Sex Differences in the Massively Transfused Trauma Patient

Sharven Taghavi, Danielle Tatum, Tara Reza, Alison Smith, Patrick McGrew, Charles Harris, Chrissy Guidry, Rebecca Schroll, Juan Duchesne
Shock 2020 June 9

INTRODUCTION: Recent studies have suggested the female hypercoaguable state may have a protective effect in trauma. However, whether this hypercoagulable profile confers a survival benefit in massively transfused trauma patients has yet to be determined. We hypothesized that females would have better outcomes than males after traumatic injury that required massive transfusion protocol (MTP).

MATERIALS AND METHODS: All trauma patients that underwent MTP at an urban, level 1, academic trauma center were reviewed from November 2007 to October 2018. Female MTP patients were compared to their male counterparts.

RESULTS: There were a total of 643 trauma patients undergoing MTP. Of these, 90 (13.8%) were female and 563 (86.2%) were male. Presenting blood pressure, heart rate, shock index, and injury severity score (ISS) were not significantly different. Overall mortality and incidence of venous thromboembolism (VTE) were similar. Complication profile and hospital stay were similar. On logistic regression, female sex was not associated with survival (HR: 1.04, 95%CI: 0.56-1.92, p = 0.91). Variables associated with mortality included age (HR: 1.02, 95%CI: 1.05-1.09, p = 0.03) and ISS (HR: 1.07, 95%CI: 1.05-1.09, p < 0.001). Increasing GCS was associated with survival (HR: 0.85, 95%CI: 0.82-0.89, p < 0.001). On subset analysis, pre-menopausal women (age < 50) did not have a survival advantage in comparison to similar aged males (HR: 0.68, 95%CI: 0.36-1.28, p = 0.24).

DISCUSSION: Sex differences in coagulation profile does not result in a survival advantage for females when MTP is required.

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