Sex and gender bias in major trauma care: a scoping review

Background: 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. Methods: 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. Results: 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. Conclusion: 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.