The importance of gender on outcome after major trauma: Functional and psychologic outcomes in women versus men

被引:104
作者
Holbrook, TL
Hoyt, DB
Anderson, JP
机构
[1] Univ Calif San Diego, Sch Med, Trauma Recovery Project Adolescents 0073, Dept Family & Prevent Med, La Jolla, CA 92093 USA
[2] Univ Calif San Diego, Sch Med, Dept Surg, Div Traumatol, La Jolla, CA 92093 USA
来源
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE | 2001年 / 50卷 / 02期
关键词
D O I
10.1097/00005373-200102000-00012
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background: outcome after major trauma is an increasingly important focus of injury research. The effect of gender on functional and psychological outcomes has not been examined. The Trauma Recovery Project is a large, prospective, epidemiologic study designed to examine multiple outcomes after major trauma, including quality of life, functional outcome, and psychological sequelae such as depression and early symptoms of acute stress reaction. The specific objectives of the present report are to examine gender differences in short- and long-term functional and psychological outcomes in the Trauma Recovery Project population. Methods: Between December 1, 1993, and September 1, 1996, 1,048 eligible trauma patients triaged to four participating trauma center hospitals in the San Diego Regionalized Trauma System were enrolled in the study. The enrollment criteria for the study included age 18 Sears and older, admission Glasgow Coma Scale score of 12 or greater, and length of stay greater than 24 hours. Quality of life was measured after injury using the Quality of Well-being scale, a sensitive index to the well end of the functioning continuum (range, 0 = death to 1.000 = optimum functioning). Depression was assessed using the Center for Epidemiologic Studies Depression scale and early symptoms of acute stress reaction were assessed using the Impact of Events scale, Patient outcomes mere assessed at discharge and at 6, 12, and 18 months after discharge. Results: Functional outcome was significantly worse at each follow-up time point in women (n = 313) versus men (n = 735). Quality of Well-being scale scores were markedly and significantly lower at 6-month follow-up in n omen compared with those in men (0.606 vs. 0.646, p < 0.0001). This association persisted at 12-month (0.637 vs, 0.6685, p < 0.0001) and 18-month (0.646 us. 0.6696, p < 0.0001) follow-up. Women were also significantly more likely to be depressed at all follow-up time points (discharge odds ratio [OR] = 1.4, p < 0.05; 6-month follow-up OR = 2.2, p < 0.01; 12-month follow-up OR = 2.0, p < 0.01; 18-month follow-up OR = 2.2, p < 0.01) and to have early symptoms of acute stress reaction at discharge (OR = 1.4,p < 0.05), These differences remained significant and independent after adjusting for injury severity, mechanism, age, and sociodemographic factors. Conclusion: women are at risk for markedly worse functional and psychological outcomes after major trauma than men, independent of injury severity and mechanism. Gender differences In short- and long-term trauma outcomes have important implications for future studies of recovery from trauma.
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页码:270 / 273
页数:4
相关论文
共 20 条
[1]   Testosterone and/or low estradiol: Normally required but harmful immunologically for males after trauma-hemorrhage [J].
Angele, MK ;
Ayala, A ;
Monfils, BA ;
Cioffi, WG ;
Bland, KI ;
Chaudry, IH .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 1998, 44 (01) :78-84
[2]   Long-term prevalence of impairments and disabilities after multiple trauma [J].
Anke, AGW ;
Stanghelle, JK ;
Finset, A ;
Roaldsen, KS ;
PillgramLarsen, J ;
FuglMeyer, AR .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 1997, 42 (01) :54-61
[3]  
[Anonymous], 1982, CASE CONTROL STUDIES
[4]   Long-term outcomes after lower extremity trauma [J].
Butcher, JL ;
MacKenzie, EJ ;
Cushing, B ;
Jurkovich, G ;
Morris, J ;
Burgess, A ;
McAndrew, M ;
Swiontkowski, M .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 1996, 41 (01) :4-9
[5]   Sepsis - Lessons learned in the last century and future directions [J].
Chaudry, IH .
ARCHIVES OF SURGERY, 1999, 134 (09) :922-929
[6]   Effect of trauma and pelvic fracture on female genitourinary, sexual, and reproductive function [J].
Copeland, CE ;
Bosse, MJ ;
McCarthy, ML ;
MacKenzie, EJ ;
Guzinski, GM ;
Hash, CS ;
Burgess, AR .
JOURNAL OF ORTHOPAEDIC TRAUMA, 1997, 11 (02) :73-81
[7]  
Dannenberg Andrew L., 1994, Annals of Epidemiology, V4, P133
[8]   MULTIVARIATE MODELS FOR PREDICTING SURVIVAL OF PATIENTS WITH TRAUMA FROM LOW FALLS - THE IMPACT OF GENDER AND PRE-EXISTING CONDITIONS [J].
HANNAN, EL ;
MENDELOFF, J ;
FARRELL, LS ;
CAYTEN, CG ;
MURPHY, JG .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 1995, 38 (05) :697-704
[9]   Outcome after major trauma: Discharge and 6-month follow-up results from the trauma recovery project [J].
Holbrook, TL ;
Anderson, JP ;
Sieber, WJ ;
Browner, D ;
Hoyt, DB .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 1998, 45 (02) :315-323
[10]   Outcome after major trauma: 12-month and 18-month follow-up results from the Trauma Recovery Project [J].
Holbrook, TL ;
Anderson, JP ;
Sieber, WJ ;
Browner, D ;
Hoyt, DB .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 1999, 46 (05) :765-771