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Gender-specific differences in therapy and laboratory parameters and validation of mortality predictors in severely injured patients—results of a German level 1 trauma center

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Abstract

Purpose

Gender-specific differences in trauma patients have been reported in several studies. There is a lack of knowledge about differences in therapy and laboratory parameters. The objective of this study is to analyze differences between genders, confirming the therapy and laboratory parameters. Additionally, predictors for mortality were validated.

Methods

Patients on primary admission to the hospital between 2002 and 2012 with an Injury Severity Score (ISS) ≥ 16 were included. 1073 patients met the inclusion criteria. Comparisons and matched-pair analyses between deceased and survived females, males, and between deceased females and males were conducted.

Results

The analyzed laboratory parameters differed between genders, especially the base excess, lactate, and coagulation parameters. In particular, females presented values that were normal or only slightly pathological. The prothrombin ratio was 75.3 % in female and 63.2 % in male (p = 0.027) and lactate 2.5 mmol/l in female and 3.8 mmol/l in male (p = 0.049). No differences between genders could be found in the initial treatment of severely injured patients. Only the infused volume differed between genders with 1178.2 ml in male and 793.6 ml in female (p = 0.02). The known predictors for mortality, lactate, and prothrombin ratio could not be validated in female trauma patients.

Conclusions

No gender differences, except the infused volume, in the treatment of severely injured patients could be found. Differences in laboratory tests, especially base excess, lactate, and coagulation parameters were found. As these parameters are also used as predictors of mortality in trauma patients, gender-specific cut-offs of these laboratory tests might be necessary to avoid underestimating injured women.

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Abbreviations

AIS:

Abbreviated injury scale

AS:

Accident scene

CCT:

Cranial computed tomography

PRBC:

Units of packed red blood cells

DGU:

German Trauma Society

FFP:

Fresh frozen plasma

GCS:

Glasgow Coma Scale

Hb:

Hemoglobin

ICU:

Intensive care unit

ISS:

Injury Severity Score

MOF:

Multi-organ failure

OF:

Organ failure

PPSB:

Prothrombin complex

PTT:

Partial thromboplastin time

RISC:

Revised injury severity classification

RTS:

Revised Trauma Score

SBP:

Systolic blood pressure

SD:

Standard deviation

SPSS:

Statistical Package for the Social Sciences

TR:

Trauma room

TRISS:

Trauma and Injury Severity Score

vs.:

Versus

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Acknowledgments

A professional language editing service, American Manuscript Editors, was commissioned with the correction of grammar, spelling and other errors. Statistical consulting from the Institute for Medical Informatics, Biometry and Epidemiology, University Duisburg-Essen was received.

Compliance with Ethical Standards

Funding: There are no sources of funding

Conflicts of interest

All authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors. The data from the Trauma Registry of the DGU received full approval from the Ethics Committee of the University of Witten/Herdecke in Cologne, Germany. Ancillary, full approval of the Ethics Committee of the University of Duisburg-Essen was also received.

Authors’ contributions

C.S. and S.L. designed this study. C.S., D.S., S.S., and B.H. collected and analyzed the data. C.S. drafted the manuscript, and all authors contributed substantially to its revision. C.S. takes responsibility for the paper as a whole. All authors read and approved the final manuscript for publication.

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Authors and Affiliations

  1. Department of Emergency and Orthopedic Surgery, Alfried Krupp Hospital, Hellweg 100, 45276, Essen, Germany

    Carsten Schoeneberg, Daniel Schmitz, Sandra Schoeneberg, Björn Hussmann & Sven Lendemans

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  1. Carsten Schoeneberg
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  2. Daniel Schmitz
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  3. Sandra Schoeneberg
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  4. Björn Hussmann
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  5. Sven Lendemans
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Correspondence to Carsten Schoeneberg.

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Schoeneberg, C., Schmitz, D., Schoeneberg, S. et al. Gender-specific differences in therapy and laboratory parameters and validation of mortality predictors in severely injured patients—results of a German level 1 trauma center. Langenbecks Arch Surg 400, 781–790 (2015). https://doi.org/10.1007/s00423-015-1327-6

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