title: Females have fewer complications and lower mortality following trauma than similarly injured males: a risk adjusted analysis of adults in the National Trauma Data Bank.
abstract: BACKGROUND
  Studies of sexual dimorphism in trauma outcomes suggest that women have a survival advantage compared to equivalently injured men. It is unknown if this gender disparity is mediated by potentially life-threatening complications.
  
  
  OBJECTIVE
  To determine (1) if there is a sex-based differences in the odds of developing inpatient complications after trauma, and (2) if are these complications associated with death among trauma patients.
  
  
  METHODS
  Review of adult trauma patients admitted to hospitals in the National Trauma Data Bank that report complications. Patient and injury severity covariates were adjusted using multiple logistic regression and the independent effect of sex on developing complications and associated mortality was determined.
  
  
  RESULTS
  A total of 681,730 adult patients met the inclusion criteria of hospital admission > or =3 days. Women demonstrated a 21% lower adjusted risk of death compared to males (OR 0.79, 95% CI 0.76-0.83). Females had decreased adjusted odds of developing life-threatening complications including pneumonia, acute respiratory distress syndrome, acute renal failure and pulmonary embolism. However, when compared to males with life-threatening complications, females with complications were found to be at greater risk of dying.
  
  
  CONCLUSIONS
  This study demonstrates that women are less likely than men to develop inpatient complications, suggesting that the survival advantage among women after traumatic injury may involve a reduced susceptibility to developing life-threatening complications.
authors.affiliation: Trauma Outcomes Research Group-Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. ahaider1@jhmi.edu
authors.forename: Adil H
authors.initials: AH
authors.lastname: Haider
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Crompton
authors.forename: Tolulope
authors.initials: T
authors.lastname: Oyetunji
authors.forename: Kent A
authors.initials: KA
authors.lastname: Stevens
authors.forename: David T
authors.initials: DT
authors.lastname: Efron
authors.forename: Alicia N
authors.initials: AN
authors.lastname: Kieninger
authors.forename: David C
authors.initials: DC
authors.lastname: Chang
authors.forename: Edward E
authors.initials: EE
authors.lastname: Cornwell
authors.forename: Elliott R
authors.initials: ER
authors.lastname: Haut
mesh_terms: D018784:Abdominal Abscess / Q000209:etiology / Q000401:mortality; D058186:Acute Kidney Injury / Q000209:etiology / Q000401:mortality; D000328:Adult; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D011014:Pneumonia / Q000209:etiology / Q000401:mortality; D011655:Pulmonary Embolism / Q000188:drug therapy / Q000401:mortality; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000401:mortality; D012307:Risk Factors; D017678:Sex Distribution; D015996:Survival Rate; D014481:United States; D014947:Wounds and Injuries / Q000150:complications* / Q000401:mortality / Q000473:pathology