Female risk-adjusted survival advantage after injuries caused by falls, traffic or assault: a nationwide 11-year study

Firearms-related injury and sex: a comparative National Trauma Database (NTDB) Study

Background

Existing study findings on firearms-related injury patterns are largely skewed towards males, who comprise the majority of this injury population. Given the paucity of existing data for females with these injuries, we aimed to elucidate the demographics, injury patterns, and outcomes of firearms-related injury in females compared with males in the USA.

Materials and methods

A 7-year (2013-2019) retrospective review of the National Trauma Database was conducted to identify all adult patients who suffered firearms-related injuries. Patients who were males were matched (1:1, caliper 0.2) to patients who were females by demographics, comorbidities, injury patterns and severity, and payment method, to compare differences in mortality and several other post-injury outcomes.

Results

There were 196 696 patients admitted after firearms-related injury during the study period. Of these patients, 23 379 (11.9%) were females, 23 378 of whom were successfully matched to a male counterpart. After matching, females had a lower rate of in-hospital mortality (18.6% vs. 20.0%, p<0.001), deep vein thrombosis (1.2% vs. 1.5%, p=0.014), and had a lower incidence of drug or alcohol withdrawal syndrome (0.2% vs. 0.5%, p<0.001) compared with males.

Conclusion

Female victims of firearms-related injuries experience lower rates of mortality and complications compared with males. Further studies are needed to elucidate the cause of these differences.

Level of evidence

Level III.

Impact of hospital type on risk-adjusted, traffic-related 30-day mortality: a population-based registry study

Background

Traffic incidents are still a major contributor to hospital admissions and trauma-related mortality. The aim of this nationwide study was to examine risk-adjusted traffic injury mortality to determine whether hospital type was an independent survival factor.

Methods

Data on all patients admitted to Swedish hospitals with traffic-related injuries, based on International Classification of Diseases codes, between 2001 and 2011 were extracted from the Swedish inpatient and cause of death registries. Using the binary outcome measure of death or survival, data were analysed using logistic regression, adjusting for age, sex, comorbidity, severity of injury and hospital type. The severity of injury was established using the International Classification of Diseases Injury Severity Score (ICISS).

Results

The final study population consisted of 152,693 hospital admissions. Young individuals (0-25 years of age) were overrepresented, accounting for 41% of traffic-related injuries. Men were overrepresented in all age categories. Fatalities at university hospitals had the lowest mean (SD) ICISS 0.68 (0.19). Regional and county hospitals had mean ICISS 0.75 (0.15) and 0.77 (0.15), respectively, for fatal traffic incidents. The crude overall mortality in the study population was 1193, with a mean ICISS 0.72 (0.17). Fatalities at university hospitals had the lowest mean ICISS 0.68 (0.19). Regional and county hospitals had mean ICISS 0.75 (0.15) and 0.77 (0.15), respectively, for fatal traffic incidents.When regional and county hospitals were merged into one group and its risk-adjusted mortality compared with university hospitals, no significant difference was found. A comparison between hospital groups with the most severely injured patients (ICISS ≤0.85) also did not show a significant difference (odds ratio, 1.13; 95% confidence interval, 0.97-1.32).

Conclusions

This study shows that, in Sweden, the type of hospital does not influence risk adjusted traffic related mortality, where the most severely injured patients are transported to the university hospitals and centralization of treatment is common.

Gender differences in response to abdominal compartment syndrome in rats

Objective

Our study aims to emphasize the novelty of female rats in regard to their hemodynamic changes in response to abdominal compartment syndrome. A group of 64 rats was randomly divided into 4 subgroups for each gender. Except for the control, intra-abdominal pressure was increased to 10, 20, 30 mmHg. Survival time, mean arterial pressure, pH and lactate were determined at different time intervals.

Results

As IAP was 20 mmHg, a statistically difference was seen between the male group and the female group starting from 15 min (126 ± 9.7 mmHg, 124 ± 14.7 mmHg respectively, p < 0.02) and lasting 2 h. At 30 mmHg, a statistically difference was seen between 30 to 60 min (p < 0.05). Only group 2 presented results with statistical power both at 30 and at 60 min concerning pH (p = 0.003, p < 0.001 respectively). In the lactate measurements at IAP of 10 mmHg, at 60 min male lactate level was 3.93 ± 1.13 and 2.25 ± 0.33 in female rats (p = 0.034). Female rats that were subjected to IAP of 20 mmHg and 30 mmHg had significantly better survival than male rats that were subjected to the same pressure (p < 0.05 and p < 0.01, respectively). We concluded that female rats have better preserved their hemodynamic and metabolic parameters during ACS than male rats.