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Introduction
Globally, trauma is a leading cause of mortality, contributing to over 4.4 million deaths annually, with a disproportionate burden in low- and middle-income countries [1]. While Northern America and European countries have contributed extensively to the body of trauma literature, there remains a relative lack of data from Asian countries despite their significant trauma burden [2, 3]. Among the factors that contribute to trauma mortality, aside from the mechanism and the severity of the injury, are the healthcare system, comorbidities, age, and likely sex differences [4, 5, 6–7]. Understanding the nuances of sex-based differences in trauma outcomes could advance personalised trauma management, inspire research to improve trauma care, and facilitate better decision-making and prognostication.
The physiological response to trauma, characterised by initial acute inflammatory response and subsequent immunosuppression, may have sex-specific differences [8]. Laboratory research has demonstrated differences in outcomes after major trauma, sepsis, and haemorrhage in females [9, 10]. Hormonal variations, particularly estrogen and testosterone, could influence the immune and overall physiological responses to traumatic injuries in animal studies [11, 12]. These findings are supported by studies indicating that genetic factors, such as X-chromosome-linked polymorphisms in the innate immune response to sepsis, are associated with poor outcomes, which can be a plausible mechanism for sex-based differences in outcomes following injuries [9, 13, 14].
Clinical studies, however, have presented inconsistent results. An analysis of 36,000 patients with blunt trauma in Germany showed no difference in outcome between sexes, although the male sex was an independent negative predictor of morbidity [15]. In the Netherlands, a study involving 7,000 patients at level 1 trauma centres showed that sex was not an independent predictor for in-hospital mortality. Still, males were more likely to be admitted into the ICU. Two Chinese studies showed that females had a lower risk of mortality than males after severe blunt trauma [3, 16]. Notably, studies specific to Asian populations have suggested potential regional differences in these patterns, a hypothesis that has yet to be fully explored with large-scale data [17].
Our study aimed to bridge this gap by analysing the differences in trauma outcomes between sexes in a diverse patient population from the Asia-Pacific region. We focused on in-hospital mortality rates and functionality at discharge, using the Glasgow Outcome Scale (GOS) and...
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