scholarly journals MP06: Predictors of hypothermia upon emergency department arrival in severe trauma patients transported to hospital via emergency medical services

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S42-S42
Author(s):  
C. Forristal ◽  
K. Van Aarsen ◽  
M. Columbus ◽  
J. Wei ◽  
K. Vogt ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Emergency Medical Services ◽  
Blunt Trauma ◽  
Major Trauma ◽  
Injury Severity ◽  
Severe Trauma ◽  
Trauma Centre ◽  
Trauma Patients ◽  
Local Trauma ◽  
Continental Climate

Introduction: Hypothermia in severe trauma patients can increase mortality by 25%. Active re-warming decreases mortality and is recommended in trauma management guidelines. Despite this, many emergency medical services (EMS) vehicles do not carry equipment for active re-warming. This study sought to determine the local rate of hypothermia in major trauma patients on trauma centre arrival (TCA), and to establish which patients are at highest risk by identifying factors present in the pre-hospital setting associated with hypothermia in a humid continental climate. Methods: This single-centre retrospective chart review included adults (age 18) in the local trauma registry (trauma team activation or injury severity score >12) from January 2009-June 2016. Patients were excluded if: temperature on TCA unknown or 38°C, not transported by EMS, or if there was >24 hrs from injury to TCA. The primary outcome was the rate of hypothermia (<35°C) in major trauma patients transported by EMS on arrival at the local trauma centre. Secondary outcomes included hospital length of stay and survival to discharge. Logistic regression was used to identify predictors of hypothermia on TCA; it included the following factors: age, sex, weight, number of comorbidities, injury severity, injury mechanism, EMS modality, direct transport from scene or referred from peripheral hospital, time on scene, transport time, local temperature, and pre-hospital heart rate, systolic blood pressure (SBP), intubation, and volume of crystalloid. Results: A total of 3070 adult traumas were included, 159 of which were hypothermic on TCA a rate of 5%. Multivariate analysis identified seven risk factors for hypothermia: intubation pre-hospital (OR 8.10, p<0.001), blunt trauma (OR 3.37, p=0.044 vs. penetrating, and OR 7.35, p=0.023 vs. other), direct transport (OR 1.94, p=0.005), number of comorbidities (OR 1.14, p=0.036), injury severity (OR 1.03, p<0.001), 1°C local temperature drop (OR 1.03, p<0.001), and 1mmHg SBP drop (OR 1.01, p<0.001). Ninety-four percent of normothermic patients and 69.2% of hypothermic patients survived to discharge. Average length of stay was 7.98 and 15.23 days respectively. Conclusion: Avoidance of hypothermia is imperative to the management of major trauma patients. Those at highest risk in a humid continental climate are severely injured blunt trauma patients with multiple co-morbidities, a low pre-hospital SBP and EMS intubation. Future studies should focus on the benefits of pre-hospital rewarming in these high-risk patients.

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.

Intraabdominal Injury is Common in Blunt Trauma Patients who Sustain Spinal Cord Injury

2007 ◽  
Vol 73 (10) ◽  
pp. 1035-1038
Author(s):  
Ali Salim ◽  
Marcus Ottochian ◽  
Ryan J. Gertz ◽  
Carlos Brown ◽  
Kenji Inaba ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Length Of Stay ◽  
Blunt Trauma ◽  
Injury Severity ◽  
Unit Length ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Cord Injury ◽  
Intraabdominal Injury

The evaluation of the abdomen in patients with spinal cord injury (SCI) is challenging for obvious reasons. There are very little data on the incidence and complications of patients who sustain SCI with concomitant intraabdominal injury (IAI). To determine the incidence and outcomes of IAI in blunt trauma patients with SCI, a trauma registry and record review was performed between January 1998 and December 2005. Baseline demographic data, Injury Severity Score, and associated IAI were collected. Two groups were established and outcomes were analyzed based on the presence or absence of IAI. Intraabdominal and hollow viscus injures were found in 15 per cent and 6 per cent, respectively, of 292 patients with blunt SCI. The presence of intraabdominal injury varied according to the level of the SCI: 10 per cent of cervical, 23 per cent of thoracic, and 18 per cent of lumbar SCI. The overall mortality was 16 per cent. The presence of intraabdominal injury was associated with longer intensive care unit length of stay (13 versus 6 days, P < 0.01), hospital length of stay (23 versus 18 days, P < 0.05), higher complication rate (46% versus 33%, P = 0.09), and higher mortality (44% versus 11%, P < 0.01) when compared with patients with SCI without IAI. Intraabdominal injuries are common in blunt SCI. Liberal evaluation with computed tomography is necessary to identify injuries early.

scholarly journals Overexpression of miR-24 Is Involved in the Formation of Hypocoagulation State after Severe Trauma by Inhibiting the Synthesis of Coagulation Factor X

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Lu-Jia Chen ◽  
Lian Yang ◽  
Xing Cheng ◽  
Yin-Kai Xue ◽  
Li-Bo Chen
Keyword(s):  
Negative Correlation ◽  
Major Trauma ◽  
Injury Severity ◽  
Coagulation Factor ◽  
In Vitro Study ◽  
Severe Trauma ◽  
Trauma Patients ◽  
Factor Xii ◽  
Factor X

Background. Dysregulation of microRNAs may contribute to the progression of trauma-induced coagulopathy (TIC). We aimed to explore the biological function that miRNA-24-3p (miR-24) might have in coagulation factor deficiency after major trauma and TIC. Methods. 15 healthy volunteers and 36 severe trauma patients (Injury Severity Score ≥ 16 were enrolled. TIC was determined as the initial international normalized ratio >1.5. The miR-24 expression and concentrations of factor X (FX) and factor XII in plasma were measured. In vitro study was conducted on L02 cell line. Results. The plasma miR-24 expression was significantly elevated by 3.17-fold (P=0.043) in major trauma patients and reduced after 3 days (P<0.01). The expression level was significantly higher in TIC than in non-TIC patients (P=0.040). Multivariate analysis showed that the higher miR-24 expression was associated with TIC. The plasma concentration of FX in TIC patients was significantly lower than in the non-TIC ones (P=0.030) and controls (P<0.01). A negative correlation was observed between miR-24 and FX. miR-24 transduction significantly reduced the FX level in the supernatant of L02 cells (P=0.030). Conclusions. miR-24 was overexpressed in major trauma and TIC patients. The negative correlation of miR-24 with FX suggested the possibility that miR-24 might inhibit the synthesis of FX during TIC.

The sensitivity of pre-hospital and in-hospital tools for the identification of major trauma patients presenting to a major trauma centre.

2013 ◽  
Vol 99 (1) ◽  
pp. 16-19
Author(s):  
D Potter ◽  
A Kehoe ◽  
JE Smith
Keyword(s):  
Major Trauma ◽  
Injury Severity ◽  
Trauma Centre ◽  
Research Network ◽  
Trauma Network ◽  
Trauma Patients ◽  
Major Trauma Centre ◽  
Injury Assessment ◽  
Trauma Response ◽  
Retrospective Database

AbstractThe identification of major trauma patients before arrival in hospital allows the activation of an appropriate trauma response. The Wessex triage tool (WTT) uses a combination of anatomical injury assessment and physiological criteria to identify patients with major trauma suitable for triage direct to a major trauma centre (MTC), and has been adopted by the South-West Peninsula Trauma Network (PTN). A retrospective database review, using the Trauma Audit Research Network (TARN) database, was undertaken to identify a population of patients presenting to Derriford Hospital with an injury severity score (ISS) > 15. The WTT was then applied to this population to identify the sensitivity of the tool. The sensitivity of the WTT at identifying patients with an ISS>15 was 53%. One of the reasons for this finding was that elderly patients who are defined as having major trauma due to the nature of their injuries, but who did not have a mechanism to suggest they had sustained major trauma (such as a fall from standing height), were not identified by these triage tools. The implications of this are discussed.

Long-term follow-up after severe suicide attempt by multiple blunt trauma

2005 ◽  
Vol 20 (2) ◽  
pp. 115-120 ◽  
Author(s):  
Frank-Gerald Pajonk ◽  
Steffen Ruchholtz ◽  
Christian Waydhas ◽  
Thomas Schneider-Axmann
Keyword(s):  
Suicide Attempt ◽  
Blunt Trauma ◽  
Injury Severity ◽  
Psychiatric Treatment ◽  
Trauma Centre ◽  
Trauma Patients ◽  
Predictive Variables ◽  
Long Term Follow Up ◽  
Level I

AbstractBackgroundAfter parasuicide there is a high risk of reattempts. However, it seems that patients who survived severe suicidal trauma recover well. Therefore, the outcome of patients with severe multiple blunt trauma as a result of a suicide attempt was investigated with respect to psychiatric and somatic health, quality of life (QOL) and suicide reattempt rates.MethodsPatients who underwent a suicide attempt were isolated from a prospectively collected sample of trauma patients from a level I University Trauma Centre. Follow-up examination was performed 6.1 ± 3 years after the trauma. A physical and psychiatric examination was performed, using established psychiatric scales.ResultsTwelve percent of severely injured patients were identified as suicide attempters (male/female: 37/28, mean age 38 ± 18 years, mean Injury Severity Score (ISS) 40 ± 15 points). A psychiatric diagnosis was present in 90% at the time of the suicide attempt. Twenty-one patients died during the hospital stay (32%) and six subjects died thereafter, none due to suicide. Thirty-five individuals were eligible for examination. None of them had reattempted suicide. Seventeen (48%) had good outcomes reflected by absent or ambulatory psychiatric treatment, employment, normal psychiatric findings and good psychosocial ability. An indeterminate outcome was determined in 24%. Predictive variables for an adverse outcome (10 patients, 28%) were found to be a diagnosis of schizophrenia, continued psychiatric treatment and being without employment.ConclusionsDespite the seriousness of the suicide attempt, survivors recovered well in about half the cases with no further suicide attempt in any patient. An early psychiatric consultation already on the Intensive Care Unit (ICU) is recommended.

scholarly journals Prehospital critical care is associated with increased survival in adult trauma patients in Scotland

2020 ◽  
Vol 37 (3) ◽  
pp. 141-145 ◽  
Author(s):  
Alistair Maddock ◽  
Alasdair R Corfield ◽  
Michael J Donald ◽  
Richard M Lyon ◽  
Neil Sinclair ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Critical Care ◽  
Major Trauma ◽  
Injury Severity ◽  
Prehospital Care ◽  
National Registry ◽  
Trauma Centre ◽  
Trauma Patients ◽  
Data Set ◽  
Major Trauma Centre

BackgroundScotland has three prehospital critical care teams (PHCCTs) providing enhanced care support to a usually paramedic-delivered ambulance service. The effect of the PHCCTs on patient survival following trauma in Scotland is not currently known nationally.MethodsNational registry-based retrospective cohort study using 2011–2016 data from the Scottish Trauma Audit Group. 30-day mortality was compared between groups after multivariate analysis to account for confounding variables.ResultsOur data set comprised 17 157 patients, with a mean age of 54.7 years and 8206 (57.5%) of male gender. 2877 patients in the registry were excluded due to incomplete data on their level of prehospital care, leaving an eligible group of 14 280. 13 504 injured adults who received care from ambulance clinicians (paramedics or technicians) were compared with 776 whose care included input from a PHCCT. The median Injury Severity Score (ISS) across all eligible patients was 9; 3076 patients (21.5%) met the ISS>15 criterion for major trauma. Patients in the PHCCT cohort were statistically significantly (all p<0.01) more likely to be male; be transported to a prospective Major Trauma Centre; have suffered major trauma; have suffered a severe head injury; be transported by air and be intubated prior to arrival in hospital. Following multivariate analysis, the OR for 30-day mortality for patients seen by a PHCCT was 0.56 (95% CI 0.36 to 0.86, p=0.01).ConclusionPrehospital care provided by a physician-led critical care team was associated with an increased chance of survival at 30 days when compared with care provided by ambulance clinicians.

The Impact of Enhanced Intensive Care on Outcome of Major Trauma Patients in a Regional Hospital in Hong Kong

2008 ◽  
Vol 15 (4) ◽  
pp. 218-229
Author(s):  
ANL Chan ◽  
ACH Lit
Keyword(s):  
Hong Kong ◽  
Intensive Care ◽  
Mortality Rate ◽  
Length Of Stay ◽  
Major Trauma ◽  
Injury Severity ◽  
Regional Hospital ◽  
Blunt Injury ◽  
Trauma Patients ◽  
The Impact

Objectives To describe an updated epidemiology of major trauma cases presenting to a regional hospital in Hong Kong and to analyse the impact of enhanced intensive care on the outcome of major trauma patients. Methods This was a retrospective comparative study. In late 2004, we amended our trauma care system with enhancement of intensive care in the management of major trauma patients. An 18-month period was chosen before and after the amendment respectively and patients' data and crude mortality rate between the two periods were compared. Stratified analyses based on mechanism of injury, injury severity and physiological parameters were also performed. Finally, a TRISS analysis was included. Results Altogether 163 and 155 patients were included in our study from the two periods respectively. The majority involved blunt injury and one third of them had injury severity score (ISS) greater than 15. Road traffic accidents and fall from height remained as the two leading causes of major trauma. The median length of stay in the intensive care unit increased for one day (p<0.01) in the later period but the median total length of stay in hospital remained the same. The mortality rate decreased from 10.4% to 9.7% (p=0.82). Conclusion With enhanced intensive care, there is an apparent decrease in mortality of major trauma patients but its significance needs to be determined with a larger scale study.

Evaluating the effect of driving distance to the nearest higher level trauma centre on undertriage: a cohort study

2021 ◽  
pp. emermed-2021-211635
Author(s):  
Job F Waalwijk ◽  
Robin D Lokerman ◽  
Rogier van der Sluijs ◽  
Audrey A A Fiddelers ◽  
Luke P H Leenen ◽  
...  
Keyword(s):  
Injury Severity Score ◽  
Emergency Medical Services ◽  
Resource Use ◽  
Severity Score ◽  
Injury Severity ◽  
Trauma Centre ◽  
Medical Services ◽  
Trauma Patients ◽  
Emergency Medical ◽  
Critical Resource

BackgroundIt is of great importance that emergency medical services professionals transport trauma patients in need of specialised care to higher level trauma centres to achieve optimal patient outcomes. Possibly, undertriage is more likely to occur in patients with a longer distance to the nearest higher level trauma centre. This study aims to determine the association between driving distance and undertriage.MethodThis prospective cohort study was conducted from January 2015 to December 2017. All trauma patients in need of specialised care that were transported to a trauma centre by emergency medical services professionals from eight ambulance regions in the Netherlands were included. Patients with critical resource use or an Injury Severity Score ≥16 were defined as in need of specialised care. Driving distance was calculated between the scene of injury and the nearest higher level trauma centre. Undertriage was defined as transporting a patient in need of specialised care to a lower level trauma centre. Generalised linear models adjusting for confounders were constructed to determine the association between driving distance to the nearest higher level trauma centre per 1 and 10 km and undertriage. A sensitivity analysis was conducted with a generalised linear model including inverse probability weights.Results6101 patients, of which 4404 patients with critical resource use and 3760 patients with an Injury Severity Score ≥16, were included. The adjusted generalised linear model demonstrated a significant association between a 1 km (OR 1.04; 95% CI 1.04 to 1.05) and 10 kilometre (OR 1.50; 95% CI 1.42 to 1.58) increase in driving distance and undertriage in patients with critical resource use. Also in patients with an Injury Severity Score ≥16, a significant association between driving distance (1 km (OR 1.06; 95% CI 1.06 to 1.07), 10 km (OR 1.83; 95% CI 1.71 to 1.95)) and undertriage was observed.ConclusionPatients in need of specialised care are less likely to be transported to the appropriate trauma centre with increasing driving distance. Our results suggest that emergency medical services professionals incorporate driving distance into their decision making regarding transport destinations, although distance is not included in the triage protocol.

scholarly journals Is computerized tomography of trauma patients associated with a transfer delay to a regional trauma centre?

CJEM ◽  
2008 ◽  
Vol 10 (03) ◽  
pp. 205-208 ◽  
Author(s):  
Justin Onzuka ◽  
Andrew Worster ◽  
Bill McCreadie
Keyword(s):  
Length Of Stay ◽  
Injury Severity ◽  
Significant Proportion ◽  
Ct Scanning ◽  
Trauma Centre ◽  
Trauma Patients ◽  
Transfer Delay ◽  
Significant Difference ◽  
Primary Hospital ◽  
Record Review

ABSTRACT Objective: Many trauma patients undergo advanced diagnostic imaging before being transferred to a regional trauma centre, but this step can delay definitive care. This study compared the length-of-stay at the primary hospital between patients who underwent CT scans and those who did not. Methods: This was a medical record review of all consecutive trauma cases transferred to a regional trauma centre servicing 2.2 million people during a 2-year period. Two trained abstractors, blind to each other's results, collected data independently. Results: Of 249 cases, 79 (31%) underwent a CT scan before being transferred. There was no significant difference in the Injury Severity Score between the 2 groups (p = 0.16), yet the CT group remained at the primary hospital approximately 90 minutes longer before transfer (p &lt; 0.001). Conclusion: A significant proportion of trauma patients transferred to a regional trauma centre undergo CT scanning at the primary hospital. These patients experience an increased length-of-stay of 90 minutes, on average, before transfer. This appears to be a common practice that does not appear to contribute to definitive trauma management.

scholarly journals Major trauma in the elderly: Frailty decline and patient experience after injury

Trauma ◽  
2018 ◽  
Vol 21 (1) ◽  
pp. 21-26 ◽  
Author(s):  
Louis Koizia ◽  
Rosalind Kings ◽  
Alexander Koizia ◽  
George Peck ◽  
Mark Wilson ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Patient Experience ◽  
Major Trauma ◽  
Injury Severity ◽  
The Elderly ◽  
Trauma Centre ◽  
Trauma Patients ◽  
Post Injury ◽  
Frailty Status

Introduction The prevalence of major trauma in the elderly is increasing with ageing western societies. Frailty is now a well-recognised predictor of poor outcome after injury; however, few studies have focused on the progression of frailty and patients’ perceptions of their injuries after discharge. Aim We hypothesised that the number of elderly patients that survive major trauma is low and, of those that do, frailty post injury worsens with overall negative views about quality of life. To investigate this, we examined mortality, frailty and patient experience for elderly major trauma admissions to a level 1 trauma centre at one year after admission. Method All consecutive patients > 75 with an injury severity score of > 15 were included in the study. Patients were invited to participate in a structured telephone interview to assess change in frailty status as well as assess patient experience after injury. Results A total of 79 patients met inclusion criteria; 34 patients had died and 17 were uncontactable; 88% had become more frail ( p < 0.05), and more than half commented positively on their overall quality of life following injury. Conclusions These findings highlight the elevated mortality in elderly major trauma patients, but also indicate that preconceived opinions on quality of life, post injury, might not be appropriate.

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