Patterns of sex-specific outcomes and mortality in polytrauma: a demographic and epidemiologic analysis by injury severity score.

Abstract

Purpose: This study evaluates an updated demographic and epidemiological analysis of polytrauma patients, examining sex-specific outcomes, age distribution, and injury severity measured by the Injury Severity Score (ISS).

Methods: This retrospective observational cohort analysis at a level I trauma center in Germany analyzed data from polytrauma patients with an ISS > 16, which were treated in an ICU between 2018 and 2021. Parameters collected included injury scores, pre-hospital data, and clinical outcomes. Assessed was distribution and correlation in pre-hospital and in-hospital outcomes.

Results: In a cohort of 87 polytrauma patients (78.2% male, mean age 45.6 years, mean ISS of 35.4) thoracic injuries were the most frequent (83.9%), followed by injuries of the lower extremity, head, and upper extremity. Females had higher Apache scores and more severe head and neck injuries (p < 0.05). Mortality was 15%, deceased patients showing significantly higher ISS. Younger patients had longer hospital stays, averaging 26.1 days. Complications occurred in 90% of patients, predominantly SIRS, followed by kidney failure, ARDS, and sepsis. Prehospital care, including on-scene time, showed no overall correlation with outcomes, except chest drainage, which was associated with higher ARDS and MODS rates. Females received more platelet concentrates, FFPs and TXA.Higher ISS correlated with increased Apache, SOFA, lactate levels and required more blood transfusions and coagulation therapy (p < 0.001).

Conclusion: Sex and age were shown to be associated with variations in injury severity, physical response and coagulation management, with females showing distinct injury patterns and physiological burdens. These findings highlight the importance of demographic factors in optimizing polytrauma management and guiding future evidence-based approaches to improve patient care.