Gender Disparities in Trauma Patients With an Elevated Shock Index at a Rural Appalachian Trauma Center

TL;DR

This study finds that male trauma patients with a high shock index have worse outcomes and longer hospital stays compared to females in a rural trauma center.

Contribution

The study highlights gender disparities in trauma outcomes using shock index in a rural Appalachian setting.

Findings

Males with a shock index ≥1.0 had longer hospital stays and higher mortality rates than females.

Males were more likely to die and require blood transfusions compared to females.

Males were more likely to have motorcycle accidents, while females were more likely to have falls or motor vehicle collisions.

Abstract

Introduction: Although men are more likely to experience a traumatic injury, research demonstrates that gender may impact patients’ biological responses to trauma. Shock index (SI) is a validated tool used to predict patient outcomes. This study aims to determine if gender is associated with differences in outcomes in patients with an SI ≥1.0 in the rural setting.

Methods: This retrospective study included 699 trauma patients with an SI ≥1.0 admitted to a rural trauma center from January 2017 to December 2022. Student’s t-test, chi-square analysis, and univariate logistic regression were used to analyze the study data. Primary outcomes included mortality and blood transfusions. Secondary outcomes included discharge to a care facility, hospital days, ICU days, and ventilator days.

Results: Males with a SI ≥1.0 had a significantly longer length of stay (LOS) (7.0 ± 7.4 vs. 5.8 ± 6.7, P = 0.039), had a higher injury severity score (14.5 ± 12.2 vs. 10.4 ± 10.1, P < 0.001), were x1.99 more likely to die (OR = 1.999, 95% CI = 0.213-1.171, P = 0.005), and were x1.7 more likely to require blood transfusion (OR = 1.700, 95% CI = 0.323-0.937, P = 0.002) than females. Males were 4.4 times more likely to have a motorcycle accident (OR = 4.4, 95% CI = 1.935-9.816, P < 0.001). Females were 1.5 times more likely to have a fall (OR = 1.5, 95% CI = 1.099-2.146, P = 0.012) and 1.6 times more likely to have an MVC (OR = 1.6, 95% CI = 1.141-2.175, P = 0.006).

Conclusion: These findings emphasize a gender disparity in trauma patients with an SI ≥1.0 at this study’s rural institution. This study adds to the literature on SI and gender disparities.

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