The importance of gender on outcome after major trauma: Functional and psychologic outcomes in women versus men
The importance of gender on outcome after major trauma: Functional and psychologic outcomes in women versus men
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DOI：
10.1097/00005373-200102000-00012
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发表时间：
2001-02-01
影响因子：
--
通讯作者：
Anderson, JP
中科院分区：
文献类型：
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作者：
Holbrook, TL;Hoyt, DB;Anderson, JP
背景：严重创伤后的预后是创伤研究的一个日益重要的焦点。性别对功能和心理结果的影响尚未得到研究。创伤恢复项目是一项大型的前瞻性流行病学研究，旨在检查重大创伤后的多种结局，包括生活质量，功能结局和心理后遗症，如抑郁和急性应激反应的早期症状。本报告的具体目标是研究性别差异的短期和长期的功能和心理的结果在创伤Recovery Projectpopulation.Methods：1993年12月1日和1996年9月1日之间，1,048名符合条件的创伤患者分流到四个参与创伤中心医院在圣地亚哥区域化创伤系统参加了这项研究。该研究的入选标准包括年龄18岁及以上，入院格拉斯哥昏迷量表评分为12分或更高，住院时间超过24小时。使用幸福质量量表测量受伤后的生活质量，该量表是功能连续体良好端的敏感指数（范围，0 =死亡至1.000 =最佳功能）。抑郁症进行了评估，使用流行病学研究中心抑郁量表和急性应激反应的早期症状进行了评估，使用事件量表的影响，患者的结果仅仅在出院时，并在6，12和18个月后discharge.Results：功能结果是显着恶化，在每个随访时间点的女性（n = 313）与男性（n = 735）。6个月随访时，女性的幸福质量量表评分明显低于男性（0.606 vs. 0.646，p < 0.0001）。这种相关性在12个月（0.637 vs，0.6685，p < 0.0001）和18个月（0.646 us. 0.6696，p < 0.0001）随访。在所有随访时间点，（出院比值比[OR] = 1.4，p < 0.05; 6个月随访OR = 2.2，p < 0.01; 12个月随访OR = 2.0，p < 0.01; 18个月随访OR = 2.2，p < 0.01），出院时有急性应激反应的早期症状（OR = 1.4，p < 0.05），在调整损伤严重程度、损伤机制、年龄和社会人口学因素后，这些差异仍然是显著的和独立的。在严重创伤后，女性的功能和心理后果明显比男性差，与损伤的严重程度和机制无关。短期和长期创伤结果的性别差异对未来创伤恢复的研究具有重要意义。
Background: outcome after major trauma is an increasingly important focus of injury research. The effect of gender on functional and psychological outcomes has not been examined. The Trauma Recovery Project is a large, prospective, epidemiologic study designed to examine multiple outcomes after major trauma, including quality of life, functional outcome, and psychological sequelae such as depression and early symptoms of acute stress reaction. The specific objectives of the present report are to examine gender differences in short- and long-term functional and psychological outcomes in the Trauma Recovery Project population.Methods: Between December 1, 1993, and September 1, 1996, 1,048 eligible trauma patients triaged to four participating trauma center hospitals in the San Diego Regionalized Trauma System were enrolled in the study. The enrollment criteria for the study included age 18 Sears and older, admission Glasgow Coma Scale score of 12 or greater, and length of stay greater than 24 hours. Quality of life was measured after injury using the Quality of Well-being scale, a sensitive index to the well end of the functioning continuum (range, 0 = death to 1.000 = optimum functioning). Depression was assessed using the Center for Epidemiologic Studies Depression scale and early symptoms of acute stress reaction were assessed using the Impact of Events scale, Patient outcomes mere assessed at discharge and at 6, 12, and 18 months after discharge.Results: Functional outcome was significantly worse at each follow-up time point in women (n = 313) versus men (n = 735). Quality of Well-being scale scores were markedly and significantly lower at 6-month follow-up in n omen compared with those in men (0.606 vs. 0.646, p < 0.0001). This association persisted at 12-month (0.637 vs, 0.6685, p < 0.0001) and 18-month (0.646 us. 0.6696, p < 0.0001) follow-up. Women were also significantly more likely to be depressed at all follow-up time points (discharge odds ratio [OR] = 1.4, p < 0.05; 6-month follow-up OR = 2.2, p < 0.01; 12-month follow-up OR = 2.0, p < 0.01; 18-month follow-up OR = 2.2, p < 0.01) and to have early symptoms of acute stress reaction at discharge (OR = 1.4,p < 0.05), These differences remained significant and independent after adjusting for injury severity, mechanism, age, and sociodemographic factors.Conclusion: women are at risk for markedly worse functional and psychological outcomes after major trauma than men, independent of injury severity and mechanism. Gender differences In short- and long-term trauma outcomes have important implications for future studies of recovery from trauma.