Sex differences in trauma resuscitation: different early treatment patterns of transfusion and fluid therapy without differences in clinical outcome

Abstract Purpose We aimed to investigate sex-related differences in trauma resuscitation while considering physiological characteristics relevant to treatment decisions. Methods In this retrospective single-center study, trauma patients admitted to the intensive care unit (ICU) were analyzed. Sex-related differences in transfusion practices, fluid therapy, and coagulation management were assessed across various pre-ICU and ICU phases. Multivariable regression models adjusted for injury severity and shock parameters were applied. Trigger-adjusted analyses accounted for hemoglobin concentration at emergency department (ED) admission and body weight. Results Among 219 patients, 54 (24.7%) were female. Women had lower body weight and hemoglobin concentrations at ED admission. Female patients received higher weight-adjusted red blood cell (RBC) transfusion volumes in the pre-ICU phase. After additional normalization to hemoglobin concentration at ED admission, female sex remained associated with higher normalized RBC transfusion volumes. Female sex was associated with higher administration of both colloids (β = 3.6 mL/kg, p = 0.011) and crystalloids (β = 4.72 mL/kg, p = 0.008). Female patients showed a modest increase in cumulative fluid overload (β = 0.55%, p = 0.023). Sex was not associated with mortality, and renal findings were not consistent across modeling approaches. Conclusion Sex-related differences in trauma resuscitation were particularly observed during the pre-ICU phase and involved both RBC transfusions and fluid administration. Interpretation of sex-related differences in transfusion practice should account for physiological baseline characteristics, including body size and hemoglobin concentration. Despite differences in early management, sex was not an independent predictor of mortality, which was instead primarily determined by physiological derangement.