Change of initial and ICU treatment over time in trauma patients. An analysis from the TraumaRegister DGU®

2016 ◽  
Vol 401 (4) ◽  
pp. 531-540 ◽  
Author(s):  
Andreas B. Böhmer ◽  
Marcel Poels ◽  
Kathrin Kleinbrahm ◽  
Rolf Lefering ◽  
Thomas Paffrath ◽  
...  
Keyword(s):  
Trauma Patients ◽  
Over Time ◽  
Icu Treatment

scholarly journals A retrospective cohort study of 27,049 polytraumatized patients age 60 and above: identifying changes over 16 years

2021 ◽  
Author(s):  
Y. Kalbas ◽  
M. Lempert ◽  
F. Ziegenhain ◽  
J. Scherer ◽  
V. Neuhaus ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Injury Severity ◽  
Descriptive Analysis ◽  
Patient Characteristics ◽  
Severe Trauma ◽  
Diagnostic Tools ◽  
Trauma Patients ◽  
Treatment Algorithms ◽  
Injured Patients ◽  
Over Time

Abstract Purpose The number of severely injured patients exceeding the age of 60 has shown a steep increase within the last decades. These patients present with numerous co-morbidities, polypharmacy, and increased frailty requiring an adjusted treatment approach. In this study, we establish an overview of changes we observed in demographics of older severe trauma patients from 2002 to 2017. Methods A descriptive analysis of the data from the TraumaRegister DGU® (TR-DGU) was performed. Patients admitted to a level one trauma center in Germany, Austria and Switzerland between 2002 and 2017, aged 60 years or older and with an injury severity score (ISS) over 15 were included. Patients were stratified into subgroups based on the admission: 2002–2005 (1), 2006–2009 (2), 2010–2013 (3) and 2014–2017 (4). Trauma and patient characteristics, diagnostics, treatment and outcome were compared. Results In total 27,049 patients with an average age of 73.9 years met the inclusion criteria. The majority were males (64%), and the mean ISS was 27.4. The proportion of patients 60 years or older [(23% (1) to 40% (4)] rose considerably over time. Trauma mechanisms changed over time and more specifically low falls (< 3 m) rose from 17.6% (1) to 40.1% (4). Altered injury patterns were also identified. Length-of-stay decreased from 28.9 (1) to 19.5 days (4) and the length-of-stay on ICU decreased from 17.1 (1) to 12.7 days (4). Mortality decreased from 40.5% (1) to 31.8% (4). Conclusion Length of stay and mortality decreased despite an increase in patient age. We ascribe this observation mainly to increased use of diagnostic tools, improved treatment algorithms, and the implementation of specialized trauma centers for older patients allowing interdisciplinary care.

Radiation exposure has increased in trauma patients over time

2012 ◽  
Vol 72 (2) ◽  
pp. 410-415 ◽  
Author(s):  
Kasra Ahmadinia ◽  
J. Benjamin Smucker ◽  
Clyde L. Nash ◽  
Heather A. Vallier
Keyword(s):  
Radiation Exposure ◽  
Trauma Patients ◽  
Over Time

Factors affecting the caloric and protein intake over time in critically ill trauma patients

2018 ◽  
Vol 226 ◽  
pp. 64-71 ◽  
Author(s):  
Tobias Haltmeier ◽  
Kenji Inaba ◽  
Beat Schnüriger ◽  
Stefano Siboni ◽  
Elizabeth Benjamin ◽  
...  
Keyword(s):  
Critically Ill ◽  
Protein Intake ◽  
Trauma Patients ◽  
Factors Affecting ◽  
Over Time

scholarly journals Transthyretin at Admission and Over Time as a Marker for Clinical Outcomes in Critically Ill Trauma Patients: A Prospective Single-Center Study

2019 ◽  
Vol 44 (1) ◽  
pp. 115-123
Author(s):  
Tobias Haltmeier ◽  
Kenji Inaba ◽  
Joseph Durso ◽  
Moazzam Khan ◽  
Stefano Siboni ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Critically Ill ◽  
Trauma Patients ◽  
Single Center ◽  
Single Center Study ◽  
Over Time ◽  
Center Study

Epidemiological trends of spine and spinal cord injuries in the largest Canadian adult trauma center from 1986 to 2006

2010 ◽  
Vol 12 (2) ◽  
pp. 131-140 ◽  
Author(s):  
Farhad Pirouzmand
Keyword(s):  
Spinal Cord ◽  
Trauma Center ◽  
Case Fatality Rate ◽  
Spinal Cord Injuries ◽  
Head Injuries ◽  
Case Fatality ◽  
Trauma Patients ◽  
Relative Distribution ◽  
Fatality Rate ◽  
Over Time

Object In this study the author documents the epidemiology of spine and spinal cord injuries (SCIs) over 2 decades at the largest Level I adult trauma center in Canada. He describes the current state of spine injuries (SIs), their changing patterns over the years, and the relative distribution of different demographic factors in a defined group of trauma patients. Methods Data on all trauma patients admitted to Sunnybrook Health Sciences Centre between 1986 and 2006 were collected from the Sunnybrook Trauma Registry Database. Aggregate data on SIs and SCIs, including demographic information, etiology, severity of injuries (injury severity score [ISS]), and associated injuries, were recorded. The data were analyzed in a main category of spinal fracture and/or dislocation with or without SI and in two subgroups of patients with SIs, one encompassing all forms of SCIs and the other including only complete SCIs (CSCIs). Collected data were evaluated using univariate techniques to depict the trend of variables over the years. The number of deaths per year and the length of stay (LOS) were used as crude measures of outcome. Several multivariate analysis techniques, including Poisson regression, were used to model the frequency of death and LOS as functions of various trauma variables. Results There were 12,192 trauma patients in the study period with 23.2% having SIs, 5.4% having SCIs, and 3% having CSCIs. The SCIs constituted 23.3% of all SIs. The respective characteristics of the SI, SCI, and CSCI groups were as follows: median age 36, 33, and 30 years; median LOS 18, 27, and 29 days; median ISS 29, 30, and 34; female sex ratio 34, 24, and 23%; and case fatality rate 16.7, 16.6, and 21%. Seventy-nine percent of patients had associated head injuries; conversely, 24% of patients with head injuries had SIs. The mean admission age of patients increased by ~ 10 years over the study period, from the early 30s to the early 40s. The relative incidence of SIs remained stable at ~ 23%, but the incidence of SCIs decreased ~ 40% over time to 4.5%. Motor vehicle accidents remained the principal etiology of trauma, although falling and violence became more frequent contributors of SIs. The average annual ISS remained stable over time, but the LOS was reduced by 50% in both the SI and SCI groups. Age, ISS, and SCIs were associated with a longer LOS. The case fatality rate remained relatively unchanged over time. Poisson analysis suggested that the presence of an SCI does not change the case fatality rate. Conclusions Data in this analysis will provide useful information to guide future studies on changing SI patterns, possible etiologies, and efficient resource allocation for the management of these diseases.

scholarly journals Focused Assessment with Sonography in Trauma and Abdominal Computed Tomography Utilization in Adult Trauma Patients: Trends over the Last Decade

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Alexander Y. Sheng ◽  
Peregrine Dalziel ◽  
Andrew S. Liteplo ◽  
Peter Fagenholz ◽  
Vicki E. Noble
Keyword(s):  
Computed Tomography ◽  
Trauma Center ◽  
Trauma Registry ◽  
Imaging Modality ◽  
Point Of Care ◽  
Trauma Patients ◽  
Abdominal Ct ◽  
Head Ct ◽  
Ct Utilization ◽  
Over Time

Objective. We sought to describe the trend in abdominal CT use in adult trauma patients after a point-of-care emergency ultrasound program was introduced. We hypothesized that abdominal CT use would decrease as FAST use increased.Methods. We performed a retrospective study of 19940 consecutive trauma patients over the age of 18 admitted to our level one trauma center from 2002 through 2011. Data was collected retrospectively and recorded in a trauma registry. We plotted the rate of FAST and abdominal CT utilization over time. Head CT was used as a surrogate for overall CT utilization rates during the study period.Results. Use of FAST increased by an average of 2.3% (95% CI 2.1 to 2.5,P<0.01) while abdominal CT use decreased by the same rate annually. The percentage of patients who received FAST as the sole imaging modality for the abdomen rose from 2.0% to 21.9% while those who only received an abdominal CT dropped from 21.7% to 2.3%.Conclusions. Abdominal CT use in our cohort declined while FAST utilization grew in the last decade. The rising use of FAST may have played a role in the reduction of abdominal CT performed as decline in CT utilization appears contrary to overall trends.

scholarly journals Procoagulant and fibrinolytic activity after polytrauma in rat

2016 ◽  
Vol 310 (4) ◽  
pp. R323-R329 ◽  
Author(s):  
Xiaowu Wu ◽  
Daniel N. Darlington ◽  
Andrew P. Cap
Keyword(s):  
Plasminogen Activator ◽  
Plasminogen Activator Inhibitor ◽  
Trauma Patients ◽  
Sprague Dawley ◽  
Plasmin Activity ◽  
Plasminogen Activator Inhibitor 1 ◽  
Soluble Thrombomodulin ◽  
Thrombin Activity ◽  
Fibrinolysis Inhibitor ◽  
Over Time

The purpose of this study was to determine whether trauma-induced coagulopathy is due to changes in 1) thrombin activity, 2) plasmin activity, and/or 3) factors that stimulate or inhibit thrombin or plasmin. Sprague-Dawley rats were anesthetized with 1–2% isoflurane/100% oxygen, and their left femoral artery and vein were cannulated. Polytrauma included right femur fracture, and damage to the small intestines, the left and medial liver lobes, and right leg skeletal muscle. Rats were then bled 40% of blood volume. Plasma samples were taken before trauma, and at 30, 60, 120, and 240 min. Polytrauma and hemorrhage led to a significant fall in prothrombin levels. However, circulating thrombin activity did not change significantly over time. Antithrombin III and α2macroglobulin fell significantly by 2 h, then rose by 4 h. Soluble thrombomodulin was significantly elevated over the 4 h. Circulating plasmin activity, plasminogen, and D-dimers were elevated for the entire 4 h. Tissue plasminogen activator (tPA) was elevated at 30 min, then decreased below baseline levels after 1 h. Plasminogen activator inhibitor-1 was significantly elevated at 2–4 h. Neither tissue factor pathway inhibitor nor thrombin activatable fibrinolysis inhibitor changed significantly over time. The levels of prothrombin and plasminogen were 30–100 times higher than their respective active enzymes. Polytrauma and hemorrhage in rats lead to a fibrinolytic coagulopathy, as demonstrated by an elevation in plasmin activity, D-dimers, and tPA. These results are consistent with the observed clinical benefit of tranexamic acid in trauma patients.

scholarly journals Spatiotemporal mapping of major trauma in Victoria, Australia

2021 ◽  
Author(s):  
Ben Beck ◽  
Andrew Zammit-Mangion ◽  
Richard Fry ◽  
Karen Smith ◽  
Belinda Gabbe
Keyword(s):  
Injury Risk ◽  
Major Trauma ◽  
Motor Vehicle ◽  
Metropolitan Areas ◽  
Trauma Patients ◽  
Injury Incidence ◽  
Spatial And Temporal Patterns ◽  
Spatiotemporal Modelling ◽  
Risk Of Injury ◽  
Over Time

Background: Spatiotemporal modelling techniques allow one to predict injury across time and space. However, such methods have been underutilised in injury studies. This study demonstrates the use of statistical spatiotemporal modelling in identifying areas of significantly high injury risk, and areas witnessing significantly increasing risk over time. Methods: We performed a retrospective review of hospitalised major trauma patients from the Victorian State Trauma Registry, Australia, between 2007 and 2019. Geographical locations of injury events were mapped to the 79 local government areas (LGAs) in the state. We employed Bayesian spatiotemporal models to quantify spatial and temporal patterns, and analysed the results across a range of geographical remoteness and socioeconomic levels. Results: There were 31,317 major trauma patients included. For major trauma overall, we observed substantial spatial variation in injury incidence and a significant 2.1% increase in injury incidence per year. Area-specific risk of injury by motor vehicle collision was higher in regional areas relative to metropolitan areas, while risk of injury by low fall was higher in metropolitan areas. Significant temporal increases were observed in injury by low fall, and the greatest increases were observed in the most disadvantaged LGAs. Conclusions: These findings can be used to inform injury prevention initiatives, which could be designed to target areas with relatively high injury risk and with significantly increasing injury risk over time. Our finding that the greatest year-on-year increases in injury incidence were observed in the most disadvantaged areas highlights the need for a greater emphasis on reducing inequities in injury.

A Prospective Evaluation of Acute Traumatic Coagulopathy and Effects of Damage Control Resuscitation in Military Trauma Patients in Afghanistan

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2848-2848
Author(s):  
Zachary Edward Wright ◽  
Ian Stewart ◽  
Jonathan Sosnov ◽  
Heather F Pidcoke ◽  
Fedyk Chriselda ◽  
...  
Keyword(s):  
High Risk ◽  
Conflicts Of Interest ◽  
Damage Control ◽  
Trauma Patients ◽  
Damage Control Resuscitation ◽  
Acute Traumatic Coagulopathy ◽  
Transfusion Requirements ◽  
Severity Scores ◽  
Over Time ◽  
Traumatic Coagulopathy

Abstract Hemorrhage remains the leading cause of preventable morality, resulting in the death of over a third of all trauma patients. Additionally, twenty-five percent of trauma patients present on admission with acute traumatic coagulopathy (ATC) which portends a mortality approaching fifty percent. ATC has been defined by multiple parameters including international normalized ratio (INR) >1.2, rotational thromboelastometry (ROTEM) clot amplitude at 5 minutes (CA5) ≤ 35 mm and lysis at 60 minutes (LI60) ≤ 85%. Damage control resuscitation (DCR), the practice of the Joint Theater Trauma System in Iraq and Afghanistan, is based on rapid hemorrhage control, permissive hypotension and transfusion of blood products in a ratio that aims to deliver the functionality of whole blood (1:1:1, red cells:plasma:platelets), in addition to limiting crystalloid resuscitation. ROTEM defined ATC has not been observed over time among DCR eligible combat casualties. The goal of this study was to identify ATC and the effects of DCR in trauma patients treated at level III trauma hospitals in Afghanistan. In this prospective observational study, 88 trauma patients were treated at Craig Air Force Theatre Hospital – Bagram, or Kandahar NATO Hospital in the Afghanistan Theatre. We included only patients from coalition forces identified as having injury that would result in the loss of life or total disability resulting in activation of DCR. Blood was obtained for analysis upon admission and at 6 and 24 hours after admission by a designated research team. Blood was analyzed by ROTEM with multiple assays (EXTEM, FIBTEM, APTEM); however, data was not available to the treatment team. Complete blood counts and INR were also obtained and Injury Severity Scores (ISS) were determined. Transfusion requirements of red blood cells (RBCs), platelets (PLT), fresh frozen plasma (FFP) and cryoprecipitate were recorded for the first 24 hours following admission. ROTEM changes over time were analyzed using Wilcoxon signed-rank test. Forty patients in the cohort had ROTEM (EXTEM) data obtained for evaluation as equipment was unavailable during a portion of the study. The median ISS was 21.5 (IQR 14-27). Four of the patients in the cohort died. The median admission hemoglobin and hematocrit were 11.1 g/dL (IQR 10.1-12) and 32.3% (IQR 29-34.5) respectively. The median INR was 1.3 (IQR 1.2-1.4). The median patient RBC to FFP to PLT ratio was 1:1:0.8. The median clot time (CT) and maximum clot firmness (MCF) were 58.5 sec (IQR 51-65.5) and 56 mm (IQR 51-60.5) respectively. Median CA5 was 37.5 mm (IQR 31-45). ATC as identified by CA5 ≤ 35 mm was present in 15 of 40 patients (38%) upon admission. The median CA5 of patients who met criteria for ATC on admission was 26 mm (IQR 15-34) which improved to 38 mm (IQR 33-44) at 24 hours (p < 0.01). Median LI45 was 98% (IQR 96-99). Hyperfibrinolysis as defined by LI45 ≤ 85% was observed in 4 of 40 patients (10%) upon admission which did not change significantly at 24 hours. The incidence of acute traumatic coagulopathy as defined by ROTEM parameters in this high risk military cohort appears to be higher compared to that reported for civilian populations. These data suggest that current DCR practices including a 1:1:1 RBC:FFP:PLT ratio appropriately target high risk trauma patients with ATC and that this strategy appears to be associated with a reduction in the burden of coagulopathy by 24 hours. Disclosures No relevant conflicts of interest to declare.

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