Comparative analysis of gender differences in outcomes after trauma in India and the USA: case for standardised coding of injury mechanisms in trauma registries.
Comparative analysis of gender differences in outcomes after trauma in India and the USA: case for standardised coding of injury mechanisms in trauma registries.
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DOI：
10.1136/bmjgh-2017-000322
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发表时间：
2017
影响因子：
8.1
通讯作者：
Roy N
中科院分区：
文献类型：
--
作者：
Dasari M;David SD;Miller E;Puyana JC;Roy N
虽然女性在创伤后的结果通常比男性好，但在低收入国家，女性在故意创伤后的死亡率较高。然而，以前没有比较过不同国家创伤结局的性别差异。我们进行了一项两国比较分析，以确定不同损伤机制死亡率的性别差异。对2013年至2015年期间来自印度和美国的两个城市创伤数据库进行了跌倒，机动车碰撞（MVC）和袭击患者的分析。根据性别、年龄、损伤严重程度评分、格拉斯哥昏迷评分和损伤类型（钝性与穿透性），使用粗化精确匹配对两组进行匹配。死亡率的主要结局是通过使用逻辑回归来计算四个国家/性别亚组的死亡几率。分别从印度和美国数据库中共纳入10 089例和14 144例患者。在协变量匹配后，7505和9448例患者被纳入logistic回归。与美国男性、美国女性和印度女性相比，印度男性在福尔斯、MVC和袭击方面的死亡几率最高。与美国女性相比，印度女性在福尔斯摔倒后死亡的几率是美国女性的7倍，死于MVC的几率是美国女性的5倍，死于袭击的几率是美国女性的40倍。与美国女性相比，印度女性的死亡率较高，这表明还有其他损伤和全身因素导致死亡率差异。与所有亚组相比，印度男性的死亡率模式和影响相同。创伤登记中的损伤机制标准化编码，以及损伤的故意性，可以帮助进一步消除性别和国家之间的结果差异，以指导有针对性的损伤预防和护理。
While females generally have better outcomes than males after traumatic injury, higher mortality has been shown to occur in females after intentional trauma in lower-income countries. However, gender differences in trauma outcomes in different countries have not been previously compared. We conducted a two-country comparative analysis to characterise gender differences in mortality for different mechanisms of injury. Two urban trauma databases were analysed from India and the USA for fall, motor vehicle collision (MVC) and assault patients between 2013 and 2015. Coarsened exact matching was used to match the two groups based on gender, age, injury severity score, Glasgow Coma Score and type of injury (blunt vs penetrating). The primary outcome of mortality was studied by using logistic regression to calculate the odds of death in the four country/gender subgroups. A total of 10 089 and 14 144 patients were included from the Indian and US databases, respectively. After matching on covariates, 7505 and 9448 patients were included in the logistic regression. Indian males had the highest odds of death compared with US males, US females and Indian females for falls, MVC and assaults. Indian females had over 7 times the odds of dying after falls, 5 times the odds of dying for MVC and 40 times the odds of dying after assaults when compared with US females. The high odds of death for Indian females compared with US females suggests that there are other injury and systemic factors that contribute to this discrepancy in mortality odds. This same mortality pattern and implication is seen for Indian males compared with all subgroups. Standardised coding of injury mechanism in trauma registries, in addition to intentionality of injury, can help further characterise discrepancies in outcomes by gender and country, to guide targeted injury prevention and care.
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DOI：
10.1097/01.ta.0000042021.47579.b6
发表时间：
2003-02-01
影响因子：
--
作者：
Davis, JW;Parks, SN;Bilello, JF
通讯作者：
Bilello, JF
影响因子：
2.6
作者：
Kesinger, Matthew Ryan;Puyana, Juan Carlos;Rubiano, Andres M.
通讯作者：
Rubiano, Andres M.
DOI：
10.1076/icsp.10.1.45.14114
发表时间：
2003-03-01
期刊：
Injury control and safety promotion
影响因子：
--
作者：
Mock, Charles;Arreola-Risa, Carlos;Quansah, Robert
通讯作者：
Quansah, Robert
DOI：
10.1016/s0020-1383(00)00029-2
发表时间：
2000-09-01
影响因子：
2.5
作者：
Templeton, J;Oakley, PA;Trunkey, DD
通讯作者：
Trunkey, DD
DOI：
10.1016/j.injury.2014.04.037
发表时间：
2014-09-01
影响因子：
2.5
作者：
Kesinger, Matthew R.;Nagy, Lisa R.;Rubiano, Andres M.
通讯作者：
Rubiano, Andres M.