Fibrin monomers and association with significant hemorrhage or mortality in severely injured trauma patients

AbstractTrauma patients die from massive bleeding due to disseminated intravascular coagulation (DIC) with a fibrinolytic phenotype in the early phase, which transforms to DIC with a thrombotic phenotype in the late phase of trauma, contributing to the development of multiple organ dysfunction syndrome (MODS) and a consequently poor outcome. This is a sub-analysis of a multicenter prospective descriptive cross-sectional study on DIC to evaluate the effect of a DIC diagnosis on the survival probability and predictive performance of DIC scores for massive transfusion, MODS, and hospital death in severely injured trauma patients. A DIC diagnosis on admission was associated with a lower survival probability (Log Rank P < 0.001), higher frequency of massive transfusion and MODS and a higher mortality rate than no such diagnosis. The DIC scores at 0 and 3 h significantly predicted massive transfusion, MODS, and hospital death. Markers of thrombin and plasmin generation and fibrinolysis inhibition also showed a good predictive ability for these three items. In conclusion, a DIC diagnosis on admission was associated with a low survival probability. DIC scores obtained immediately after trauma predicted a poor prognosis of severely injured trauma patients.

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Risk Factors for Trauma-Induced Coagulopathy- and Transfusion-Associated Multiple Organ Failure in Severely Injured Trauma Patients

Frontiers in Medicine ◽

10.3389/fmed.2015.00024 ◽

2015 ◽

Vol 2 ◽

Cited By ~ 7

Author(s):

Kirsten Balvers ◽

Mathijs R. Wirtz ◽

Susan van Dieren ◽

J. Carel Goslings ◽

Nicole P. Juffermans

Keyword(s):

Risk Factors ◽

Multiple Organ Failure ◽

Organ Failure ◽

Multiple Organ ◽

Trauma Patients ◽

Severely Injured ◽

Trauma Induced Coagulopathy

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Resuscitation and coagulation in the severely injured trauma patient

Philosophical Transactions of the Royal Society B Biological Sciences ◽

10.1098/rstb.2010.0220 ◽

2011 ◽

Vol 366 (1562) ◽

pp. 192-203 ◽

Cited By ~ 39

Author(s):

Mark J. Midwinter ◽

Tom Woolley

Keyword(s):

Trauma Patient ◽

Damage Control ◽

Damage Control Surgery ◽

Physiological Status ◽

Trauma Patients ◽

Severely Injured ◽

Mortality And Morbidity ◽

Tissue Hypoperfusion ◽

Coagulation Status ◽

Haemostatic Resuscitation

Developments in the resuscitation of the severely injured trauma patient in the last decade have been through the increased understanding of the early pathophysiological consequences of injury together with some observations and experiences of recent casualties of conflict. In particular, the recognition of early derangements of haemostasis with hypocoagulopathy being associated with increased mortality and morbidity and the prime importance of tissue hypoperfusion as a central driver to this process in this population of patients has led to new resuscitation strategies. These strategies have focused on haemostatic resuscitation and the development of the ideas of damage control resuscitation and damage control surgery continuum. This in turn has led to a requirement to be able to more closely monitor the physiological status, of major trauma patients, including their coagulation status, and react in an anticipatory fashion.

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Prehospital Telemedical Emergency Management of Severely Injured Trauma Patients

Methods of Information in Medicine ◽

10.3414/me18-05-0001 ◽

2018 ◽

Vol 57 (05/06) ◽

pp. e1-e1 ◽

Cited By ~ 1

Author(s):

Birgit Reime ◽

Thomas Wurmb ◽

Uwe Kippnich ◽

Layal Shammas ◽

Asarnusch Rashid ◽

...

Keyword(s):

Emergency Management ◽

Trauma Patients ◽

Severely Injured

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Trauma in pregnancy: A review of the Pennsylvania Trauma Systems Foundation database

Trauma ◽

10.1177/1460408617703677 ◽

2017 ◽

Vol 20 (1) ◽

pp. 30-37 ◽

Cited By ~ 3

Author(s):

Meike Schuster ◽

Natasha Becker ◽

Amanda Young ◽

Michael J Paglia ◽

A Dhanya Mackeen

Keyword(s):

Blunt Trauma ◽

Motor Vehicle ◽

Penetrating Trauma ◽

Blunt Injury ◽

Trauma Patients ◽

Severely Injured ◽

Trauma Systems ◽

Severely Injured Patients ◽

Vaginal Deliveries ◽

Injured Patients

Objective The goal of this study is to determine if injury severity score (ISS) of ≥9 and systolic blood pressure (SBP) predict poor maternal/pregnancy outcomes in blunt and penetrating trauma, respectively. Methods The Pennsylvania Trauma Systems Foundation database was used to identify pregnant trauma patients. Blunt trauma patients were analyzed with regard to ISS, while penetrating trauma patients were analyzed to determine whether SBP < 90 mmHg was predictive of poor maternal outcome. Results Patients with severe blunt injury (ISS ≥ 9) due to motor vehicle accident were less likely to wear seatbelts (51% vs. 63%, p = 0.005), and delivery was required in 17% of these patients as compared to 6% of the less severely injured, and only 6% of those were vaginal deliveries. Severely injured patients were discharged home 68% of the time and 6% died compared to less severely injured patients of which 83% were discharged home and <1% died; all other patients required discharge to a rehabilitation facility. Patients with penetrating trauma and SBP < 90 mmHg on arrival were more likely to require delivery (35% vs. 5%, p < 0.001) and were 14 times more likely to die (58% vs. 4%, p < 0.001) when compared to the normotensive group. Conclusion ISS ≥ 9 and SBP < 90 mmHg are predictors for poor outcomes after trauma during pregnancy. Severely injured blunt trauma patients often require surgery and delivery. Patients who present with SBP < 90 after penetrating trauma are more likely to deliver and are 14 times more likely to die.

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Integration of ophthalmology in ocular trauma to improve patient care: A narrative review

Trauma ◽

10.1177/14604086211030793 ◽

2021 ◽

pp. 146040862110307

Author(s):

Christopher Bartimote ◽

Clare L Fraser ◽

Stephanie Watson

Keyword(s):

Ocular Trauma ◽

Improve Patient Care ◽

The United States ◽

Narrative Review ◽

Trauma Patients ◽

Severely Injured ◽

Specialist Care ◽

Trauma Service ◽

Trauma Model ◽

Meta Analyses

Introduction Ocular trauma can cause significant morbidity and is a leading cause of unilateral blindness. In multi-trauma, life- and sight-threatening injuries can co-occur causing increased complexity in the assessment and management of ocular injuries as the competing priorities in the severely injured must be balanced. We conducted a narrative review to determine how ophthalmology may be further integrated into a trauma service and/or the organisation of an ocular trauma service. Methods The literature was reviewed via EMBASE, MEDLINE, CINAHL and Google Scholar utilising comprehensive search strategies and keyword searches. Our review was conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Results The search yielded 437 articles, 30 studies met selection criteria and were included in the review. The included literature comprised guidelines, observational studies and reviews of registry data from Australia, England, the United States, Singapore, Iran and Israel. Conclusion The Australian Trauma Model has clear guidelines for referral of trauma patients to ensure appropriate care of the severely injured. However, there are no clear guidelines for the integration of ophthalmology into trauma. Therefore, early referral to ophthalmology and streamlining of referral pathways of specialist care would improve the care of patients with ocular trauma.

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Thrombelastography and Transfusion Patterns in Severely Injured Pediatric Trauma Patients with Blunt Solid Organ Injuries

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0000000000003392 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Jenny Stevens ◽

Kaci Pickett ◽

Hunter Moore ◽

Marina L. Reppucci ◽

Ryan Phillips ◽

...

Keyword(s):

Pediatric Trauma ◽

Trauma Patients ◽

Solid Organ ◽

Severely Injured

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Delays in Transfer of Elderly Less-injured Trauma Patients Can Have Deadly Consequences

The American Surgeon ◽

10.1177/000313481408001130 ◽

2014 ◽

Vol 80 (11) ◽

pp. 1132-1135 ◽

Cited By ~ 4

Author(s):

Peter E. Fischer ◽

Paul D. Colavita ◽

Gregory P. Fleming ◽

Toan T. Huynh ◽

A. Britton Christmas ◽

...

Keyword(s):

Trauma Center ◽

Injury Severity ◽

Trauma Patients ◽

Severely Injured ◽

Severely Injured Patients ◽

Local Trauma ◽

Level 1 ◽

Poor Outcomes ◽

Injured Patients ◽

Level 1 Trauma Center

Transfer of severely injured patients to regional trauma centers is often expedited; however, transfer of less-injured, older patients may not evoke the same urgency. We examined referring hospitals’ length of stay (LOS) and compared the subsequent outcomes in less-injured transfer patients (TP) with patients presenting directly (DP) to the trauma center. We reviewed the medical records of less-injured (Injury Severity Score [ISS] 9 or less), older (age older than 60 years) patients transferred to a regional Level 1 trauma center to determine the referring facility LOS, demographics, and injury information. Outcomes of the TP were then compared with similarly injured DP using local trauma registry data. In 2011, there were 1657 transfers; the referring facility LOS averaged greater than 3 hours. In the less-injured patients (ISS 9 or less), the average referring facility LOS was 3 hours 20 minutes compared with 2 hours 24 minutes in more severely injured patients (ISS 25 or greater, P < 0.05). The mortality was significantly lower in the DP patients (5.8% TP vs 2.6% DP, P = 0.035). Delays in transfer of less-injured, older trauma patients can result in poor outcomes including increased mortality. Geographic challenges do not allow for every patient to be transported directly to a trauma center. As a result, we propose further outreach efforts to identify potential causes for delay and to promote compliance with regional referral guidelines.

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