Women survived traumatic shock more often, most clearly after 55

Design

Retrospective registry cohort, National Trauma Data Bank 2019–2023

Population

109,819 adults with ISS ≥16 and systolic BP ≤90 mmHg

Primary outcome

In-hospital mortality

Effect

Female aOR 0.86 (0.82–0.89); age ≥55: 17.4% vs 20.4%

This Journal of the American College of Surgeons cohort, published on 28 September, used the US National Trauma Data Bank for 2019 to 2023. It included 109,819 adults with Injury Severity Score of 16 or more and a first systolic pressure of 90 mmHg or less.

Female sex was associated with lower in-hospital mortality after adjustment (aOR 0.86). The gap depended on age: lower in women aged 18 to 44 (15.6% vs 17.0%), not significantly different at 45 to 54, and widest at 55 and over (17.4% vs 20.4%).

The largest advantage in older women argues against oestrogen as the simple explanation. The authors call the result hypothesis-generating; differences in care limitation and injury pattern may contribute. It does not change how any individual patient should be resuscitated.

• Resuscitate by physiology and injury, not by sex; this finding does not alter protocols.
• Be cautious with prognostic assumptions in older men with shock, who had the highest mortality here.
• Record decisions to limit treatment clearly; they may shape outcome data like these.
• Treat hormonal explanations for sex differences in trauma survival as unproven.

Why it matters

The age pattern undercuts the common assumption that oestrogen explains women's better trauma survival.

Don't overread it

Registry data cannot separate biology from differences in care or decisions to limit treatment.

The statistics, in plain English

An adjusted odds ratio of 0.86 means women's odds of dying were about 14% lower after accounting for injury severity and other factors. Absolute differences were small: 1.4 to 3.0 percentage points.

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