0.001 | 0.437 | 0.279 | 0.684 |
Craniotomy | −0.844 | 0.170 | 24.538 | 1 | <0.001 | 0.430 | 0.308 | 0.600 |
Constant | 5.479 | 0.397 | 190.591 | 1 | <0.001 | 239.649 |
ICU Admission | ||||||||
---|---|---|---|---|---|---|---|---|
B | S.E. | Wald | df | Sig. | Exp(B) | 95% C.I. for EXP(B) | ||
Lower | Upper | |||||||
Sex | −0.228 | 0.138 | 2.746 | 1 | 0.098 | 0.796 | 0.608 | 1.043 |
Age | −0.017 | 0.003 | 24.535 | 1 | <0.001 | 0.984 | 0.977 | 0.990 |
MOI | 0.076 | 0.470 | 0.026 | 1 | 0.872 | 1.079 | 0.430 | 2.710 |
ISS | 0.037 | 0.008 | 21.033 | 1 | <0.001 | 1.038 | 1.021 | 1.054 |
RTS < 4 | −0.190 | 0.309 | 0.380 | 1 | 0.538 | 0.827 | 0.451 | 1.515 |
GCS ≤ 8 | 1.248 | 0.146 | 73.219 | 1 | <0.001 | 3.484 | 2.618 | 4.638 |
SI | −0.395 | 0.265 | 2.218 | 1 | 0.136 | 0.674 | 0.401 | 1.133 |
ASA ≥ III | 0.163 | 0.167 | 0.953 | 1 | 0.329 | 1.177 | 0.848 | 1.633 |
ICP | 3.554 | 0.719 | 24.439 | 1 | <0.001 | 34.952 | 8.542 | 143.024 |
Craniotomy | 2.158 | 0.247 | 76.113 | 1 | <0.001 | 8.656 | 5.330 | 14.057 |
Constant | 0.144 | 0.313 | 0.212 | 1 | 0.645 | 1.155 |
30-Day Mortality | ||||||||
---|---|---|---|---|---|---|---|---|
B | S.E. | Wald | df | Sig. | Exp(B) | 95% C.I. for EXP(B) | ||
Lower | Upper | |||||||
Sex | 0.050 | 0.137 | 0.132 | 1 | 0.717 | 1.051 | 0.803 | 1.375 |
Age | 0.047 | 0.004 | 147.664 | 1 | <0.001 | 1.048 | 1.040 | 1.056 |
MOI | 1.025 | 0.485 | 4.467 | 1 | 0.035 | 2.787 | 1.077 | 7.212 |
ISS | 0.054 | 0.007 | 54.834 | 1 | <0.001 | 1.056 | 1.041 | 1.071 |
RTS <4 | 0.514 | 0.267 | 3.705 | 1 | 0.054 | 1.672 | 0.991 | 2.822 |
GCS ≤ 8 | 1.878 | 0.151 | 155.285 | 1 | <0.001 | 6.541 | 4.868 | 8.789 |
SI | 1.027 | 0.247 | 17.254 | 1 | <0.001 | 2.794 | 1.721 | 4.537 |
ASA ≥ III | 0.472 | 0.170 | 7.758 | 1 | 0.005 | 1.604 | 1.150 | 2.236 |
ICP | −0.221 | 0.200 | 1.215 | 1 | 0.270 | 0.802 | 0.541 | 1.188 |
Craniotomy | 0.241 | 0.165 | 2.127 | 1 | 0.145 | 1.273 | 0.920 | 1.760 |
Constant | −6.968 | 0.419 | 277.091 | 1 | <0.001 | 0.001 |
ICU > 7 Days | ||||||||
---|---|---|---|---|---|---|---|---|
B | S.E. | Wald | df | Sig. | Exp(B) | 95% C.I. for EXP(B) | ||
Lower | Upper | |||||||
Sex | −0.330 | 0.143 | 5.355 | 1 | 0.021 | 0.719 | 0.544 | 0.951 |
Age | −0.006 | 0.003 | 3.328 | 1 | 0.068 | 0.994 | 0.988 | 1.000 |
MOI | 0.052 | 0.459 | 0.013 | 1 | 0.910 | 1.054 | 0.428 | 2.593 |
ISS | 0.031 | 0.007 | 20.960 | 1 | <0.001 | 1.031 | 1.018 | 1.045 |
RTS < 4 | −0.960 | 0.288 | 11.082 | 1 | <0.001 | 0.383 | 0.218 | 0.674 |
GCS ≤ 8 | 1.027 | 0.143 | 51.640 | 1 | <0.001 | 2.794 | 2.111 | 3.697 |
SI | −0.455 | 0.252 | 3.271 | 1 | 0.071 | 0.634 | 0.387 | 1.039 |
ASA ≥ III | 0.335 | 0.182 | 3.404 | 1 | 0.065 | 1.398 | 0.979 | 1.997 |
ICP | 2.180 | 0.193 | 127.288 | 1 | <0.001 | 8.846 | 6.058 | 12.919 |
Craniotomy | 1.461 | 0.151 | 94.142 | 1 | <0.001 | 4.311 | 3.209 | 5.791 |
Constant | −2.328 | 0.319 | 53.408 | 1 | <0.001 | 0.097 |
Hospital > 7 Days | ||||||||
---|---|---|---|---|---|---|---|---|
B | S.E. | Wald | df | Sig. | Exp(B) | 95% C.I. for EXP(B) | ||
Lower | Upper | |||||||
Sex | −0.178 | 0.115 | 2.395 | 1 | 0.122 | 0.837 | 0.667 | 1.049 |
Age | −0.005 | 0.003 | 4.002 | 1 | 0.045 | 0.995 | 0.989 | 1.000 |
MOI | −0.307 | 0.400 | 0.590 | 1 | 0.442 | 0.736 | 0.336 | 1.610 |
ISS | 0.011 | 0.006 | 3.363 | 1 | 0.067 | 1.011 | 0.999 | 1.022 |
RTS < 4 | −0.719 | 0.248 | 8.372 | 1 | 0.004 | 0.487 | 0.299 | 0.793 |
GCS ≤ 8 | 0.012 | 0.118 | 0.011 | 1 | 0.917 | 1.012 | 0.803 | 1.276 |
SI | −0.594 | 0.218 | 7.445 | 1 | 0.006 | 0.552 | 0.360 | 0.846 |
ASA ≥ III | 0.055 | 0.146 | 0.143 | 1 | 0.706 | 1.057 | 0.793 | 1.408 |
ICP | 1.539 | 0.194 | 62.802 | 1 | <0.001 | 4.661 | 3.185 | 6.820 |
Craniotomy | 0.978 | 0.140 | 48.802 | 1 | <0.001 | 2.659 | 2.021 | 3.499 |
Constant | 0.093 | 0.258 | 0.129 | 1 | 0.720 | 1.097 |
MV Admission | ||||||||
---|---|---|---|---|---|---|---|---|
B | S.E. | Wald | df | Sig. | Exp(B) | 95% C.I. for EXP(B) | ||
Lower | Upper | |||||||
Sex | −0.214 | 0.144 | 2.194 | 1 | 0.139 | 0.808 | 0.609 | 1.071 |
Age | −0.014 | 0.003 | 17.592 | 1 | <0.001 | 0.986 | 0.979 | 0.992 |
MOI | 1.241 | 0.517 | 5.751 | 1 | 0.016 | 3.459 | 1.254 | 9.538 |
ISS | 0.038 | 0.008 | 24.373 | 1 | <0.001 | 1.039 | 1.023 | 1.055 |
RTS < 4 | −0.195 | 0.288 | 0.460 | 1 | 0.498 | 0.823 | 0.468 | 1.447 |
GCS ≤ 8 | 2.207 | 0.146 | 227.996 | 1 | <0.001 | 9.086 | 6.823 | 12.100 |
SI | −0.338 | 0.263 | 1.649 | 1 | 0.199 | 0.713 | 0.426 | 1.194 |
ASA ≥ III | 0.451 | 0.179 | 6.303 | 1 | 0.012 | 1.569 | 1.104 | 2.231 |
ICP | 2.737 | 0.354 | 59.744 | 1 | <0.001 | 15.434 | 7.711 | 30.891 |
Craniotomy | 2.034 | 0.187 | 117.747 | 1 | <0.001 | 7.644 | 5.294 | 11.037 |
Constant | −1.520 | 0.321 | 22.375 | 1 | <0.001 | 0.219 |
MV >7 Days | ||||||||
---|---|---|---|---|---|---|---|---|
B | S.E. | Wald | df | Sig. | Exp(B) | 95% C.I. for EXP(B) | ||
Lower | Upper | |||||||
Sex | 0.033 | 0.153 | 0.047 | 1 | 0.828 | 1.034 | 0.765 | 1.396 |
Age | −0.008 | 0.004 | 4.509 | 1 | 0.034 | 0.992 | 0.985 | 0.999 |
MOI | −0.134 | 0.523 | 0.066 | 1 | 0.798 | 0.875 | 0.314 | 2.436 |
ISS | 0.033 | 0.007 | 21.238 | 1 | <0.001 | 1.033 | 1.019 | 1.048 |
RTS < 4 | −0.660 | 0.302 | 4.784 | 1 | 0.029 | 0.517 | 0.286 | 0.934 |
GCS ≤ 8 | 1.195 | 0.165 | 52.379 | 1 | <0.001 | 3.303 | 2.390 | 4.565 |
SI | −0.456 | 0.272 | 2.806 | 1 | 0.094 | 0.634 | 0.372 | 1.081 |
ASA ≥ III | 0.245 | 0.206 | 1.413 | 1 | 0.235 | 1.278 | 0.853 | 1.914 |
ICP | 2.074 | 0.191 | 117.374 | 1 | <0.001 | 7.957 | 5.467 | 11.579 |
Craniotomy | 1.522 | 0.164 | 86.072 | 1 | <0.001 | 4.580 | 3.321 | 6.316 |
Constant | −3.046 | 0.359 | 71.842 | 1 | <0.001 | 0.048 |
Appendix B
16–44 Years | ≥45 Years | |||||
---|---|---|---|---|---|---|
Female (n = 108) | Male (n = 372) | p-Value | Female (n = 412) | Male (n = 674) | p-Value | |
Age | ||||||
Age (years) median (IQR) | 25 (16–44) | 28 (16–44) | 0.001 | 70 (45–98) | 68 (45–95) | 0.008 |
Injury and severity | ||||||
Blunt | 103 (95.4%) | 361 (97.3%) | 0.345 | 408 (99.8%) | 654 (97.8%) | 0.008 |
Penetrating | 5 (4.6%) | 10 (2.7%) | 0.345 | 1 (0.2%) | 15 (2.2%) | 0.008 |
AIS Neck ≥ 3 | 1 (0.9%) | 9 (2.4%) | 0.339 | 2 (0.5%) | 5 (0.7%) | 0.716 |
AIS Spine ≥ 3 | 11 (10.2%) | 28 (7.5%) | 0.373 | 10 (2.4%) | 41 (6.1%) | 0.006 |
AIS Thorax ≥ 3 | 31 (28.7%) | 116 (31.2%) | 0.623 | 59 (14.3%) | 161 (23.9%) | <0.001 |
AIS Abdomen ≥ 3 | 11 (10.2%) | 23 (6.2%) | 0.153 | 2 (0.5%) | 6 (0.9%) | 0.717 |
AIS Lower extremities ≥ 3 | 17 (15.7%) | 40 (10.8%) | 0.158 | 18 (4.4%) | 35 (5.2%) | 0.541 |
ISS median (IQR) | 26 (16–75) | 29 (16–75) | 0.395 | 25 (16–59) | 25 (16–75) | 0.006 |
Vital signs | ||||||
RTS median (IQR) | 4.09 (0–7.84) | 5.03 (0–7.84) | 0.650 | 6.76 (0–7.84) | 5.97 (1.76–7.84) | 0.007 |
RTS < 4 | 9 (8.3%) | 45 (12.1%) | 0.276 | 18 (4.4%) | 46 (6.8%) | 0.095 |
SBP median (IQR) | 122 (54–184) | 130 (50–240) | 0.002 | 145 (45–245) | 141 (50–240) | 0.113 |
SBP < 90 mmHg | 10 (9.3%) | 32 (8.6%) | 0.832 | 15 (3.6%) | 56 (8.3%) | 0.003 |
SI median (IQR) | 0.7 (0.4–2.2) | 0.7 (0.2–2.7) | 0.038 | 0.6 (0.2–2.3) | 0.6 (0.2–2.4) | 0.008 |
Neurological | ||||||
GCS median (IQR) | 3 (3–15) | 3 (3–15) | 0.610 | 9 (3–15) | 7 (3–15) | 0.010 |
GCS ≤ 8 | 70 (64.8%) | 220 (59.1%) | 0.288 | 194 (47.1%) | 345 (51.2%) | 0.190 |
Craniotomy | 20 (18.5%) | 76 (20.4%) | 0.662 | 91 (22.1%) | 113 (16.8%) | 0.029 |
ICP measurement | 18 (16.7%) | 60 (16.1%) | 0.894 | 30 (7.3%) | 71 (10.5%) | 0.073 |
Comorbidity | ||||||
Healthy or mild (ASA ≤ II) | 93 (97.9%) | 294 (95.1%) | 0.381 | 276 (74.2%) | 414 (70.2%) | 0.177 |
Severe comorbidity (ASA ≥ III) | 2 (2.1%) | 15 (4.9%) | 0.381 | 96 (25.8%) | 176 (29.8%) | 0.177 |
Prehospital | ||||||
Prehospital intubation | 60 (57.1%) | 198 (54.1%) | 0.581 | 151 (37.2%) | 311 (46.7%) | 0.002 |
P-HEMS | 38 (35.2%) | 134 (36.0%) | 0.873 | 107 (26.0%) | 246 (36.5%) | <0.001 |
Total (n = 831) | Female (n = 297) | Male (n = 534) | p-Value | |
---|---|---|---|---|
Age | ||||
Age (years) median (IQR) | 62 (16–98) | 68 (16–98) | 58 (16–95) | <0.001 |
Age 16–44 years | 212 (25.5%) | 40 (13.5%) | 172 (32.2%) | <0.001 |
Age ≥ 45 years | 619 (74.5%) | 257 (86.5%) | 362 (67.8%) | <0.001 |
Injury and severity | ||||
Blunt | 808 (98.1%) | 294 (99.7%) | 514 (97.2%) | 0.013 |
Penetrating | 16 (1.9%) | 1 (0.3%) | 15 (2.8%) | 0.013 |
ISS median (IQR) | 25 (16–75) | 25 (16–75) | 25 (16–75) | 0.807 |
Vital signs | ||||
RTS median (IQR) | 6.90 (0–7.84) | 6.07 (0–7.84) | 6.90 (1.76–7.84) | 0.986 |
RTS < 4 | 34 (4.1%) | 11 (3.7%) | 23 (4.3%) | 0.674 |
SBP median (IQR) | 141 (45–245) | 140 (45–245) | 142 (50–240) | 0.731 |
SBP < 90 mmHg | 31 (3.7%) | 8 (2.7%) | 23 (4.3%) | 0.239 |
SI median (IQR) | 0.6 (0.2–2.4) | 0.6 (0.2–1.6) | 0.6 (0.2–2.4) | 0.386 |
Neurological | ||||
GCS median (IQR) | 9 (3–15) | 8 (3–15) | 9 (3–15) | 0.883 |
GCS ≤ 8 | 370 (44.5%) | 139 (46.8%) | 231 (43.3%) | 0.325 |
Craniotomy | 154 (18.5%) | 58 (19.5%) | 96 (18.0%) | 0.581 |
ICP measurement | 74 (8.9%) | 22 (7.4%) | 52 (9.7%) | 0.258 |
Comorbidity | ||||
Healthy or mild (ASA ≤ II) | 526 (71.1%) | 191 (71.0%) | 335 (71.1%) | 0.972 |
Severe comorbidity (ASA ≥ III) | 214 (28.9%) | 78 (29.0%) | 136 (28.9%) | 0.972 |
Prehospital | ||||
Prehospital intubation | 314 (37.9%) | 106 (35.7%) | 208 (39.2%) | 0.322 |
P-HEMS | 234 (28.2%) | 74 (24.9%) | 160 (30.0%) | 0.121 |
Total (n = 831) | Female (n = 297) | Male (n = 534) | p-Value | |
---|---|---|---|---|
Primary outcomes | ||||
In-hospital mortality | 234 (28.2%) | 94 (31.6%) | 140 (26.2%) | 0.095 |
GOS ≤ 3 at discharge | 434 (54.3%) | 162 (56.8%) | 272 (52.9%) | 0.286 |
ICU admission | 557 (67.0%) | 193 (65.0%) | 364 (68.2%) | 0.350 |
Secondary outcomes | ||||
30-day mortality | 253 (30.4%) | 100 (33.7%) | 153 (28.7%) | 0.132 |
ICU days median (IQR) | 2 (0–53) | 2 (0–39) | 2 (0–53) | 0.348 |
ICU > 7 days | 201 (24.2%) | 65 (21.9%) | 136 (25.5%) | 0.248 |
Hospital days median (IQR) | 5 (0–135) | 5 (0–98) | 6 (0–135) | 0.074 |
Hospital > 7 days | 376 (45.2%) | 126 (42.4%) | 250 (46.8%) | 0.223 |
MV admission | 424 (51.0%) | 145 (48.8%) | 279 (52.2%) | 0.344 |
MV days median (IQR) | 1 (0–42) | 1 (0–33) | 1 (0–42) | 0.232 |
MV > 7 days | 156 (18.8%) | 57 (19.2%) | 99 (18.5%) | 0.817 |
OR | 95% CI | p-Value | |
---|---|---|---|
Unadjusted values | |||
In-hospital mortality | 1.303 | 0.954–1.779 | 0.096 |
GOS ≤ 3 at discharge | 0.853 | 0.640–1.136 | 0.277 |
ICU admission | 0.867 | 0.642–1.170 | 0.350 |
30-day mortality | 1.264 | 0.932–1.715 | 0.132 |
ICU > 7 days | 0.820 | 0.585–1.148 | 0.248 |
Hospital > 7 days | 0.837 | 0.629–1.114 | 0.223 |
MV admission | 0.872 | 0.656–1.158 | 0.344 |
MV > 7 days | 1.044 | 0.727–1.499 | 0.817 |
Adjusted values * | |||
In-hospital mortality | 1.056 | 0.719–1.550 | 0.781 |
GOS ≤ 3 at discharge | 1.146 | 0.794–1.654 | 0.468 |
ICU admission | 0.909 | 0.629–1.312 | 0.609 |
30-day mortality | 0.991 | 0.674–1.457 | 0.963 |
ICU > 7 days | 0.786 | 0.522–1.183 | 0.248 |
Hospital > 7 days | 0.847 | 0.621–1.155 | 0.293 |
MV admission | 0.744 | 0.481–1.150 | 0.183 |
MV > 7 days | 1.120 | 0.714–1.756 | 0.622 |
16–44 Years | ≥45 Years | |||||
---|---|---|---|---|---|---|
Female (n = 40) | Male (n = 172) | p-Value | Female (n = 257) | Male (n = 362) | p-Value | |
Age | ||||||
Age (years) median (IQR) | 25 (16–44) | 30 (16–44) | 0.014 | 71 (45–98) | 68 (45–95) | 0.024 |
Injury and severity | ||||||
Blunt | 39 (97.5%) | 169 (98.3%) | 0.570 | 255 (99.2%) | 345 (96.6%) | 0.003 |
Penetrating | 1 (2.5%) | 3 (1.7%) | 0.570 | 2 (0.8%) | 12 (3.3%) | 0.003 |
ISS median (IQR) | 23 (16–75) | 24 (16–75) | 0.202 | 25 (16–33) | 25 (16–75) | 0.826 |
Vital signs | ||||||
RTS median (IQR) | 5.97 (4.09–7.84) | 6.90 (2.63–7.84) | 0.612 | 6.75 (0–7.84) | 6.90 (1.76–7.84) | 0.765 |
RTS < 4 | 0 (0%) | 8 (4.7%) | 0.357 | 11 (4.3%) | 15 (4.1%) | 0.934 |
SBP median (IQR) | 125 (99–170) | 134 (55–240) | 0.005 | 144 (45–245) | 147 (50–224) | 0.660 |
SBP < 90 mmHg | 0 (0%) | 6 (3.5%) | 0.597 | 8 (3.1%) | 17 (4.7%) | 0.324 |
SI median (IQR) | 0.6 (0.4–1.1) | 0.6 (0.2–1.9) | 0.134 | 0.5 (0.2–1.6) | 0.6 (0.2–2.4) | 0.284 |
Neurological | ||||||
GCS median (IQR) | 7 (3–15) | 9 (3–15) | 0.569 | 9 (3–15) | 9 (3–15) | 0.998 |
GCS ≤ 8 | 20 (50.0%) | 76 (44.2%) | 0.506 | 119 (46.3%) | 155 (42.8%) | 0.390 |
Craniotomy | 5 (12.5%) | 34 (19.8%) | 0.285 | 53 (20.6%) | 62 (17.1%) | 0.271 |
ICP measurement | 6 (15.0%) | 20 (11.6%) | 0.558 | 16 (6.2%) | 32 (8.8%) | 0.231 |
Comorbidity | ||||||
Healthy or mild (ASA ≤ II) | 31 (93.9%) | 140 (93.3%) | 0.087 | 160 (67.8%) | 195 (60.7%) | 1.000 |
Severe comorbidity (ASA ≥ III) | 2 (6.1%) | 10 (6.7%) | 0.087 | 76 (32.2%) | 126 (39.3%) | 1.000 |
Prehospital | ||||||
Prehospital intubation | 15 (37.5%) | 67 (39.2%) | 0.322 | 91 (35.4%) | 141 (39.2%) | 0.342 |
P-HEMS | 11 (27.5%) | 51 (29.7%) | 0.788 | 63 (24.5%) | 109 (30.1%) | 0.126 |
16–44 Years | ≥45 Years | |||||
---|---|---|---|---|---|---|
Female (n = 40) | Male (n = 172) | p-Value | Female (n = 257) | Male (n = 362) | p-Value | |
Primary outcomes | ||||||
In-hospital mortality | 5 (12.5%) | 23 (13.4%) | 0.883 | 89 (34.6%) | 117 (32.3%) | 0.548 |
GOS ≤ 3 at discharge | 15 (37.5%) | 62 (36.0%) | 0.877 | 147 (57.2%) | 210 (58.0%) | 0.852 |
ICU admission | 27 (67.5%) | 119 (69.2%) | 0.836 | 166 (64.6%) | 245 (67.7%) | 0.423 |
Secondary outcomes | ||||||
30-day mortality | 5 (12.5%) | 23 (13.4%) | 0.883 | 95 (37.0%) | 130 (35.9%) | 0.788 |
ICU days median (IQR) | 2 (0–39) | 3 (0–47) | 0.642 | 2 (0–34) | 2 (0–53) | 0.523 |
ICU > 7 days | 8 (29.6%) | 47 (39.5%) | 0.341 | 57 (34.3%) | 89 (36.3%) | 0.487 |
Hospital days median (IQR) | 6 (0–98) | 6 (0–93) | 0.931 | 5 (0–74) | 6 (0–135) | 0.090 |
Hospital > 7 days | 18 (45.0%) | 78 (45.3%) | 0.968 | 108 (42.0%) | 172 (47.5%) | 0.176 |
MV admission | 19 (47.5%) | 93 (54.1%) | 0.453 | 126 (49.0%) | 186 (51.4%) | 0.564 |
MV days median (IQR) | 1 (0–28) | 1 (0–42) | 0.358 | 1 (0–33) | 1 (0–33) | 0.499 |
MV > 7 days | 8 (42.1%) | 34 (36.6%) | 0.973 | 49 (38.9%) | 65 (34.9%) | 0.725 |
16–44 Years | ≥45 Years | |||||
---|---|---|---|---|---|---|
OR | 95% CI | p-value | OR | 95% CI | p-value | |
Unadjusted values | ||||||
In-hospital mortality | 0.925 | 0.329–2.605 | 0.883 | 1.109 | 0.791–1.556 | 0.548 |
GOS ≤ 3 at discharge | 0.945 | 0.461–1.936 | 0.877 | 1.032 | 0.740–1.441 | 0.852 |
ICU admission | 0.925 | 0.443–1.932 | 0.836 | 0.871 | 0.622–1.221 | 0.423 |
30-day mortality | 0.925 | 0.329–2.605 | 0.883 | 1.047 | 0.751–1.459 | 0.788 |
ICU > 7 days | 0.665 | 0.286–1.547 | 0.343 | 0.874 | 0.598–1.277 | 0.487 |
Hospital > 7 days | 0.986 | 0.494–1.969 | 0.968 | 0.801 | 0.580–1.105 | 0.177 |
MV admission | 0.769 | 0.386–1.531 | 0.454 | 0.910 | 0.661–1.253 | 0.564 |
MV > 7 days | 1.015 | 0.429–2.400 | 0.973 | 1.076 | 0.714–1.624 | 0.725 |
Adjusted values * | ||||||
In-hospital mortality | 1.083 | 0.273–4.302 | 0.910 | 1.067 | 0.712–1.600 | 0.753 |
GOS ≤ 3 at discharge | 0.992 | 0.375–2.625 | 0.987 | 1.241 | 0.814–1.894 | 0.316 |
ICU admission | 0.725 | 0.280–1.875 | 0.507 | 0.886 | 0.585–1.343 | 0.569 |
30-day mortality | 1.083 | 0.273–4.302 | 0.910 | 0.992 | 0.660–1.489 | 0.968 |
ICU > 7 days | 0.378 | 0.110–1.301 | 0.123 | 0.819 | 0.520–1.289 | 0.387 |
Hospital > 7 days | 0.907 | 0.397–2.073 | 0.818 | 0.811 | 0.575–1.142 | 0.230 |
MV admission | 0.356 | 0.103–1.226 | 0.102 | 0.792 | 0.493–1.272 | 0.792 |
MV > 7 days | 1.007 | 0.321–3.158 | 0.991 | 1.087 | 0.651–1.815 | 0.750 |
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Total (n = 1566) | Female (n = 520) | Male (n = 1046) | p-Value | |
---|---|---|---|---|
Age | ||||
Age (years) median (IQR) | 60 (16–98) | 65 (16–98) | 56 (16–95) | <0.001 |
Age 16–44 years | 480 (30.7%) | 108 (20.8%) | 372 (35.6%) | <0.001 |
Age ≥ 45 years | 1086 (69.3%) | 412 (79.2%) | 674 (64.4%) | <0.001 |
Injury and severity | ||||
Blunt | 1526 (98.0%) | 511 (98.0%) | 1015 (97.6%) | 0.098 |
Penetrating | 31 (2.0%) | 6 (2.0%) | 25 (2.4%) | 0.098 |
AIS Neck ≥ 3 | 17 (1.1%) | 3 (0.6%) | 14 (1.3%) | 0.171 |
AIS Spine ≥ 3 | 90 (5.7%) | 21 (4.0%) | 69 (6.6%) | 0.041 |
AIS Thorax ≥ 3 | 367 (23.4%) | 90 (17.3%) | 277 (26.5%) | <0.001 |
AIS Abdomen ≥ 3 | 42 (2.7%) | 13 (2.5%) | 29 (2.8%) | 0.753 |
AIS Lower extremities ≥ 3 | 110 (7.0%) | 35 (6.7%) | 75 (7.2%) | 0.749 |
ISS median (IQR) | 26 (16–75) | 25 (16–75) | 26 (16–75) | <0.001 |
Vital signs | ||||
RTS median (IQR) | 5.97 (0–7.84) | 5.97 (0–7.84) | 5.97 (0–7.84) | 0.005 |
RTS < 4 | 118 (7.5%) | 27 (5.2%) | 91 (8.7%) | 0.013 |
SBP median (IQR) | 137 (45–245) | 138 (45–245) | 136 (50–240) | 0.156 |
SBP < 90 mmHg | 113 (7.2%) | 25 (4.8%) | 88 (8.4%) | 0.009 |
SI median (IQR) | 0.6 (0.2–2.7) | 0.6 (0.2–2.3) | 0.6 (0.2–2.7) | 0.012 |
Neurological | ||||
GCS median (IQR) | 6 (3–15) | 8 (3–15) | 6 (3–15) | 0.010 |
GCS ≤ 8 | 829 (52.9%) | 264 (50.8%) | 565 (54.0%) | 0.226 |
Craniotomy | 300 (19.2%) | 111 (21.3%) | 189 (18.1%) | 0.121 |
ICP measurement | 179 (11.4%) | 48 (9.2%) | 131 (12.5%) | 0.054 |
Comorbidity | ||||
Healthy or mild (ASA ≤ II) | 1077 (68.7%) | 369 (71.0%) | 708 (67.7%) | 0.911 |
Severe comorbidity (ASA ≥ III) | 289 (18.5%) | 98 (18.8%) | 191 (18.3%) | 0.911 |
Prehospital | ||||
Prehospital intubation | 720 (46.7%) | 211 (41.3%) | 509 (49.3%) | 0.003 |
P-HEMS | 525 (33.5%) | 145 (27.9%) | 380 (36.3%) | <0.001 |
Total (n = 1566) | Female (n = 520) | Male (n = 1046) | p-Value | |
---|---|---|---|---|
Primary outcomes | ||||
In-hospital mortality | 526 (33.6%) | 178 (34.2%) | 348 (33.3%) | 0.704 |
GOS ≤ 3 at discharge | 879 (58.2%) | 287 (57.3%) | 592 (58.6%) | 0.622 |
ICU admission | 1097 (70.1%) | 339 (65.2%) | 758 (72.5%) | 0.003 |
Secondary outcomes | ||||
30-day mortality | 543 (34.7%) | 184 (35.4%) | 359 (34.3%) | 0.677 |
ICU days median (IQR) | 2 (0–67) | 2 (0–67) | 3 (0–67) | 0.002 |
ICU > 7 days | 446 (28.5%) | 124 (23.8%) | 322 (30.8%) | 0.004 |
Hospital days median (IQR) | 6 (0–152) | 6 (0–152) | 7 (0–135) | 0.044 |
Hospital > 7 days | 761 (48.6%) | 236 (45.4%) | 525 (50.2%) | 0.073 |
MV admission | 861 (55.0%) | 261 (50.2%) | 600 (57.4%) | 0.007 |
MV days median (IQR) | 1 (0–60) | 1 (0–37) | 2 (0–60) | 0.004 |
MV > 7 days | 334 (38.8%) | 105 (40.2%) | 229 (38.2%) | 0.439 |
OR | 95% CI | p-Value | |
---|---|---|---|
Unadjusted values | |||
In-hospital mortality | 1.044 | 0.836–1.304 | 0.704 |
GOS ≤ 3 at discharge | 1.056 | 0.850–1.312 | 0.622 |
ICU admission | 0.712 | 0.568–0.892 | 0.003 |
30-day mortality | 1.048 | 0.841–1.306 | 0.677 |
ICU > 7 days | 0.704 | 0.553–0.896 | 0.004 |
Hospital > 7 days | 0.825 | 0.668–1.018 | 0.073 |
MV admission | 0.749 | 0.607–0.925 | 0.007 |
MV > 7 days | 0.903 | 0.696–1.170 | 0.439 |
Adjusted values * | |||
In-hospital mortality | 1.074 | 0.822–1.405 | 0.600 |
GOS ≤ 3 at discharge | 1.127 | 0.857–1.481 | 0.394 |
ICU admission | 0.796 | 0.608–1.043 | 0.098 |
30-day mortality | 1.051 | 0.803–1.375 | 0.717 |
ICU > 7 days | 0.719 | 0.544–0.951 | 0.021 |
Hospital > 7 days | 0.837 | 0.667–1.049 | 0.122 |
MV admission | 0.808 | 0.609–1.071 | 0.139 |
MV > 7 days | 1.034 | 0.765–1.396 | 0.828 |
16–44 Years | ≥45 Years | |||||
---|---|---|---|---|---|---|
Female (n = 108) | Male (n = 372) | p-Value | Female (n = 412) | Male (n = 674) | p-Value | |
Primary outcomes | ||||||
In-hospital mortality | 23 (21.3%) | 86 (23.1%) | 0.691 | 155 (37.6%) | 262 (38.9%) | 0.681 |
GOS ≤ 3 at discharge | 54 (51.4%) | 178 (49.7%) | 0.758 | 233 (58.8%) | 414 (63.5%) | 0.132 |
ICU admission | 83 (76.9%) | 289 (77.7%) | 0.855 | 256 (62.1%) | 469 (69.6%) | 0.011 |
Secondary outcomes | ||||||
30-day mortality | 23 (21.3%) | 85 (22.8%) | 0.734 | 161 (39.1%) | 274 (40.7%) | 0.607 |
ICU days median (IQR) | 3 (0–67) | 3 (0–59) | 0.908 | 2 (0–38) | 2 (0–67) | 0.004 |
ICU > 7 days | 35 (42.2%) | 125 (43.3%) | 0.817 | 89 (34.8%) | 197 (42.0%) | 0.006 |
Hospital days median (IQR) | 8 (0–152) | 7 (0–108) | 0.431 | 5 (0–96) | 7 (0–135) | 0.024 |
Hospital > 7 days | 55 (50.9%) | 189 (50.8%) | 0.983 | 181 (43.9%) | 336 (49.9%) | 0.058 |
MV admission | 69 (63.9%) | 240 (64.5%) | 0.905 | 192 (46.6%) | 360 (53.4%) | 0.029 |
MV days median (IQR) | 2 (0–37) | 2 (0–42) | 0.606 | 1 (0–33) | 1 (0–60) | 0.005 |
MV > 7 days | 32 (46.4%) | 92 (38.3%) | 0.306 | 73 (38.0%) | 137 (38.1%) | 0.291 |
16–44 Years | ≥45 Years | |||||
---|---|---|---|---|---|---|
OR | 95% CI | p-Value | OR | 95% CI | p-Value | |
Unadjusted values | ||||||
In-hospital mortality | 0.900 | 0.535–1.513 | 0.691 | 0.948 | 0.737–1.221 | 0.681 |
GOS ≤ 3 at discharge | 0.934 | 0.604–1.443 | 0.758 | 1.217 | 0.942–1.572 | 0.133 |
ICU admission | 0.953 | 0.573–1.587 | 0.855 | 0.717 | 0.554–0.928 | 0.012 |
30-day mortality | 0.914 | 0.543–1.537 | 0.734 | 0.936 | 0.729–1.203 | 0.607 |
ICU > 7 days | 0.947 | 0.600–1.496 | 0.817 | 0.667 | 0.501–0.889 | 0.006 |
Hospital > 7 days | 1.005 | 0.655–1.542 | 0.983 | 0.788 | 0.616–1.008 | 0.058 |
MV admission | 0.973 | 0.623–1.521 | 0.905 | 0.761 | 0.595–0.973 | 0.030 |
MV > 7 days | 1.281 | 0.797–2.062 | 0.307 | 0.844 | 0.616–1.156 | 0.291 |
Adjusted values * | ||||||
In-hospital mortality | 0.818 | 0.426–1.571 | 0.546 | 1.132 | 0.836–1.534 | 0.422 |
GOS ≤ 3 at discharge | 1.029 | 0.578–1.833 | 0.922 | 1.192 | 0.867–1.639 | 0.280 |
ICU admission | 0.773 | 0.416–1.435 | 0.415 | 0.742 | 0.544–1.012 | 0.060 |
30-day mortality | 0.858 | 0.449–1.640 | 0.644 | 1.090 | 0.804–1.478 | 0.578 |
ICU > 7 days | 0.820 | 0.471–1.429 | 0.484 | 0.644 | 0.462–0.898 | 0.010 |
Hospital > 7 days | 0.928 | 0.575–1.498 | 0.760 | 0.755 | 0.580–0.983 | 0.037 |
MV admission | 0.680 | 0.363–1.273 | 0.228 | 0.761 | 0.547–1.058 | 0.104 |
MV > 7 days | 1.318 | 0.749–2.321 | 0.338 | 0.933 | 0.647–1.345 | 0.709 |
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Beijer, E.; van Wonderen, S.F.; Zuidema, W.P.; Visser, M.C.; Edwards, M.J.R.; Verhofstad, M.H.J.; Tromp, T.N.; van den Brom, C.E.; van Lieshout, E.M.M.; Bloemers, F.W.; et al. Sex Differences in Outcome of Trauma Patients Presented with Severe Traumatic Brain Injury: A Multicenter Cohort Study. J. Clin. Med. 2023, 12, 6892. https://doi.org/10.3390/jcm12216892
Beijer E, van Wonderen SF, Zuidema WP, Visser MC, Edwards MJR, Verhofstad MHJ, Tromp TN, van den Brom CE, van Lieshout EMM, Bloemers FW, et al. Sex Differences in Outcome of Trauma Patients Presented with Severe Traumatic Brain Injury: A Multicenter Cohort Study. Journal of Clinical Medicine. 2023; 12(21):6892. https://doi.org/10.3390/jcm12216892
Chicago/Turabian StyleBeijer, Elise, Stefan F. van Wonderen, Wietse P. Zuidema, Marieke C. Visser, Michael J. R. Edwards, Michael H. J. Verhofstad, Tjarda N. Tromp, Charissa E. van den Brom, Esther M. M. van Lieshout, Frank W. Bloemers, and et al. 2023. "Sex Differences in Outcome of Trauma Patients Presented with Severe Traumatic Brain Injury: A Multicenter Cohort Study" Journal of Clinical Medicine 12, no. 21: 6892. https://doi.org/10.3390/jcm12216892
APA StyleBeijer, E., van Wonderen, S. F., Zuidema, W. P., Visser, M. C., Edwards, M. J. R., Verhofstad, M. H. J., Tromp, T. N., van den Brom, C. E., van Lieshout, E. M. M., Bloemers, F. W., & Geeraedts, L. M. G., Jr. (2023). Sex Differences in Outcome of Trauma Patients Presented with Severe Traumatic Brain Injury: A Multicenter Cohort Study. Journal of Clinical Medicine, 12(21), 6892. https://doi.org/10.3390/jcm12216892