Sex and Age-Based Effect on Outcomes in the Setting of Traumatic Hemorrhage

Survival differences between injured females and males have been demonstrated.

To analyze trauma survival stratified by sex and age for a given transfusion volume.

The Trauma Quality Improvement Program registry was analyzed from 2020 to 2023. Patients ≥15 years who received any volume of blood products within 4 hours were included.

There were 13,987 patients (3165/13,987, 22.6% female) who received 75-600 mL/kg of all blood products within the first 4 hours of admission, i.e., the range where a difference in cumulative 24-hour survival between males and females was observed. In this range, the cumulative probability of 24-hour survival was lower for females compared to males (46 vs. 51%, respectively). This difference was not observed in the adjusted analysis (odds ratio 0.93, 95% confidence interval 0.84-1.02). In the unadjusted age and sex subanalysis, females >50 years had the highest mortality of any of the four groups of patients once ∼100 mL/kg of blood products had been transfused. Both males and females aged 15-50 years had the lowest mortality for any volume of transfusion; males >50 years had intermediate mortality. In the regression analysis performed on patients who received a total volume of 100-600 mL/kg of transfusion, 15- to 50-year-old males had significantly lower 24-hour survival compared to similarly aged females. There was no difference in this parameter between the females and males who were >50 years.

Adjusting for differences did not reveal a difference in overall survival between males and females; younger males had lower survival compared to similarly aged females.