scholarly journals Predicting Factors of Clinical Outcomes in Traumatized Adults and Older Adults

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 597-597
Author(s):  
Pornthip Suyasith ◽  
Prangtip Chayaput ◽  
Orapan Thosingha ◽  
Suzanne G Leveille ◽  
Jatuporn Sirikun
Keyword(s):  
Older Adults ◽  
Hospital Mortality ◽  
Clinical Data ◽  
Road Traffic ◽  
Hospital Length Of Stay ◽  
Early Warning Score ◽  
Trauma Patients ◽  
Close Monitoring ◽  
Risk Of Death ◽  
Severity Of Injury

Abstract To investigate factors predicting hospital mortality and hospital length of stay (LOS) in traumatized adults and older adults, we conducted a three-year retrospective study at an academic hospital, Bangkok, Thailand. We reviewed medical records of 627 trauma patients admitted to the ED. Subjects were classified into 2 groups: adults (⃞55y), and older adults (□55y). Data were collected for demographic and clinical characteristics, physiologic deterioration using the Modified Early Warning Score (MEWS), severity of injury using the Circulation Respiration Abdomen Motor and Speech Score (CRAMS), and outcomes of hospital mortality and LOS. Multivariable logistic and linear regression models were performed. For hospital mortality, an elevated MEWS (Older adults [n= 267]: MEWS≥3, OR=4.80, 95%CI, 1.02-22.56 vs Adults [n = 360]: MEWS≥4, OR=11.63, 95%CI, 1.94-69.82) and CRAMS (Older adults: CRAMS≤9, OR=19.21, 95%CI, 2.78-132.98 vs Adults: CRAMS≤6, OR=18.58, 95%CI, 3.40-101.65) were strongly predictive, adjusted for demographic and clinical data. For LOS, road traffic accident (RTA) (Older adults: β=0.80, 95%CI, 0.31-1.29, p < .01 vs Adults: β=0.44, 95%CI, 0.21-0.67, p < .001) and falls (Older adults: β=0.88, 95%CI, 0.44-1.32, p < .001 vs Adults: β=0.33, 95%CI, 0.02-0.65, p < .05) were associated with LOS, adjusted for demographic and clinical data. MEWS and CRAMS predicted hospital mortality, and RTA and falls predicted LOS in both age groups. Results support the need for interventions for close monitoring and medical management for older traumatized patients based on CRAMS and MEWS assessment to decrease the risk of death, and targeting those sustaining falls and RTA to reduce prolonged LOS.

scholarly journals Outcomes of major trauma among patients with chronic kidney disease and receiving dialysis in Nova Scotia: a retrospective analysis

2021 ◽  
Vol 6 (1) ◽  
pp. e000672
Author(s):  
Ryan Pratt ◽  
Mete Erdogan ◽  
Robert Green ◽  
David Clark ◽  
Amanda Vinson ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Nova Scotia ◽  
Kidney Disease ◽  
Hospital Mortality ◽  
Major Trauma ◽  
Injury Severity ◽  
Cox Regression ◽  
Trauma Patients ◽  
Risk Of Death ◽  
Increased Risk

BackgroundThe risk of death and complications after major trauma in patients with chronic kidney disease (CKD) is higher than in the general population, but whether this association holds true among Canadian trauma patients is unknown.ObjectivesTo characterize patients with CKD/receiving dialysis within a regional major trauma cohort and compare their outcomes with patients without CKD.MethodsAll major traumas requiring hospitalization between 2006 and 2017 were identified from a provincial trauma registry in Nova Scotia, Canada. Trauma patients with stage ≥3 CKD (estimated glomerular filtration rate <60 mL/min/1.73 m2) or receiving dialysis were identified by cross-referencing two regional databases for nephrology clinics and dialysis treatments. The primary outcome was in-hospital mortality; secondary outcomes included hospital/intensive care unit (ICU) length of stay (LOS) and ventilator-days. Cox regression was used to adjust for the effects of patient characteristics on in-hospital mortality.ResultsIn total, 6237 trauma patients were identified, of whom 4997 lived within the regional nephrology catchment area. CKD/dialysis trauma patients (n=101; 28 on dialysis) were older than patients without CKD (n=4896), with higher rates of hypertension, diabetes, and cardiovascular disease, and had increased risk of in-hospital mortality (31% vs 11%, p<0.001). No differences were observed in injury severity, ICU LOS, or ventilator-days. After adjustment for age, sex, and injury severity, the HR for in-hospital mortality was 1.90 (95% CI 1.33 to 2.70) for CKD/dialysis compared with patients without CKD.ConclusionIndependent of injury severity, patients without CKD/dialysis have significantly increased risk of in-hospital mortality after major trauma.

scholarly journals 132 Physical Function Comparison of Acutely Unwell COVID-Negative Older Adults Pre-Pandemic and Through-Pandemic; “Covid-Protected”

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
S Ritchie ◽  
C Snape ◽  
N Triteos ◽  
R Vamadevan ◽  
L Olesk ◽  
...  
Keyword(s):  
Older Adults ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Physical Function ◽  
Gait Speed ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Ethical Review ◽  
Short Period ◽  
Elderly Mobility

Abstract Introduction The risk of severe morbidity after COVID-19 infection is high in older adults (Lithander et al, 2020). Subsequent responsive UK Government guidance for older adults included self-isolation during the pandemic. It is therefore hypothesised that during the pandemic older adults are inadvertently deconditioned due to iatrogenic factors such as inactivity, social isolation, hospital-avoidance and malnutrition, and present with reduced resilience to illness and lower levels of function. The OPU continued to admit COVID-negative, or recently termed “COVID-protected”, patients throughout the pandemic. Data captured prior to, and during the COVID-19 pandemic has been compared to explore the implications on older adults, and elicit whether they are protected from the consequences of the pandemic? Method Demographic and physical function data (average 6 m gait-speed, Elderly Mobility Scale) were captured pre- and through-pandemic for all patients admitted to a COVID-negative OPU ward over a one month period. Ethical review was provided through local Trust governance process. Results Pre-pandemic 2019 (n = 67, mean(±SD) age 82.7(±8.2) years, 61%, hospital length-of-stay (LOS) 7.9(±7.3) days, hospital mortality-rate 7.2%) and through-pandemic 2020 (n = 73, 83.1(±8.3) years, 59%♀, LOS 9.0(±9.1) days, hospital mortality-rate 7.5%) data were captured during July 2019 and May 2020 respectively. There were no between-group differences in age [t(−.313) = 138, p = 0.755], gender [X2, 1 df, p = 0.782], LOS [t(0.78) = 134, p = 0.44], or hospital mortality-rate [X2 1 df, p = 0.96]. Through-pandemic patients had a significantly slower 6 m gait-speed (0.11(±0.05) m.s-1) than pre-pandemic (0.16(±0.24) m.s-1); [t(2.74) = 93, p = 0.007] and lower median (IQR) Elderly Mobility Scale (4(6 IQR) vs 9 (12 IQR) [u = 866, p = 0.015]). Conclusion Our data indicates this relatively short period of self-isolation might have significant implications on the physical function of older adults. The likely mechanism is iatrogenic deconditioning. Critical Public Health and policy responses are required to mitigate these unforeseen risks by deploying prehabilitative counter-measures and accurately targeted hospital and community rehabilitation.

Economic impact of hyponatremia in hospitalized patients with cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 17053-17053
Author(s):  
M. A. Callahan ◽  
H. T. Do ◽  
D. W. Caplan ◽  
K. Yoon-Flannery ◽  
R. Seifeldin
Keyword(s):  
Hospital Mortality ◽  
Cancer Patients ◽  
Admission Rate ◽  
Cost Of Care ◽  
Hospital Length Of Stay ◽  
Controlled Study ◽  
Severe Hyponatremia ◽  
Accounting Data ◽  
Risk Of Death ◽  
Control Subjects

17053 Background: Hyponatremia, defined as a serum sodium concentration ([Na+]) =134 mEq/L, is a common electrolyte abnormality in hospitalized cancer patients that may be caused by the primary tumor or metastasis, diagnostic or therapeutic interventions, or a secondary complication. Hospital-acquired hyponatremia is associated with higher costs of care, but many patients present with hyponatremia at admission. Methods: This retrospective case-controlled study assessed the outcomes and cost of care among patients hospitalized for neoplasm who presented with hyponatremia at admission. Laboratory and cost-accounting data from 841 adult patients admitted to an 811-bed university hospital between January 2004 and May 2005 with a principal diagnosis of neoplasm and either mild-to- moderate or moderate-to-severe hyponatremia (serum [Na+] 130–134 mEq/L or <130 mEq/L, respectively) were compared with data from control subjects with matching ICD-9 codes and normal serum [Na+] (135–145 mEq/L) at admission during the same period. Endpoints included hospital length of stay (LOS), ICU admissions, in-hospital mortality, and total costs per admission. Results: Hyponatremia was evident in 18.9% of patients admitted for neoplasm. Patients with moderate-to-severe hyponatremia (n=192) and mild-to- moderate hyponatremia (n=649) demonstrated a significantly longer hospital LOS, higher ICU admission rate, higher in-hospital mortality, and higher median costs than control subjects (n=3610) (Table). These differences among groups remained significant after adjustments were made for age, race, sex, and comorbidity score. Conclusions: Cancer patients presenting with hyponatremia at admission have a longer hospital LOS and higher risk of death and cost of care than do cancer patients presenting without hyponatremia. [Table: see text] No significant financial relationships to disclose.

scholarly journals Clinical decision-making in older adults following emergency admission to hospital. Derivation and validation of a risk stratification score: OPERA

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248477
Author(s):  
Khushal Arjan ◽  
Lui G. Forni ◽  
Richard M. Venn ◽  
David Hunt ◽  
Luke Eliot Hodgson
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Risk Stratification ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Risk Score ◽  
Clinical Decision Making ◽  
External Validation ◽  
Clinical Decision ◽  
Early Warning Score

Objectives of the study Demographic changes alongside medical advances have resulted in older adults accounting for an increasing proportion of emergency hospital admissions. Current measures of illness severity, limited to physiological parameters, have shortcomings in this cohort, partly due to patient complexity. This study aimed to derive and validate a risk score for acutely unwell older adults which may enhance risk stratification and support clinical decision-making. Methods Data was collected from emergency admissions in patients ≥65 years from two UK general hospitals (April 2017- April 2018). Variables underwent regression analysis for in-hospital mortality and independent predictors were used to create a risk score. Performance was assessed on external validation. Secondary outcomes included seven-day mortality and extended hospital stay. Results Derivation (n = 8,974) and validation (n = 8,391) cohorts were analysed. The model included the National Early Warning Score 2 (NEWS2), clinical frailty scale (CFS), acute kidney injury, age, sex, and Malnutrition Universal Screening Tool. For mortality, area under the curve for the model was 0.79 (95% CI 0.78–0.80), superior to NEWS2 0.65 (0.62–0.67) and CFS 0.76 (0.74–0.77) (P<0.0001). Risk groups predicted prolonged hospital stay: the highest risk group had an odds ratio of 9.7 (5.8–16.1) to stay >30 days. Conclusions Our simple validated model (Older Persons’ Emergency Risk Assessment [OPERA] score) predicts in-hospital mortality and prolonged length of stay and could be easily integrated into electronic hospital systems, enabling automatic digital generation of risk stratification within hours of admission. Future studies may validate the OPERA score in external populations and consider an impact analysis.

scholarly journals Maturation process and international accreditation of trauma system in a rapidly developing country

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243658
Author(s):  
Ayman El-Menyar ◽  
Ahammad Mekkodathil ◽  
Mohammad Asim ◽  
Rafael Consunji ◽  
Gustav Strandvik ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Trauma Center ◽  
Trauma System ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Maturation Process ◽  
Level 1 ◽  
Group 2 ◽  
Group 1

Background As trauma systems mature, they are expected to improve patient care, reduce in-hospital complications and optimize outcomes. Qatar has a single trauma center, at the Hamad General Hospital, which serves as the hub for the trauma system that was verified as a level 1 trauma system by the Accreditation Canada International Distinction program in 2014. We hypothesized that this international accreditation was a major step, in the maturation process of the Qatar trauma system, that has positively impacted patient care, reduced complications and improved outcomes of trauma patients in such a rapidly developing country. Methods A retrospective analysis of data was conducted for all trauma patients who were admitted between 2010 and 2018. Data were obtained from the level 1 trauma center registry at Hamad Medical Corporation. Patients were divided into Group 1- pre-accreditation (admitted from January 2010 to October 2014) and Group 2- post-accreditation (admitted from November 2014 to December 2018). Patients’ characteristics and in-hospital outcomes were analyzed and compared. Data included patients’ demographics; injury types, mechanism and injury severity scores, interventions, hospital stay, complications and mortality (pre-hospital and in-hospital). Time series analysis for mortality was performed using expert modeler. Results Data from a total of 15,864 patients was collected and analyzed. Group 2 patients had more severe injuries in comparison to Group 1 (p<0.05). However, Group 2, had a lower complication rate (ventilator associated pneumonia (VAP)) and a shorter mean hospital length of stay (p<0.05). The overall mortality was 8%. In Group 2; the pre-hospital mortality was higher (52% vs. 41%, p = 0.001), while in-hospital mortality was lower (48% vs. 59%) compared to Group 1 (p = 0.001). Conclusions The international recognition and accreditation of the trauma center in 2014 was the key factor in the maturation of the trauma system that improved the in-hospital outcomes. Accreditation also brought other benefits including a reduction in VAP and hospital length of stay. However, further studies are required to explore the maturation process of all individual components of the trauma system including the prehospital setting.

Manual Respiratory Support Increases Cardiac Parasympathetic Activity in Healthy Adults

2019 ◽  
pp. 1-3
Keyword(s):  
Tranexamic Acid ◽  
Final Diagnosis ◽  
Response To Treatment ◽  
Trauma Patients ◽  
Close Monitoring ◽  
Risk Of Death ◽  
Multiple Imaging ◽  
Thrombotic Complications ◽  
Cardiac Parasympathetic Activity ◽  
Intracardiac Masses

Intracardiac masses can be presented in multiple forms. Differentiating the type of the mass is often challenging but crucial to direct the management. This report describes a 31-year-old female who presented with multiple intracardiac masses after one hour of tranexamic acid administration. Multiple imaging modalities used in our patient to reach the final diagnosis of intracardiac thrombosis and to follow up the response to treatment. Tranexamic acid has been used commonly in trauma patients to reduce the risk of death with a good safety profile. Large prospective trials have failed to show a significant association of vascular occlusive events with TXA administration. This case demonstrates the need for close monitoring in post‐trauma TXA recipients to avoid thrombotic complications. Heparin was used successfully to treat these thrombi, and the patient was discharged on enoxaparin to finish six months course of treatment.

Patterns and Effects of Admission Hyperglycemia And Inflammatory Response in Trauma Patients: A Prospective Study

2020 ◽  
Author(s):  
Ayman El-Menyar ◽  
Mohammad Asim ◽  
Fayaz Mir ◽  
Suhail Hakim ◽  
Ahad Kanbar ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Length Of Stay ◽  
Inflammatory Response ◽  
Injury Severity ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Severity Of Injury ◽  
Hs Crp ◽  
Initial Blood

Abstract Background: Hyperglycemia following trauma could be a response to stress. The constellation of the initial hyperglycemia, proinflammatory cytokines and severity of injury among trauma patients is understudied. We aimed to evaluate the patterns and effects of on-admission hyperglycemia and inflammatory response in a level 1 trauma center admissions. Methods: A prospective, observational study was conducted for adult trauma patients who were admitted and tested for on-admission blood glucose, hemoglobin A1c, interleukin (IL)-6 ,Il-18 and hs-CRP. Patients were categorized into 4 groups (non-diabetic normoglycemic, diabetic normoglycemic, diabetic hyperglycemic (DH) and stress-induced hyperglycemic (SIH)). The inflammatory markers were measured on 3 time points (admission, 24 h, and 48 h). Pearson’s correlation test and logistic regression analysis were performed. We hypothesized that higher initial readings of blood glucose and cytokines are associated with severe injuries and worse in-hospital outcomes in trauma patients.Results: During the study period, 250 adult trauma patients were enrolled. Almost 13% of patients presented with hyperglycemia (SIH&DH); of whom 50% had SIH. Compared to the other 3 groups; SIH patients were younger, had significantly higher ISS, higher IL-6 readings, prolonged hospital length of stay and higher mortality. The SIH group had lower Revised Trauma Score (p=0.005), lower Trauma Injury Severity Score (p=0.01) and lower GCS (p=0.001). IL-18 and hs-CRP were comparable among the study groups. Compared to the normoglycemia groups, patients with hyperglycemia had elevated high- sensitive troponin T (p=0.001) and required more blood transfusion (p=0.03). Patients with hyperglycemia had 3-times higher in-hospital mortality than the normoglycemia groups (p=0.02). A significant correlation was identified between initial blood glucose and serum lactate, IL-6, ISS and hospital length of stay. IL-6 correlated well with ISS (r=0.40, p=0.001). On- admission blood glucose had age-sex-GCS adjusted odd ratio 1.20(95% CI 1.06-1.33, p=0.003) for severe injury (ISS≥16).Conclusions: On-admission hyperglycemia is associated with a significant severer injury than normoglycemia patients. Initial blood glucose correlates with serum IL-6 which indicates a potential role of the systemic inflammatory response in the disease pathogenesis among the injured patients. On-admission glucose level could be a useful marker of injury severity, triage and risk assessment in trauma patients.This study was registered at the ClinicalTrials.gov (Identifier: NCT02999386), retrospectively Registered on December 21, 2016 https://clinicaltrials.gov/ct2/show/NCT02999386.

Cirrhosis and Trauma: A Deadly Duo

2005 ◽  
Vol 71 (12) ◽  
pp. 996-1000 ◽  
Author(s):  
A. Britton Christmas ◽  
Ashley K. Wilson ◽  
Glen A. Franklin ◽  
Frank B. Miller ◽  
J. David Richardson ◽  
...  
Keyword(s):  
Hepatic Cirrhosis ◽  
Injury Severity ◽  
Prognostic Indicator ◽  
Outcome Data ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Fourfold Increase ◽  
Abdominal Operation ◽  
Severity Of Injury ◽  
The Impact

It has been previously reported that trauma patients with cirrhosis undergoing emergency abdominal operations exhibit a fourfold increase in mortality independent of their Child's classification. We undertook this review to assess the impact of cirrhosis on trauma patients. We reviewed the records of patients from 1993 to 2003 with documented hepatic cirrhosis and compared them to a 2:1 control population without hepatic cirrhosis and matched for age, sex, Injury Severity Score (ISS), and Glasgow Coma Score (GCS). Demographic, severity of injury, and outcome data were recorded. Student's t test and χ2 were used for statistical analysis and a P < 0.05 was significant. Sixty-one patients had documented cirrhosis and were compared to 156 matched controls. Comparing the two groups demonstrates there was no difference in age, ISS, or GCS. Intensive care stay, hospital length of stay, blood requirements in the first 24 hours postinjury, and mortality (33% vs 1%) was significantly greater in the trauma patients with cirrhosis. Fifty-five per cent of deaths in the cirrhosis group was due to sepsis, and, as the Child's class increases, so does the mortality (Child's A, 15%; B, 37%; and C, 63%). In 64 per cent of cirrhotics without an emergent abdominal operation, mortality was 21 per cent. In the 36 per cent of cirrhotics who had emergent abdominal operation, mortality was 55 per cent. Hepatic cirrhosis in trauma patients, regardless of severity of injury or the need for an abdominal intervention, is a poor prognostic indicator. The necessity of an abdominal operative intervention further amplifies this effect. Trauma and cirrhosis is, in fact, a deadly duo.

Incidental finding of multiple intracardiac masses in severe trauma patient: The challenges in the diagnosis and management of these masses and its implications on patients’ outcome

2019 ◽  
pp. 1-3
Keyword(s):  
Tranexamic Acid ◽  
Incidental Finding ◽  
Final Diagnosis ◽  
Severe Trauma ◽  
Response To Treatment ◽  
Trauma Patients ◽  
Close Monitoring ◽  
Risk Of Death ◽  
Multiple Imaging ◽  
Intracardiac Masses

Intracardiac masses can be presented in multiple forms. Differentiating the type of the mass is often challenging but crucial to direct the management. This report describes a 31-year-old female who presented with multiple intracardiac masses after one hour of tranexamic acid administration. Multiple imaging modalities used in our patient to reach the final diagnosis of intracardiac thrombosis and to follow up the response to treatment. Tranexamic acid has been used commonly in trauma patients to reduce the risk of death with a good safety profile. Large prospective trials have failed to show a significant association of vascular occlusive events with TXA administration. This case demonstrates the need for close monitoring in post‐trauma TXA recipients to avoid thrombotic complications. Heparin was used successfully to treat these thrombi, and the patient was discharged on enoxaparin to finish six months course of treatment.

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