{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T22:30:04Z","timestamp":1791757804218,"version":"4.3.4"},"reference-count":85,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T00:00:00Z","timestamp":1774310400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"vor","delay-in-days":38,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Scand J Trauma Resusc Emerg Med"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Sex\/gender bias have been well-documented in clinical medicine. However, few studies have assessed sex\/gender disparities specifically in major trauma care. This scoping review aims to explore sex and gender-based differences in the emergency management of severely injured patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic literature review was conducted in the following electronic databases: Medline Ovid ALL, Embase, CINAHL with Full Text, Web of Science Core Collection, Cochrane Central Register of Controlled Trials with search criteria including keywords and mesh terms: gender, sex, major trauma, wounds and injuries. Three reviewers conducted the article selection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Seventy-four full-text articles were included in the study. Main themes of sex\/gender-based differences were mechanism of injury, severity of trauma, trauma triage, trauma care, mortality, and complications. Women were older with more low-energy trauma than men. Women were more likely to suffer from pelvic and spinal cord injuries. Women were more likely to be under-triaged and under-treated. Sex\/gender-based differences in mortality were inconsistent across studies. Adjusted mortality appeared similar between women and men, with conflicting evidence of increased mortality in men in some studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Women received less trauma care and were less likely to be transported to a trauma centre. These disparities are not fully explained by differences in injury mechanism or severity and instead appear to reflect modifiable features of trauma systems, particularly triage and transfer practices. Addressing these inequities will require system-level changes to ensure that access to specialist trauma care is based on clinical need rather than sex or gender.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13049-026-01596-3","type":"journal-article","created":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T06:16:59Z","timestamp":1774333019000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Sex and gender bias in major trauma care: a scoping review"],"prefix":"10.1186","volume":"34","author":[{"given":"A","family":"Ghika-Nanchen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L","family":"Marzorati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Merra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C","family":"Girardello","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"Truong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"PN","family":"Carron","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T","family":"Nutbeam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C","family":"Clair","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"FX","family":"Ageron","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,24]]},"reference":[{"key":"1596_CR1","doi-asserted-by":"crossref","unstructured":"Rothchild J. Gender Bias. In: The Blackwell Encyclopedia of Sociology. John Wiley & Sons, Ltd; 2007. Available from: https:\/\/onlinelibrary.wiley.com\/doi\/abs\/10.1002\/9781405165518.wbeosg011. Cited 2024 Nov 10.","DOI":"10.1002\/9781405165518.wbeosg011"},{"issue":"1","key":"1596_CR2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjmed-2022-000300","volume":"1","author":"E Huber","year":"2022","unstructured":"Huber E, Le Pogam MA, Clair C. Sex related inequalities in the management and prognosis of acute coronary syndrome in Switzerland: cross sectional study. BMJ Med. 2022;1(1):e000300.","journal-title":"BMJ Med"},{"issue":"8","key":"1596_CR3","doi-asserted-by":"publisher","first-page":"1058","DOI":"10.1080\/10903127.2022.2142344","volume":"27","author":"AM Farcas","year":"2023","unstructured":"Farcas AM, Joiner AP, Rudman JS, Ramesh K, Torres G, Crowe RP, et al. Disparities in emergency medical services care delivery in the United States: a scoping review. Prehosp Emerg Care. 2023;27(8):1058\u201371.","journal-title":"Prehosp Emerg Care"},{"issue":"10157","key":"1596_CR4","doi-asserted-by":"publisher","first-page":"1500","DOI":"10.1016\/S0140-6736(18)32619-9","volume":"392","author":"S Heidari","year":"2018","unstructured":"Heidari S, Bachelet VC. Sex and gender analysis for better science and health equity. Lancet. 2018;392(10157):1500\u20132.","journal-title":"Lancet"},{"issue":"2","key":"1596_CR5","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1136\/emermed-2024-214054","volume":"42","author":"R Astin-Chamberlain","year":"2025","unstructured":"Astin-Chamberlain R, Pott J, Cole E, Bloom BM. Sex and gender reporting in UK emergency medicine trials from 2010 to 2023: a systematic review. Emerg Med J. 2025;42(2):82\u201390.","journal-title":"Emerg Med J"},{"issue":"4","key":"1596_CR6","doi-asserted-by":"publisher","first-page":"467","DOI":"10.1111\/acem.13394","volume":"25","author":"C Mackey","year":"2018","unstructured":"Mackey C, Diercks DB. Gender bias in the management of patients still exists. Acad Emerg Med. 2018;25(4):467\u20139.","journal-title":"Acad Emerg Med"},{"issue":"3","key":"1596_CR7","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1097\/SLA.0b013e318148566","volume":"246","author":"EA Deitch","year":"2007","unstructured":"Deitch EA, Livingston DH, Lavery RF, Monaghan SF, Bongu A, Machiedo GW. Hormonally active women tolerate shock-trauma better than do men: a prospective study of over 4000 trauma patients. Ann Surg. 2007;246(3):447\u201353; discussion 453-455.","journal-title":"Ann Surg."},{"issue":"3","key":"1596_CR8","first-page":"537","volume":"69","author":"AH Haider","year":"2010","unstructured":"Haider AH, Crompton JG, Chang DC, Efron DT, Haut ER, Handly N, et al. Evidence of hormonal basis for improved survival among females with trauma-associated shock: an analysis of the National Trauma Data Bank. J Trauma. 2010;69(3):537\u201340.","journal-title":"J Trauma"},{"issue":"1","key":"1596_CR9","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1186\/s12873-016-0070-9","volume":"16","author":"R Rubenson Wahlin","year":"2016","unstructured":"Rubenson Wahlin R, Ponzer S, L\u00f6vbrand H, Skrivfars M, Lossius HM, Castr\u00e9n M. Do male and female trauma patients receive the same prehospital care?: an observational follow-up study. BMC Emerg Med. 2016;16(1):6.","journal-title":"BMC Emerg Med"},{"issue":"2","key":"1596_CR10","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1016\/j.bja.2022.03.032","volume":"129","author":"T Nutbeam","year":"2022","unstructured":"Nutbeam T, Roberts I, Weekes L, Shakur-Still H, Brenner A, Ageron FX. Use of tranexamic acid in major trauma: a sex-disaggregated analysis of the Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage (CRASH-2 and CRASH-3) trials\u00a0and UK trauma registry (Trauma and Audit Research Network) data. Br J Anaesth. 2022;129(2):191\u20139.","journal-title":"Br J Anaesth"},{"issue":"7","key":"1596_CR11","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1001\/jamasurg.2022.1550","volume":"157","author":"MCE Ingram","year":"2022","unstructured":"Ingram MCE, Nagalla M, Shan Y, Nasca BJ, Thomas AC, Reddy S, et al. Sex-Based Disparities in Timeliness of Trauma Care and Discharge Disposition. JAMA Surg. 2022;157(7):609\u201316.","journal-title":"JAMA Surg"},{"issue":"2","key":"1596_CR12","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1016\/j.surg.2012.04.006","volume":"152","author":"D Gomez","year":"2012","unstructured":"Gomez D, Haas B, de Mestral C, Sharma S, Hsiao M, Zagorski B, et al. Gender-associated differences in access to trauma center care: A population-based analysis. Surgery. 2012;152(2):179\u201385.","journal-title":"Surgery"},{"issue":"7","key":"1596_CR13","doi-asserted-by":"publisher","first-page":"e1000100","DOI":"10.1371\/journal.pmed.1000100","volume":"6","author":"A Liberati","year":"2009","unstructured":"Liberati A, Altman DG, Tetzlaff J, Mulrow C, G\u00f8tzsche PC, Ioannidis JPA, et al. The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration. PLoS Med. 2009;6(7):e1000100.","journal-title":"PLoS Med"},{"key":"1596_CR14","unstructured":"Undefined U. Gender bias and sex disparity in major trauma care\u202f: a Scoping review. 2022. Available from: https:\/\/osf.io\/wvuj8. Cited 2025 Aug 4."},{"issue":"1","key":"1596_CR15","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1186\/s13643-016-0384-4","volume":"5","author":"M Ouzzani","year":"2016","unstructured":"Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan\u2014a web and mobile app for systematic reviews. Syst Rev. 2016;5(1):210.","journal-title":"Syst Rev"},{"issue":"2","key":"1596_CR16","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1097\/JTN.0b013e3182562955","volume":"19","author":"R Mitchell","year":"2012","unstructured":"Mitchell R, Curtis K, Fisher M. Understanding trauma as a men\u2019s health issue: sex differences in traumatic injury presentations at a level 1 trauma center in Australia. J Trauma Nurs. 2012;19(2):80\u20138.","journal-title":"J Trauma Nurs"},{"issue":"7","key":"1596_CR17","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1016\/S0210-5691(08)76211-9","volume":"32","author":"A Hern\u00e1ndez-Tejedor","year":"2008","unstructured":"Hern\u00e1ndez-Tejedor A, Garc\u00eda-Fuentes C, Toral-V\u00e1zquez D, Chico-Fern\u00e1ndez M, Alted-L\u00f3pez E. [Differences in injury mechanism and pattern, severity and outcome of multiple trauma patients depending on gender]. Med Intensiva. 2008;32(7):337\u201341.","journal-title":"Med Intensiva"},{"issue":"3","key":"1596_CR18","doi-asserted-by":"publisher","first-page":"464","DOI":"10.1097\/01.TA.0000051939.95039.E6","volume":"54","author":"RL George","year":"2003","unstructured":"George RL, McGwin G, Metzger J, Chaudry IH, Rue LW. The association between gender and mortality among trauma patients as modified by age. J Trauma. 2003;54(3):464\u201371.","journal-title":"J Trauma"},{"issue":"3","key":"1596_CR19","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1097\/01.TA.0000153938.77777.26","volume":"58","author":"MA Schreiber","year":"2005","unstructured":"Schreiber MA, Differding J, Thorborg P, Mayberry JC, Mullins RJ. Hypercoagulability is most prevalent early after injury and in female patients. J Trauma. 2005;58(3):475\u201380; discussion 480-481.","journal-title":"J Trauma"},{"issue":"5","key":"1596_CR20","doi-asserted-by":"publisher","first-page":"506","DOI":"10.15288\/jsa.1995.56.506","volume":"56","author":"M Ostr\u00f6m","year":"1995","unstructured":"Ostr\u00f6m M, Sj\u00f6gren H, Eriksson A. Role of alcohol in traffic crashes involving women: passenger car fatalities in northern Sweden. J Stud Alcohol. 1995;56(5):506\u201312.","journal-title":"J Stud Alcohol"},{"issue":"3","key":"1596_CR21","doi-asserted-by":"publisher","DOI":"10.1136\/emermed-2011-200657","volume":"30","author":"N Kahramansoy","year":"2013","unstructured":"Kahramansoy N, G\u00fcrb\u00fcz N, Kurt F, Erkol H, Boztas G. Gender differences in trauma mechanisms, and outcomes in a rural hospital which is not designed as trauma centre. Emerg Med J. 2013;30(3):e16.","journal-title":"Emerg Med J"},{"issue":"5","key":"1596_CR22","doi-asserted-by":"publisher","first-page":"760","DOI":"10.1016\/j.jamcollsurg.2019.01.009","volume":"228","author":"JR Coleman","year":"2019","unstructured":"Coleman JR, Moore EE, Samuels JM, Cohen MJ, Sauaia A, Sumislawski JJ, et al. Trauma Resuscitation Consideration: Sex Matters. J Am Coll Surg. 2019;228(5):760-768.e1.","journal-title":"J Am Coll Surg"},{"issue":"2","key":"1596_CR23","doi-asserted-by":"publisher","first-page":"439","DOI":"10.1016\/j.surg.2014.04.018","volume":"156","author":"MJ Pommerening","year":"2014","unstructured":"Pommerening MJ, Schwartz DA, Cohen MJ, Schreiber MA, del Junco DJ, Camp EA, et al. Hypercoagulability after injury in premenopausal females: A prospective, multicenter study. Surgery. 2014;156(2):439\u201347.","journal-title":"Surgery"},{"issue":"5","key":"1596_CR24","doi-asserted-by":"publisher","first-page":"e061076","DOI":"10.1136\/bmjopen-2022-061076","volume":"12","author":"T Nutbeam","year":"2022","unstructured":"Nutbeam T, Weekes L, Heidari S, Fenwick R, Bouamra O, Smith J, et al. Sex-disaggregated analysis of the injury patterns, outcome data and trapped status of major trauma patients injured in motor vehicle collisions: a prespecified analysis of the UK trauma registry (TARN). BMJ Open. 2022;12(5):e061076.","journal-title":"BMJ Open"},{"issue":"4","key":"1596_CR25","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1177\/14574969241271781","volume":"113","author":"H Lassila","year":"2024","unstructured":"Lassila H, Hein\u00e4nen M, Serlo J, Brinck T. Spine injuries among severely injured trauma patients: A retrospective single-center cohort study. Scand J Surg. 2024;113(4):293\u2013302.","journal-title":"Scand J Surg"},{"issue":"5","key":"1596_CR26","doi-asserted-by":"publisher","first-page":"2345","DOI":"10.1007\/s00068-023-02278-w","volume":"50","author":"N Marchesini","year":"2024","unstructured":"Marchesini N, Demetriades AK, Peul WC, Tommasi N, Zanatta P, Pinna G, et al. Concomitant trauma of brain and upper cervical spine: lessons in injury patterns and outcomes. Eur J Trauma Emerg Surg. 2024;50(5):2345\u201355.","journal-title":"Eur J Trauma Emerg Surg"},{"issue":"2","key":"1596_CR27","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2022.103446","volume":"109","author":"A Ansorge","year":"2023","unstructured":"Ansorge A, de Foy M, Gayet-Ageron A, Andereggen E, Gamulin A. Epidemiology of high-energy blunt pelvic ring injuries: a three-year retrospective case series in a level-I trauma center. Orthop Traumatol Surg Res. 2023;109(2):103446.","journal-title":"Orthop Traumatol Surg Res"},{"issue":"17","key":"1596_CR28","doi-asserted-by":"publisher","first-page":"5509","DOI":"10.3390\/jcm12175509","volume":"12","author":"L Balet","year":"2023","unstructured":"Balet L, Ageron FX, Pasquier M, The Swiss Trauma Registry null. Zingg T Performance Assessment of Out-of-Hospital Use of Pelvic Circumferential Compression Devices for Severely Injured Patients in Switzerland: A Nationwide Retrospective Cross-Sectional Study. J Clin Med. 2023;12(17):5509.","journal-title":"J Clin Med."},{"issue":"2","key":"1596_CR29","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1007\/s00068-019-01210-5","volume":"47","author":"J Toimela","year":"2021","unstructured":"Toimela J, Brinck T, Handolin L. Evolution of high-energy pelvic trauma in southern Finland: a 12-year experience from a tertiary trauma centre. Eur J Trauma Emerg Surg. 2021;47(2):541\u20136.","journal-title":"Eur J Trauma Emerg Surg"},{"issue":"1","key":"1596_CR30","doi-asserted-by":"publisher","first-page":"35","DOI":"10.11138\/gchir\/2018.39.1.035","volume":"39","author":"M Gioffr\u00e8-Florio","year":"2018","unstructured":"Gioffr\u00e8-Florio M, Murabito LM, Visalli C, Pergolizzi FP, Fam\u00e0 F. Trauma in elderly patients: a study of prevalence, comorbidities and gender differences. G Chir. 2018;39(1):35\u201340.","journal-title":"G Chir"},{"issue":"1","key":"1596_CR31","doi-asserted-by":"publisher","first-page":"38","DOI":"10.4103\/JETS.JETS_37_17","volume":"11","author":"S Paydar","year":"2018","unstructured":"Paydar S, Dalfardi B, Shayan Z, Shayan L, Saem J, Bolandparvaz S. Early Predictive Factors of Hypofibrinogenemia in Acute Trauma Patients. J Emerg Trauma Shock. 2018;11(1):38.","journal-title":"J Emerg Trauma Shock"},{"issue":"5","key":"1596_CR32","doi-asserted-by":"publisher","first-page":"831","DOI":"10.1097\/TA.0000000000004235","volume":"96","author":"RWG Dujardin","year":"2024","unstructured":"Dujardin RWG, Kleinveld DJB, van den Brom CE, Geeraedts LMGJ, Beijer E, Gaarder C, et al. Older females have increased mortality after trauma as compared with younger females and males, associated with increased fibrinolysis. J Trauma Acute Care Surg. 2024;96(5):831.","journal-title":"J Trauma Acute Care Surg"},{"issue":"3","key":"1596_CR33","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1111\/1475-6773.13270","volume":"55","author":"LJ Scheetz","year":"2020","unstructured":"Scheetz LJ, Orazem JP. The influence of sociodemographic factors on trauma center transport for severely injured older adults. Health Serv Res. 2020;55(3):411\u20138.","journal-title":"Health Serv Res"},{"issue":"7","key":"1596_CR34","doi-asserted-by":"publisher","first-page":"1471","DOI":"10.1177\/00031348221082278","volume":"88","author":"SA Quinn","year":"2022","unstructured":"Quinn SA, Edwards JD, Buccini P, Parmley MK, Leonard K, Irish W, et al. The Impact of Delays in Interfaculty Transfer on Outcomes in Elderly Trauma Patients. Am Surg. 2022;88(7):1471\u20134.","journal-title":"Am Surg"},{"issue":"3","key":"1596_CR35","doi-asserted-by":"publisher","first-page":"315","DOI":"10.5811\/westjem.2016.2.29327","volume":"17","author":"JA Holst","year":"2016","unstructured":"Holst JA, Perman SM, Capp R, Haukoos JS, Ginde AA. Undertriage of trauma-related deaths in U.S. emergency departments. West J Emerg Med. 2016;17(3):315\u201323.","journal-title":"West J Emerg Med"},{"issue":"4","key":"1596_CR36","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1016\/j.jamcollsurg.2003.12.021","volume":"198","author":"JJ Reilly","year":"2004","unstructured":"Reilly JJ, Chin B, Berkowitz J, Weedon J, Avitable M. Use of a state-wide administrative database in assessing a regional trauma system: the New York City experience. J Am Coll Surg. 2004;198(4):509\u201318.","journal-title":"J Am Coll Surg"},{"issue":"3","key":"1596_CR37","first-page":"268","volume":"8","author":"LJ Scheetz","year":"2004","unstructured":"Scheetz LJ. Trauma center versus non-trauma center admissions in adult trauma victims by age and gender. Prehosp Emerg Care. 2004;8(3):268\u201372.","journal-title":"Prehosp Emerg Care"},{"issue":"1","key":"1596_CR38","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1186\/s13049-019-0589-3","volume":"27","author":"M Pape","year":"2019","unstructured":"Pape M, Giannak\u00f3poulos GF, Zuidema WP, de Lange-Klerk ESM, Toor EJ, Edwards MJR, et al. Is there an association between female gender and outcome in severe trauma? A multi-center analysis in the Netherlands. Scand J Trauma Resusc Emerg Med. 2019;27(1):16.","journal-title":"Scand J Trauma Resusc Emerg Med"},{"issue":"4","key":"1596_CR39","doi-asserted-by":"publisher","first-page":"774","DOI":"10.1097\/SLA.0000000000000789","volume":"261","author":"H Trentzsch","year":"2015","unstructured":"Trentzsch H, Lefering R, Nienaber U, Kraft R, Faist E, Piltz S. The role of biological sex in severely traumatized patients on outcomes: a matched-pair analysis. Ann Surg. 2015;261(4):774\u201380.","journal-title":"Ann Surg"},{"issue":"5","key":"1596_CR40","doi-asserted-by":"publisher","first-page":"700","DOI":"10.1080\/10903127.2018.1560849","volume":"23","author":"SG Schauer","year":"2019","unstructured":"Schauer SG, Naylor JF, Long AN, Mora AG, Le TD, Maddry JK, et al. Analysis of injuries and prehospital interventions sustained by females in the Iraq and Afghanistan combat zones. Prehosp Emerg Care. 2019;23(5):700\u20137.","journal-title":"Prehosp Emerg Care"},{"issue":"7","key":"1596_CR41","doi-asserted-by":"publisher","first-page":"781","DOI":"10.1007\/s00423-015-1327-6","volume":"400","author":"C Schoeneberg","year":"2015","unstructured":"Schoeneberg C, Schmitz D, Schoeneberg S, Hussmann B, Lendemans S. Gender-specific differences in therapy and laboratory parameters and validation of mortality predictors in severely injured patients\u2013results of a German level 1 trauma center. Langenbecks Arch Surg. 2015;400(7):781\u201390.","journal-title":"Langenbecks Arch Surg"},{"issue":"45","key":"1596_CR42","doi-asserted-by":"publisher","first-page":"S20","DOI":"10.1016\/j.injury.2014.08.013","volume":"1","author":"H Trentzsch","year":"2014","unstructured":"Trentzsch H, Nienaber U, Behnke M, Lefering R, Piltz S. Female sex protects from organ failure and sepsis after major trauma haemorrhage. Injury. 2014;1(45):S20\u20138.","journal-title":"Injury"},{"issue":"5","key":"1596_CR43","doi-asserted-by":"publisher","first-page":"578","DOI":"10.1001\/archsurg.137.5.578","volume":"137","author":"BA McKinley","year":"2002","unstructured":"McKinley BA, Kozar RA, Cocanour CS, Valdivia A, Sailors RM, Ware DN, et al. Standardized Trauma Resuscitation: Female Hearts Respond Better. Arch Surg. 2002;137(5):578\u201384.","journal-title":"Arch Surg"},{"issue":"6","key":"1596_CR44","doi-asserted-by":"publisher","first-page":"1838","DOI":"10.1097\/CCM.0b013e3181760c14","volume":"36","author":"JL Sperry","year":"2008","unstructured":"Sperry JL, Nathens AB, Frankel HL, Vanek SL, Moore EE, Maier RV, et al. Characterization of the gender dimorphism after injury and hemorrhagic shock: are hormonal differences responsible? Crit Care Med. 2008;36(6):1838\u201345.","journal-title":"Crit Care Med"},{"issue":"2","key":"1596_CR45","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1016\/j.surg.2009.05.006","volume":"146","author":"AH Haider","year":"2009","unstructured":"Haider AH, Crompton JG, Oyetunji T, Stevens KA, Efron DT, Kieninger AN, et al. Females have fewer complications and lower mortality following trauma than similarly injured males: A risk adjusted analysis of adults in the National Trauma Data Bank. Surgery. 2009;146(2):308\u201315.","journal-title":"Surgery"},{"issue":"4","key":"1596_CR46","doi-asserted-by":"publisher","first-page":"621","DOI":"10.1097\/CCM.0b013e318206d3df","volume":"39","author":"A Wafaisade","year":"2011","unstructured":"Wafaisade A, Lefering R, Bouillon B, Sakka SG, Thamm OC, Paffrath T, et al. Epidemiology and risk factors of sepsis after multiple trauma: an analysis of 29,829 patients from the Trauma Registry of the German Society for Trauma Surgery. Crit Care Med. 2011;39(4):621\u20138.","journal-title":"Crit Care Med"},{"issue":"12","key":"1596_CR47","doi-asserted-by":"publisher","first-page":"1093","DOI":"10.1097\/JCMA.0000000000000399","volume":"83","author":"RS Lee","year":"2020","unstructured":"Lee RS, Lin WC, Harnod D, Shih HC, Jeng MJ. Role of gender in the survival outcome of acute phase of major trauma: a nationwide, population-based study. J Chin Med Assoc. 2020;83(12):1093\u2013101.","journal-title":"J Chin Med Assoc"},{"issue":"11","key":"1596_CR48","doi-asserted-by":"publisher","first-page":"1760","DOI":"10.1177\/00031348211054072","volume":"87","author":"DP Stonko","year":"2021","unstructured":"Stonko DP, Etchill EW, Giuliano KA, DiBrito SR, Eisenson D, Heinrichs T, et al. Failure to rescue in geriatric trauma: the impact of any complication increases with age and injury severity in elderly trauma patients. Am Surg. 2021;87(11):1760\u20135.","journal-title":"Am Surg"},{"issue":"1","key":"1596_CR49","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1097\/00024382-200301000-00006","volume":"19","author":"RL George","year":"2003","unstructured":"George RL, McGwin GJ, Windham ST, Melton SM, Metzger J, Chaudry IH, et al. Age-related gender differential in outcome after blunt or penetrating trauma. Shock. 2003;19(1):28.","journal-title":"Shock"},{"key":"1596_CR50","doi-asserted-by":"crossref","unstructured":"Liu T, Xie J, Yang F, Chen JJ, Li ZF, Yi CL, et al. The influence of sex on outcomes in trauma patients: a meta-analysis. Am J Surg. 2015;210(5):911\u201321.","DOI":"10.1016\/j.amjsurg.2015.03.021"},{"issue":"12","key":"1596_CR51","doi-asserted-by":"publisher","first-page":"1476","DOI":"10.1097\/00005373-199012000-00006","volume":"30","author":"JA Morris","year":"1990","unstructured":"Morris JA, Mackenzie EJ, Damiano AM, Bass SM. Mortality in trauma patients: the interaction between host factors and severity. J Trauma Injury Infect Crit Care. 1990;30(12):1476.","journal-title":"J Trauma Injury Infect Crit Care"},{"issue":"1","key":"1596_CR52","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1097\/SHK.0000000000000168","volume":"42","author":"KC Yang","year":"2014","unstructured":"Yang KC, Zhou MJ, Sperry JL, Rong L, Zhu XG, Geng L, et al. Significant sex-based outcome differences in severely injured Chinese trauma patients. Shock. 2014;42(1):11.","journal-title":"Shock"},{"issue":"1","key":"1596_CR53","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1016\/S1072-7515(02)01187-0","volume":"195","author":"CJ Gannon","year":"2002","unstructured":"Gannon CJ, Napolitano LM, Pasquale M, Tracy JK, McCarter RJ. A statewide population-based study of gender differences in trauma: validation of a prior single-institution study. J Am Coll Surg. 2002;195(1):11\u20138.","journal-title":"J Am Coll Surg"},{"issue":"4","key":"1596_CR54","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1177\/00031348211050578","volume":"88","author":"PC Newman","year":"2022","unstructured":"Newman PC, Vernon TM, Bresz KE, Schwartz JAT. Location of injury and other factors associated with increased survival among severely injured geriatric trauma patients. Am Surg. 2022;88(4):613\u20137.","journal-title":"Am Surg"},{"issue":"1","key":"1596_CR55","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1186\/s13054-015-0873-1","volume":"19","author":"C Samuelsson","year":"2015","unstructured":"Samuelsson C, Sj\u00f6berg F, Karlstr\u00f6m G, Nolin T, Walther SM. Gender differences in outcome and use of resources do exist in Swedish intensive care, but to no advantage for women of premenopausal age. Crit Care. 2015;19(1):129.","journal-title":"Crit Care"},{"issue":"8","key":"1596_CR56","doi-asserted-by":"publisher","first-page":"1263","DOI":"10.3390\/jcm8081263","volume":"8","author":"J Joestl","year":"2019","unstructured":"Joestl J, Lang NW, Kleiner A, Platzer P, Aldrian S. The Importance of Sex Differences on Outcome after Major Trauma: Clinical Outcome in Women Versus Men. J Clin Med. 2019;8(8):1263.","journal-title":"J Clin Med"},{"issue":"4","key":"1596_CR57","doi-asserted-by":"publisher","first-page":"218","DOI":"10.4103\/ijccm.IJCCM_304_16","volume":"21","author":"P Verma","year":"2017","unstructured":"Verma P, Bhoi S, Baitha U, Sinha TP, Mishra PR. Gender-based assessment of survival in trauma-hemorrhagic shock: a retrospective analysis of Indian population. Indian J Crit Care Med. 2017;21(4):218\u201323.","journal-title":"Indian J Crit Care Med"},{"issue":"5","key":"1596_CR58","doi-asserted-by":"publisher","first-page":"984","DOI":"10.1016\/j.jamcollsurg.2007.12.038","volume":"206","author":"LJ Magnotti","year":"2008","unstructured":"Magnotti LJ, Fischer PE, Zarzaur BL, Fabian TC, Croce MA. Impact of gender on outcomes after blunt injury: a definitive analysis of more than 36,000 trauma patients. J Am Coll Surg. 2008;206(5):984.","journal-title":"J Am Coll Surg"},{"issue":"4","key":"1596_CR59","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1016\/S0002-9610(01)00582-7","volume":"181","author":"CD Wohltmann","year":"2001","unstructured":"Wohltmann CD, Franklin GA, Boaz PW, Luchette FA, Kearney PA, Richardson JD, et al. A multicenter evaluation of whether gender dimorphism affects survival after trauma. Am J Surg. 2001;181(4):297\u2013300.","journal-title":"Am J Surg"},{"issue":"3","key":"1596_CR60","doi-asserted-by":"publisher","first-page":"430","DOI":"10.1097\/00005373-200209000-00006","volume":"53","author":"G Mostafa","year":"2002","unstructured":"Mostafa G, Huynh T, Sing RF, Miles WS, Norton HJ, Thomason MH. Gender-related outcomes in trauma. J Trauma Injury Infect Crit Care. 2002;53(3):430.","journal-title":"J Trauma Injury Infect Crit Care"},{"issue":"7","key":"1596_CR61","doi-asserted-by":"publisher","first-page":"1536","DOI":"10.1016\/j.injury.2020.04.045","volume":"51","author":"M Pecheva","year":"2020","unstructured":"Pecheva M, Phillips M, Hull P, Carrothers AOR, Queally JM. The impact of frailty in major trauma in older patients. Injury. 2020;51(7):1536\u201342.","journal-title":"Injury"},{"issue":"6","key":"1596_CR62","doi-asserted-by":"publisher","first-page":"1170","DOI":"10.1016\/j.injury.2016.02.027","volume":"47","author":"I Sammy","year":"2016","unstructured":"Sammy I, Lecky F, Sutton A, Leaviss J, O\u2019Cathain A. Factors affecting mortality in older trauma patients\u2014A systematic review and meta-analysis. Injury. 2016;47(6):1170\u201383.","journal-title":"Injury"},{"issue":"5","key":"1596_CR63","doi-asserted-by":"publisher","first-page":"932","DOI":"10.1097\/00005373-200005000-00019","volume":"48","author":"A Oberholzer","year":"2000","unstructured":"Oberholzer A, Keel M, Zellweger R, Steckholzer U, Trentz O, Ertel W. Incidence of septic complications and multiple organ failure in severely injured patients is sex specific. J Trauma. 2000;48(5):932\u20137.","journal-title":"J Trauma"},{"issue":"2","key":"1596_CR64","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1007\/s00068-018-0920-0","volume":"45","author":"H Llaquet Bayo","year":"2019","unstructured":"Llaquet Bayo H, Montmany S, Rebasa P, Secanella M, Alberich M, Navarro S. Analysis of quality of life after major trauma: a spanish follow-up cohort study. Eur J Trauma Emerg Surg. 2019;45(2):289\u201397.","journal-title":"Eur J Trauma Emerg Surg"},{"issue":"1","key":"1596_CR65","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1186\/s13017-018-0217-y","volume":"13","author":"AL Tan","year":"2018","unstructured":"Tan AL, Chiong Y, Nadkarni N, Cheng JYX, Chiu MT, Wong TH. Predictors of Change in Functional Outcome at six months and twelve months after Severe Injury: A Retrospective Cohort Study. World J Emerg Surg. 2018;13(1):57.","journal-title":"World J Emerg Surg"},{"issue":"4","key":"1596_CR66","doi-asserted-by":"publisher","first-page":"916","DOI":"10.1097\/TA.0b013e3181f6bce8","volume":"70","author":"AN Ringburg","year":"2011","unstructured":"Ringburg AN, Polinder S, van Ierland MCP, Steyerberg EW, van Lieshout EMM, Patka P, et al. Prevalence and prognostic factors of disability after major trauma. J Trauma Injury Infect Crit Care. 2011;70(4):916.","journal-title":"J Trauma Injury Infect Crit Care"},{"issue":"1","key":"1596_CR67","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1007\/s00068-023-02276-y","volume":"50","author":"A Lotfalla","year":"2024","unstructured":"Lotfalla A, Halm JA, Schepers T, Giannak\u00f3poulos GF. Parameters influencing health-related quality of life after severe trauma: a systematic review (part II). Eur J Trauma Emerg Surg. 2024;50(1):93\u2013106.","journal-title":"Eur J Trauma Emerg Surg"},{"issue":"235","key":"1596_CR68","doi-asserted-by":"publisher","first-page":"459","DOI":"10.1016\/j.jss.2018.10.024","volume":"1","author":"T Gross","year":"2019","unstructured":"Gross T, Morell S, Amsler F. Gender-Specific Improvements in Outcome 1 and 2 Years After Major Trauma. J Surg Res. 2019;1(235):459\u201369.","journal-title":"J Surg Res"},{"key":"1596_CR69","doi-asserted-by":"crossref","unstructured":"CRASH-2 trial collaborators. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010;376(9734):23\u201332.","DOI":"10.1016\/S0140-6736(10)60835-5"},{"key":"1596_CR70","doi-asserted-by":"crossref","unstructured":"CRASH-3 trial collaborators. Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial. Lancet. 2019;394(10210):1713\u201323.","DOI":"10.1016\/S0140-6736(19)32233-0"},{"issue":"19","key":"1596_CR71","doi-asserted-by":"publisher","first-page":"1882","DOI":"10.1001\/jama.2023.21019","volume":"330","author":"R Davenport","year":"2023","unstructured":"Davenport R, Curry N, Fox EE, Thomas H, Lucas J, Evans A, et al. Early and empirical high-dose cryoprecipitate for hemorrhage after traumatic injury: the CRYOSTAT-2 randomized clinical trial. JAMA. 2023;330(19):1882\u201391.","journal-title":"JAMA"},{"issue":"1","key":"1596_CR72","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1016\/j.anclin.2018.09.007","volume":"37","author":"EG Marcolini","year":"2019","unstructured":"Marcolini EG, Albrecht JS, Sethuraman KN, Napolitano LM. Gender disparities in trauma care: how sex determines treatment, behavior, and outcome. Anesthesiol Clin. 2019;37(1):107\u201317.","journal-title":"Anesthesiol Clin"},{"issue":"5","key":"1596_CR73","doi-asserted-by":"publisher","first-page":"905","DOI":"10.1097\/TA.0000000000001220","volume":"81","author":"M Weuster","year":"2016","unstructured":"Weuster M, Br\u00fcck A, Lippross S, Menzdorf L, Fitschen-Oestern S, Behrendt P, et al. Epidemiology of accidental hypothermia in polytrauma patients: an analysis of 15,230 patients of the TraumaRegister DGU. J Trauma Acute Care Surg. 2016;81(5):905\u201312.","journal-title":"J Trauma Acute Care Surg"},{"issue":"3","key":"1596_CR74","doi-asserted-by":"publisher","first-page":"486","DOI":"10.1097\/TA.0000000000001118","volume":"81","author":"JS Albrecht","year":"2016","unstructured":"Albrecht JS, McCunn M, Stein DM, Simoni-Wastila L, Smith GS. Sex differences in mortality following isolated traumatic brain injury among older adults. J Trauma Acute Care Surg. 2016;81(3):486\u201392.","journal-title":"J Trauma Acute Care Surg"},{"issue":"4","key":"1596_CR75","doi-asserted-by":"publisher","first-page":"436","DOI":"10.1001\/archsurg.2011.46","volume":"146","author":"JHH Yeung","year":"2011","unstructured":"Yeung JHH, Mikocka-Walus AA, Cameron PA, Poon WS, Ho HF, Chang A. Protection from traumatic brain injury in hormonally active women vs men of a similar age: a retrospective international study. Arch Surg. 2011;146(4):436\u201342.","journal-title":"Arch Surg"},{"issue":"2","key":"1596_CR76","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1089\/neu.2006.23.140","volume":"23","author":"DP Davis","year":"2006","unstructured":"Davis DP, Douglas DJ, Smith W, Sise MJ, Vilke GM, Holbrook TL, et al. Traumatic brain injury outcomes in pre- and post- menopausal females versus age-matched males. J Neurotrauma. 2006;23(2):140\u20138.","journal-title":"J Neurotrauma"},{"issue":"2","key":"1596_CR77","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1080\/02688690600682259","volume":"20","author":"I Ng","year":"2006","unstructured":"Ng I, Lee KK, Lim JHG, Wong HB, Yan XY. Investigating gender differences in outcome following severe traumatic brain injury in a predominantly Asian population. Br J Neurosurg. 2006;20(2):73\u20138.","journal-title":"Br J Neurosurg"},{"issue":"1","key":"1596_CR78","doi-asserted-by":"publisher","first-page":"e5","DOI":"10.3171\/foc.2000.8.1.156","volume":"8","author":"JF Kraus","year":"2000","unstructured":"Kraus JF, Peek-Asa C, McArthur D. The independent effect of gender on outcomes following traumatic brain injury: a preliminary investigation. Neurosurg Focus. 2000;8(1):e5.","journal-title":"Neurosurg Focus"},{"key":"1596_CR79","doi-asserted-by":"crossref","unstructured":"Mair O, Greve F, Lefering R, Biberthaler P, Hanschen M, the TraumaRegister DGU. The outcome of severely injured patients following traumatic brain injury is affected by gender\u2014A retrospective, multicenter, matched-pair analysis utilizing data of the TraumaRegister DGU\u00ae. Front Neurosci. 2022;16. Available from: https:\/\/www.frontiersin.org\/journals\/neuroscience\/articles\/10.3389\/fnins.2022.974519\/full. Cited 2024 Nov 25.","DOI":"10.3389\/fnins.2022.974519"},{"issue":"1","key":"1596_CR80","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1111\/j.2517-6161.1996.tb02080.x","volume":"58","author":"R Tibshirani","year":"1996","unstructured":"Tibshirani R. Regression shrinkage and selection via the Lasso. J R Stat Soc Ser B Stat Methodol. 1996;58(1):267\u201388.","journal-title":"J R Stat Soc Ser B Stat Methodol"},{"key":"1596_CR81","doi-asserted-by":"crossref","unstructured":"Hefele F, Ditsch A, Krysiak N, Caldwell CC, Biberthaler P, van Griensven M, et al. Trauma Induces Interleukin-17A Expression on Th17 Cells and CD4+ Regulatory T Cells as Well as Platelet Dysfunction. Front Immunol. 2019;10. Available from: https:\/\/www.frontiersin.org\/journals\/immunology\/articles\/10.3389\/fimmu.2019.02389\/full. Cited 2024 Nov 11.","DOI":"10.3389\/fimmu.2019.02389"},{"issue":"3","key":"1596_CR82","doi-asserted-by":"publisher","first-page":"580","DOI":"10.1097\/TA.0b013e31816543dd","volume":"64","author":"LA Dossett","year":"2008","unstructured":"Dossett LA, Swenson BR, Heffernan D, Bonatti H, Metzger R, Sawyer RG, et al. High levels of endogenous estrogens are associated with death in the critically injured adult. J Trauma Injury Infect Crit Care. 2008;64(3):580.","journal-title":"J Trauma Injury Infect Crit Care"},{"issue":"6","key":"1596_CR83","doi-asserted-by":"publisher","first-page":"1228","DOI":"10.1097\/01.ta.0000220386.84012.bf","volume":"60","author":"N Y\u00fccel","year":"2006","unstructured":"Y\u00fccel N, Lefering R, Maegele M, Vorweg M, Tjardes T, Ruchholtz S, et al. Trauma Associated Severe Hemorrhage (TASH)-Score: probability of mass transfusion as surrogate for life threatening hemorrhage after multiple trauma. J Trauma. 2006;60(6):1228\u201336; discussion 1236-1237.","journal-title":"J Trauma"},{"issue":"4","key":"1596_CR84","doi-asserted-by":"publisher","first-page":"402","DOI":"10.1097\/SHK.0000000000000764","volume":"47","author":"G Pena","year":"2017","unstructured":"Pena G, Michalski C, Donnelly RJ, Qin Y, Sifri ZC, Mosenthal AC, et al. Trauma-induced acute X chromosome skewing in white blood cells represents an immuno-modulatory mechanism unique to females and a likely contributor to sex-based outcome differences. Shock. 2017;47(4):402.","journal-title":"Shock"},{"issue":"1","key":"1596_CR85","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1016\/j.injury.2012.11.015","volume":"45","author":"L Mica","year":"2014","unstructured":"Mica L, Vomela J, Keel M, Trentz O. The impact of body mass index on the development of systemic inflammatory response syndrome and sepsis in patients with polytrauma. Injury. 2014;45(1):253\u20138.","journal-title":"Injury"}],"container-title":["Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13049-026-01596-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13049-026-01596-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13049-026-01596-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T09:01:44Z","timestamp":1777626104000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s13049-026-01596-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,24]]},"references-count":85,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["1596"],"URL":"https:\/\/doi.org\/10.1186\/s13049-026-01596-3","relation":{},"ISSN":["1757-7241"],"issn-type":[{"value":"1757-7241","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,24]]},"assertion":[{"value":"1 February 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 March 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 March 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"84"}}