Female Sex Associated With Lower Traumatic Shock Mortality, With Differences by Age

A retrospective cohort study in the Journal of the American College of Surgeons examined whether the association between female sex and survival after traumatic shock varies with age. Researchers analyzed National Trauma Data Bank records from 2019–2023 for 109,819 adults with Injury Severity Score ≥16 and initial systolic blood pressure ≤90 mmHg. The primary endpoint was in-hospital mortality; models adjusted for injury characteristics, comorbidity, insurance, and race/ethnicity.

Female sex was associated with lower mortality overall (adjusted odds ratio 0.86; 95% CI, 0.82–0.89), with a significant sex-by-age interaction (p=0.0214). Adjusted mortality among females versus males was 15.6% versus 17.0% at ages 18–44, 15.4% versus 16.5% at ages 45–54, and 17.4% versus 20.4% at ages ≥55. Differences were statistically significant in the youngest and oldest strata, but not at ages 45–54. The age-dependent association persisted in analyses restricted to blunt injuries and those treating age continuously.

The largest absolute mortality difference occurred in the oldest group, a pattern the authors considered inconsistent with a simple endogenous-estrogen explanation. These observational findings do not establish causality or a hormonal mechanism. The authors describe the results as hypothesis-generating and call for prospective investigation incorporating hormonal status, biological mediators, and care-limitation practices.