title: Clinical re-examination 10 or more years after polytrauma: is there a gender related difference?
abstract: BACKGROUND
  : Previous studies documented that premenopausal women better tolerate severe injuries than men in regards to mortality and intensive care complications. We test the hypothesis whether surviving women have a better long-term outcome than surviving men.
  
  
  METHODS
  : We reassessed 637 polytrauma patients 10 or more years (mean 17 +/- 5 years) after trauma. Mental health was assessed by the posttraumatic stress diagnostic scale and the Hospital Anxiety and Depression Scale. The clinical outcome was assessed by standardized scores (Hannover Score for Polytrauma Outcome and short form-12). A physical examination was performed by an orthopedic surgeon.
  
  
  RESULTS
  : We studied 479 men (M; 75.4%) and 158 women (F; 24.6%) aged M = 26.7 +/- 12.2 versus F = 25.9 +/- 13.0 years (p = 0.47). Injury Severity Score showed M = 20.4 +/- 9.9 versus F = 21.7 +/- 9.7 (p = 0.13). Women showed a higher rate of posttraumatic stress disorder (F = 14.5% vs. M = 6.2%; p = 0.035) and psychologic support (F = 28.0% vs. M = 15.0%; p < 0.001), longer duration of rehabilitation, and longer sick leave time. Quality-of-life was significantly lower in women (Short form-12 psychologic F = 48.6 +/- 10.8 vs. M = 50.8 +/- 9.4; p = 0.02), but the same rate of women (75.3%) and men (75.4%; p = 0.995) felt well rehabilitated.
  
  
  CONCLUSIONS
  : Late after polytrauma, women suffer more severe psychologic impairment than men who had similar injuries. This finding is independent of physical impairment and the subjective feeling of a good rehabilitation outcome. Clinically, women require special support even years after injury to improve their psychologic status. In the future, they might benefit from early concomitant psychologic treatment if mental problems are suspected.
authors.affiliation: Department of Trauma, Hannover Medical School, Hannover, Germany. probst.christian@mh-hannover.de
authors.forename: Christian
authors.initials: C
authors.lastname: Probst
authors.forename: Boris
authors.initials: B
authors.lastname: Zelle
authors.forename: Martin
authors.initials: M
authors.lastname: Panzica
authors.forename: Ralf
authors.initials: R
authors.lastname: Lohse
authors.forename: Nicola Alexander
authors.initials: NA
authors.lastname: Sitarro
authors.forename: Christian
authors.initials: C
authors.lastname: Krettek
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Pape
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D009104:Multiple Trauma / Q000503:physiopathology* / Q000523:psychology* / Q000628:therapy; D017060:Patient Satisfaction; D011788:Quality of Life; D020127:Recovery of Function; D012189:Retrospective Studies; D012737:Sex Factors; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D055815:Young Adult