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September 1, 2007

Mortality in Adolescent Girls vs Boys Following Traumatic Shock: An Analysis of the National Pediatric Trauma Registry

Author Affiliations

Author Affiliations: Division of Trauma and Critical Care, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland (Drs Haider, Efron, Haut, Chang, and Cornwell); and Department of Surgery, University of South Florida, Tampa (Dr Paidas).

Arch Surg. 2007;142(9):875-880. doi:10.1001/archsurg.142.9.875

Hypothesis  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 ≥ 16) with shock (systolic blood pressure ≤ 90 mm Hg, adjusted for age).

Main Outcome Measure  Adjusted odds of mortality between sexes.

Results  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 ≤ 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).

Conclusions  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.