Early ICU-acquired hypernatraemia is associated with injury severity and preceded by reduced renal sodium and chloride excretion in polytrauma patients

2021 ◽  
Author(s):  
Christopher Rugg ◽  
Mirjam Bachler ◽  
Simon Mösenbacher ◽  
Elena Wiewiora ◽  
Stefan Schmid ◽  
...  
Keyword(s):  
Injury Severity ◽  
Chloride Excretion ◽  
Polytrauma Patients

scholarly journals Endothelial glycocalyx degradation is associated with early organ impairment in polytrauma patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Feng Qi ◽  
Hao Zhou ◽  
Peng Gu ◽  
Zhi-He Tang ◽  
Bao-Feng Zhu ◽  
...  
Keyword(s):  
Injury Severity ◽  
Early Stage ◽  
Endothelial Glycocalyx ◽  
Control Group ◽  
Metabolic System ◽  
Metabolic Systems ◽  
Organ Systems ◽  
Severity Scores ◽  
Polytrauma Patients ◽  
Trauma Group

Abstract Background Endothelial glycocalyx (EG) abnormal degradation were widely found in critical illness. However, data of EG degradation in multiple traumas is limited. We performed a study to assess the EG degradation and the correlation between the degradation and organ functions in polytrauma patients. Methods A prospective observational study was conducted to enroll health participants (control group) and polytrauma patients (trauma group) at a University affiliated hospital between Feb 2020 and Oct 2020. Syndecan1 (SDC1) and heparin sulfate (HS) were detected in serum sample of both groups. In trauma group, injury severity scores (ISS) and sequential organ failure assessments (SOFA) were calculated. Occurrences of acute kidney injury (AKI), trauma-induced coagulopathy (TIC) within 48 h and 28-day all-cause mortality in trauma group were recorded. Serum SDC1 and HS levels were compared between two groups. Correlations between SDC1/HS and the indicators of organ systems in the trauma group were analyzed. ROC analyses were performed to assess the predictive value of SDC1 and HS for AKI, TIC within 48 h, and 28-day mortality in trauma group. Results There were 45 polytrauma patients and 15 healthy participants were collected, totally. SDC1 and HS were significantly higher in trauma group than in control group (69.39 [54.18–130.80] vs. 24.15 [13.89–32.36], 38.92 [30.47–67.96] vs. 15.55 [11.89–23.24], P <  0.001, respectively). Trauma group was divided into high degradation group and low degradation group according to SDC1 median. High degradation group had more severe ISS, SOFA scores, worse organ functions (respiratory, kidney, coagulation and metabolic system), and higher incidence of hypothermia, acidosis and shock. The area under the receiver operator characteristic curves (AUC) of SDC1 to predict AKI, TIC occurrence within 48 h and 28-day mortality were 0.838 (95%CI: 0.720–0.957), 0.700 (95%CI: 0.514–0.885) and 0.764 (95%CI: 0.543–0.984), respectively. Conclusions EG degradation was elevated significantly in polytrauma patients, and the degradation was correlated with impaired respiratory, kidney, coagulation and metabolic systems in early stage. Serum SDC1 is a valuable predictive indicator of early onset of AKI, TIC, and 28-day mortality in polytrauma patients.

scholarly journals Fixation of Pelvic-Acetabular Fractures Using a Midline-Modified Stoppa Approach: Clinical and Operative Outcomes

2018 ◽  
Vol 24 (1) ◽  
pp. 18-24
Author(s):  
Kenneth Kin-yan Chan ◽  
King-him Chui ◽  
Ka-chun Ip ◽  
Kin-bong Lee ◽  
Wilson Li
Keyword(s):  
Complication Rate ◽  
Injury Severity ◽  
Pelvic Ring ◽  
Functional Results ◽  
Bimodal Distribution ◽  
Harris Hip Score ◽  
Acetabular Fractures ◽  
Pelvic Ring Fractures ◽  
Stoppa Approach ◽  
Polytrauma Patients

Background/Purpose This served as the first report from our locality to evaluate the modified Stoppa approach, via a low-midline wound, for treating pelvic–acetabular fractures. Methods A total of 17 polytrauma patients with pelvic and/or acetabular fractures were consecutively treated using the modified Stoppa approach. They were followed up for at least 1 year postoperatively for radiographic and clinical assessments, which included the Modified Merle d'Aubigne Score, Harris Hip Score, and pain visual analogue scale. Results Among the 17 patients, 11 had pelvic ring fractures, two had isolated acetabular fractures, and four had a combination of both. Excellent and anatomical reduction was achieved in 73.3% of pelvic fractures and 71.4% of acetabular fractures. Functional outcomes simulated a bimodal distribution. Age of patient and Injury Severity Score were significant predictors for functional results, whereas fracture characteristics and quality of reduction were not correlated with clinical outcomes in this series. We experienced a low complication rate. Conclusion Excellent exposure for fracture reduction and fixation with low complication rate was achieved with the modified Stoppa approach. We were encouraged by the results of this preliminary series for treating pelvic–acetabular fractures in polytrauma patients.

scholarly journals The assessment of clinical evaluation and treatment results of high-energy blunt polytrauma patients

Medicina ◽  
2007 ◽  
Vol 43 (2) ◽  
pp. 137 ◽  
Author(s):  
Algimantas Pamerneckas ◽  
Andrei Pijadin ◽  
Giedrius Pilipavičius ◽  
Gintaras Tamulaitis ◽  
Vytautas Toliušis ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Injury Severity ◽  
Motor Vehicle ◽  
High Energy ◽  
Ventilation Time ◽  
Polytrauma Patients ◽  
The Mean

The aim of this study was to evaluate the mechanism of high-energy blunt trauma, age and gender of patients, severity of regional and multiple injury, ventilation time, length of stay in intensive care unit and in-hospital stay, in-hospital complications, and treatment outcome. Materials and methods. Data on 159 patients with severe multiple injuries, meeting inclusion criteria, were collected prospectively and evaluated retrospectively. Results. The mean age of multiple trauma patients was 43.9±1.4 years; males were injured 2.5 times more often than females (P<0.001). More than half (66.7%) of patients were 17–64-year-old males. Majority (83%) of all patients were injured in motor vehicle crashes, and 52.2% of these patients were pedestrians. The mean Injury Severity Score was 29.5±0.8, and severe (Abbreviated Injury Scale score of 3 and more) injuries of extremities, head, and chest made up 69.1% of all injuries. The mean ventilation time, mean length of stay in intensive care unit, and mean in-hospital stay were 5.5±0.7, 7.0±0.8, and 23.6±1.6 days, respectively. Acute lung complications were the most common (25.2%). Systemic inflammatory response syndrome developed in 7.5% of patients, and sepsis in 3.8% of patients. More than one-fifth (20.8%) of polytrauma patients died. Conclusions. Working-age male pedestrians (17–64 years old) made up two-thirds of all polytrauma patients. Severe injuries of extremities, head, and chest were present in 69.1% of all cases. Lung complications were the most common.

Concomitant Sternal Fracture in Flail Chest: An Analysis of 21,741 Polytrauma Patients from the TraumaRegister DGU®

2017 ◽  
Vol 65 (07) ◽  
pp. 551-559 ◽  
Author(s):  
Sebastian Krinner ◽  
Andreas Langenbach ◽  
Pascal Oppel ◽  
Rolf Lefering ◽  
Dominic Taylor ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Trauma Center ◽  
Injury Severity ◽  
Flail Chest ◽  
Inclusion Criteria ◽  
Sternal Fracture ◽  
Spine Injuries ◽  
Thorax Trauma ◽  
Polytrauma Patients ◽  
Sternal Fractures

Background Isolated sternal fractures (SFs) rarely show complications, but their influence in a thorax trauma of the seriously injured still remains unclear. Methods A retrospective analysis of the TraumaRegister DGU® was performed involving the years 2009 to 2013 (Injury Severity Score [ISS] ≥ 16, primary admission to a trauma center). Cohort formation: Unilateral and bilateral flail chest (FC) injuries with and without a concomitant SF, respectively. Results In total, 21,741 patients (25% female) met the inclusion criteria, with 3,492 (16.1%) showing SF. Unilateral FC patients were on average 53.6 ± 18.4 years old, and bilateral FC patients were on average 55.2 ± 17.7 years old. The ISS in unilateral FC and bilateral FC amounted to 31.2 ± 13.0 and 43.4 ± 13.1 points, respectively. FC with an SF occurred more frequently as an injury to car occupants and less frequently as an injury to motorcyclists or in injuries due to falls. Conclusion Patients with an SF additional to an FC had longer hospital and intensive care unit stays and were longer artificially respirated than those patients without an SF. SF indicates possible cardiac and thoracic spine injuries.

scholarly journals Trauma Analysis Related Injury Severity Score (Triss) in Predicting the Prognosis of Politrauma Patients in Adam Malik General Hospital

2020 ◽  
Vol 13 (1) ◽  
pp. 97-104
Author(s):  
Rahmad Gunawan ◽  
Heru Rahmadhany ◽  
Iman Dwi Winanto
Keyword(s):  
Head Injury ◽  
General Hospital ◽  
Injury Severity ◽  
Cross Sectional ◽  
Independent Variables ◽  
Dependent Variables ◽  
Polytrauma Patients ◽  
Male Sex ◽  
Cross Sectional Design ◽  
Referral Status

Objective : The purposeofthis study wastoanalyzetheabilityof TRISS in predictingthe prognosis ofpolytraumapatients in the Haji Adam Malik General Hospital Medan, January 2016 toDecember 2018. Material and Method : This type of research is an analytic study with cross sectional design, which is a study by measuring independent variables and dependent variables at the same time, which aims to analyze the ability of TRISS in predicting the prognosis of patients in Haji Adam Malik General Hospital Medan January 2016 to December 2018. Results : From January 2016 - December 2018, a total 175 polytrauma patients which mostly was adult patient (>18 y.o) observed. Based on sex, referral status and diagnosis, patients with polytrauma dominated in patients with male sex(143 patients), referred patient (68patients) and diagnosed with head injury (29 patients). Conclusion : There is an influence between TRISS Score on the prognosis of polytrauma patients.

scholarly journals Incidence of hospital mortality in polytrauma patients in a tertiary center in Bosnia and Herzegovina

2016 ◽  
Vol 6 (1) ◽  
pp. 67-71
Author(s):  
Hadžan Konjo ◽  
Emira Švraka ◽  
Đemil Omervić ◽  
Dijana Avdić
Keyword(s):  
Mortality Rate ◽  
Hospital Mortality ◽  
Bosnia And Herzegovina ◽  
Injury Severity ◽  
Age Groups ◽  
Tertiary Institution ◽  
Lethal Outcome ◽  
Clinical Center ◽  
Tertiary Center ◽  
Polytrauma Patients

Introduction: In the late 70s of the last century, the mortality rate due to polytrauma amounted to 40%. This led to a new approach to this patient category with the goal of improving the treatment outcome.  According to the German trauma register, the rate of mortality in polytrauma at the end of the last century was 18.6%. The goal of this study is to determine the incidence of hospital mortality in polytrauma patients in a tertiary institution in Bosnia and Herzegovina.Methods: We analyzed patient medical records from the Intensive Care Unit of the Clinic of Orthopedics and Traumatology at University Clinical Center Sarajevo, from January 1, 2012 to December 31, 2012.Results:  There were 70 polytrauma patients in 2012, with average age 47.55 (range 8-77) years. Half of the patients were younger than 50 years. Age groups most frequently affected were 61 and older (25.7%), 51-60 years (24.3%), and 31-40 years (21.4%). Lethal outcome occurred in 10 patients (14.3%), while 60 patients (85.7%) survived and were treated until discharge or transfer to a different department.  The average Injury Severity Score (ISS) in patients with lethal outcome was 71.50, while in survivors was 37.  The largest percentage of lethal outcomes was recorded in cases of traffic accidents.Conclusion: The mortality rate among hospitalized polytrauma patients in the tertiary institution in Bosnia and Herzegovina is similar to reported mortality rates in other countries with developed healthcare system.  

scholarly journals Study of the efficacy of trauma and injury severity score to predict survival in patients of polytrauma

2021 ◽  
Author(s):  
Anant Singh ◽  
Raj K. Chejara ◽  
Ashok K. Sharma ◽  
Aditya Tolat
Keyword(s):  
Injury Severity Score ◽  
Trauma Care ◽  
Severity Score ◽  
Injury Severity ◽  
Road Traffic ◽  
Tertiary Care ◽  
Young Patients ◽  
Physiological Status ◽  
Polytrauma Patients ◽  
Trauma And Injury

Background: Trauma is one of the major cause of mortality and morbidity in both developed and developing countries. Polytrauma patients present particular challenges as profile of the patient varies with different types and severity of injuries. Prediction of survival in trauma patients is an essential requirement of trauma care. Trauma and injury severity score (TRISS) have been considered as a standard of the quality of trauma care. Study was carried out to evaluate the performance of TRISS in predicting survival in patients of polytrauma.Methods: Prospective observational study was conducted in emergency department of a tertiary care centre. 100 patients were evaluated in the study for a period of 18 months between November 2019 and April 2021. Patient demographics, details of trauma, pattern of injuries and physiological status were recorded. Overall outcome were studied and data analysis was done on the basis of TRISS. Statistical analysis was performed using statistical package for the social sciences (SPSS) program for windows, version 25.0 (SPSS Chicago, Illinois).Results: Young patients with mean age of 34.54 were most commonly affected in polytrauma with male preponderance. Road traffic accidents were the most common mode of trauma followed by fall from height. Blunt trauma was the most common type of injury. TRISS strongly predicted survival in polytrauma patients (AUC 0.926 CI 95% 0.868-0.985). TRISS has high sensitivity 97.62% and specificity 62.50% at a cut off of 64.50%.Conclusions: TRISS is an effective method for predicting survival of polytrauma patients and thus can be utilized to evaluate and compare trauma care.

ANALYSIS OF COMPLEMENT PROTEINS IN POLYTRAUMA PATIENTS - CORRELATION WITH INJURY SEVERITY, SEPSIS AND OUTCOME.

Shock ◽  
1997 ◽  
Vol 7 (Supplement) ◽  
pp. 74 ◽  
Author(s):  
F. Hecke ◽  
U. Schmidt ◽  
A. Kola ◽  
W. Bautsch ◽  
A. Klos ◽  
...  
Keyword(s):  
Injury Severity ◽  
Complement Proteins ◽  
Polytrauma Patients
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