(1581) More Injury, More Blood, Same Outcomes in Girls With Life-Threatening Traumatic Hemorrhage

Introduction: Patient sex may impact outcomes after trauma; prior studies suggest improved survival in pubertal girls (12-17 yrs) compared to boys and pre-pubertal girls. However, sex differences in outcomes after traumatic life-threatening hemorrhage (LTH) remain uncharacterized.

Methods: We conducted a secondary analysis of the Massive Transfusion in Children study, an international prospective observational study of children with LTH, comparing girls and boys with traumatic LTH. Baseline characteristics compared included Injury Severity Score (ISS), mechanism of injury, vital signs and laboratory values. Transfusion volumes/kg, ratios and hemostatic adjunct use during the LTH were compared. Outcomes included 24-hour and 28-day mortality and adverse events of acute kidney injury, sepsis, and acute respiratory distress syndrome. Subgroup analysis evaluated cohorts of young (0-11 year) and adolescent (12-17 year) boy and girl cohorts. Kruskal-Wallis and chi-square testing were used for comparisons as appropriate.

Results: Of 207 children, 60% had blunt injury, 129 were boys and 78 were girls. Girls had a median (IQR) age of 9 (5-15) years and boys 12 (4-16) years (p=0.28). There was no difference in mechanism of injury, hypotension, hemoglobin, PTT, INR, or other baseline characteristics. Girls had higher ISS with median 33 (26-42) versus 26 (19-38) in boys (p=0.015). Girls received larger total weight-adjusted transfusion volume during the LTH with median of 58 (32-108) ml/kg vs 38 (20-66) ml/kg (p=0.005). Girls also received a median 36 (18-66) ml/kg of RBCs versus 21 (12-36) ml/kg in boys (p=0.003). There were no differences in volume or ratios of platelet or plasma transfused or antifibrinolytic use. No differences occurred in 24-hr mortality 26% vs 23% (p=0.75) or 28-day mortality 33% vs 37%, (p=0.68) for girls vs boys, respectively. There was no difference in adverse events. In sub-group analysis, transfusion volumes/kg remained increased in young girls vs young boys with no other differences in baseline values or outcomes between subgroups.

Conclusions: Despite higher injury severity scores and larger transfusion volumes, girls had no difference in survival compared to boys after life-threatening hemorrhage.