Sex-Based Differences in Mortality Following Craniomaxillofacial Trauma: A Retrospective Cohort Study From a Puerto Rico Trauma Center

Craniomaxillofacial trauma is a significant public health concern because of its association with severe injuries, long-term morbidity, and mortality. This study evaluated sex-based differences in trauma severity, length of hospital stay, and mortality among patients with craniomaxillofacial (CMF) trauma in Puerto Rico. This retrospective cohort study used electronic medical records from a trauma center in Puerto Rico from January 2018 to October 2022. Data collected included demographics, Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), length of hospital stay, comorbidities, and survival outcomes. Statistical analyses included the χ 2 test and t tests to evaluate sex-based differences. Multivariable logistic regression was used to assess the independent association between sex and in-hospital mortality. A total of 1161 patients were included in the study, comprising 960 males and 201 females. Males demonstrated higher in-hospital mortality than females (12.7% versus 6.5%; P =0.012) and presented with lower GCS and RTS scores. Motor-vehicle accidents were the most common mechanism of injury, with males more frequently involved in noncar incidents and females more commonly injured in car accidents. In the fully adjusted model including comorbidities, male sex was independently associated with in-hospital mortality (aOR: 3.73, P =0.014). Lower GCS was the strongest predictor of mortality. These findings suggest that the male sex is associated with increased mortality following CMF trauma after adjusting for injury severity and comorbid burden, highlighting the potential importance of incorporating sex into trauma risk stratification and prevention strategies.