All things being equal, women are more likely than men to survive critical injury

Several years ago, Dr. Edward E. Cornwell III, then a trauma surgeon at Johns Hopkins Hospital, treated a young man with several gunshot wounds to his chest and groin. The patient’s testicles had nearly been shot off. Despite his life-threatening condition, he survived emergency surgery and experienced a remarkable recovery. Cornwell thought he knew why. The testicles, which had been all but destroyed, abruptly shut down the man’s testosterone production.

A new study confirms Cornwell’s hunch that hormones put men at a disadvantage, compared with women, when it comes to surviving severe physical trauma. Researchers at Johns Hopkins analyzed data from more than 48,000 patients who were severely injured and arrived at an emergency room with low blood pressure -- meaning they had lost a lot of blood. They found that there was no difference in survival between the genders in children 12 years or younger or people 65 and older.

But among people 13 to 64, when hormones are in full swing, women were 14% more likely to survive than men. This was the case even when the researchers ruled out other factors that affect survival, such as race, insurance status and specific injuries.

Studies in mice show that female mice have greater survival rates from trauma than male miceexcept when the male mice are castrated. Thus, there appears to be something about testosterone, which is much higher in men than women, that diminishes male survival while estrogens in females are somewhat protective. It could be that female hormones have more of an immune-enhancing effect that can be beneficial when the body is in shock but that can also go awry in other settings, given women’s much-higher prevalence of auto-immune disorders, such as lupus.

In any case, it may be time to treat severely injured male trauma patients with drugs that temporarily block male hormones. Few new medical therapies have been developed in recent years to improve survival among critically injured trauma patients, but this idea seems worth a try. “If we can come up with ways to manipulate those hormones in men. . .we might be able to improve their survival,” the lead author of the study, Dr. Adil H. Haider, said in a news release.

The study was published in the September issue of the Journal of Trauma.

-- Shari Roan / Los Angeles Times

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