Prehospital Prediction of Intensive Care Unit Stay and Mortality in Blunt Trauma Patients

Obesity incidence in the trauma population is increasing. Abdominal compartment syndrome has poor outcomes when left untreated. Surgeons may treat obese patients differently because of concern for increased morbidity and mortality. We studied the effects of body mass index (BMI) on resource utilization and outcome. An Institutional Review Board-approved retrospective review of trauma patients requiring temporary abdominal closure (TAC) was performed. Patients were stratified as follows: Group 1-BMI = 18.5 to 24.9 kg/m2, Group 2-BMI = 25 to 29.9 kg/m2, Group 3-BMI = 30 to 39.9 kg/m2, Group 4-BMI ≥ 40 kg/m2. Demographic data, illness severity as defined by Injury Severity Score, Acute Physiology and Chronic Health Evaluation Score Version II and Simplified Acute Physiology Score Version II scores, resource utilization, fascial closure rate, and survival were collected. About 380 patients required TAC. Median age of Group 1 was significantly lower than Groups 2 and 3 ( P = 0.001). Severity of illness did not differ. Group 4 had a longer intensive care unit stay compared with Groups 1 and 2 ( P = 0.005). Group 4 required mechanical ventilation longer than Group 1 ( P = 0.027). Hospital stay, fascial closure, and survival were equivalent. Obese trauma patients with TAC have a longer intensive care unit stay and more ventilator days, but there is no difference in survival or type of closure. TAC can be used safely in trauma patients with a BMI ≥ 30 kg/m2.

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Decreasing maintenance fluids in normotensive trauma patients may reduce intensive care unit stay and ventilator days

Journal of Critical Care ◽

10.1016/j.jcrc.2015.09.030 ◽

2016 ◽

Vol 31 (1) ◽

pp. 201-205 ◽

Cited By ~ 5

Author(s):

Galinos Barmparas ◽

Ara Ko ◽

Megan Y. Harada ◽

Andrea A. Zaw ◽

Jason S. Murry ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Intensive Care Unit Stay ◽

Trauma Patients ◽

Maintenance Fluids

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Association between increased blood interleukin-6 levels on emergency department arrival and prolonged length of intensive care unit stay for blunt trauma

World Journal of Emergency Surgery ◽

10.1186/s13017-016-0063-8 ◽

2016 ◽

Vol 11 (1) ◽

Cited By ~ 2

Author(s):

Masashi Taniguchi ◽

Taka-aki Nakada ◽

Koichiro Shinozaki ◽

Yasuaki Mizushima ◽

Tetsuya Matsuoka

Keyword(s):

Intensive Care Unit ◽

Emergency Department ◽

Intensive Care ◽

Intensive Care Unit Stay ◽

Blunt Trauma ◽

Interleukin 6 ◽

Prolonged Length ◽

Emergency Department Arrival

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Sarcopenia is a predictive factor for prolonged intensive care unit stays in high‐energy blunt trauma patients

Acute Medicine & Surgery ◽

10.1002/ams2.195 ◽

2016 ◽

Vol 3 (4) ◽

pp. 326-331 ◽

Cited By ~ 6

Author(s):

Tomohiko Akahoshi ◽

Mitsuhiro Yasuda ◽

Kenta Momii ◽

Kensuke Kubota ◽

Yuji Shono ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Blunt Trauma ◽

Predictive Factor ◽

High Energy ◽

Trauma Patients

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Early prediction of length of intensive care unit stay from inflammatory mediators in trauma patients

Journal of Critical Care ◽

10.1016/j.jcrc.2010.12.027 ◽

2011 ◽

Vol 26 (2) ◽

pp. e5-e6 ◽

Cited By ~ 2

Author(s):

Cordelia Ziraldo ◽

Ali Ghuma ◽

Rajaie Namas ◽

Juan Ochoa ◽

Timothy R. Billiar ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Intensive Care Unit Stay ◽

Inflammatory Mediators ◽

Trauma Patients ◽

Early Prediction

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The clinical significance of hyperglycemia in nondiabetic critically ill multiple trauma patients

Therapeutic Advances in Endocrinology and Metabolism ◽

10.1177/2042018818779746 ◽

2018 ◽

Vol 9 (8) ◽

pp. 223-230 ◽

Cited By ~ 3

Author(s):

Leonid Koyfman ◽

Evgeni Brotfain ◽

Dmitry Frank ◽

Yoav Bichovsky ◽

Inna Kovalenko ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Blood Glucose ◽

Intensive Care Unit Stay ◽

Multiple Trauma ◽

Critically Ill ◽

Clinical Significance ◽

Trauma Patients ◽

Ventilator Associated Pneumonia ◽

Multiple Trauma Patients

Background: Information is inconsistent regarding the clinical role of acute elevations of blood glucose level secondary to hospital-acquired infections in nondiabetic critically ill patients during an intensive care unit stay. In this study we investigated the clinical significance of hyperglycemia related to new episodes of ventilator-associated pneumonia in nondiabetic critically ill multiple trauma intensive care unit patients. Materials and Methods: We analyzed the clinical data of 202 critically ill multiple trauma patients with no history of previous diabetes who developed a new ventilator-associated pneumonia episode during their intensive care unit stay. We used a time-from-event analysis method to assess whether acute changes in blood glucose levels that occurred prior to the onset of ventilator-associated pneumonia episodes had a different prognostic significance from those that occurred during such episodes. Glucose levels and other laboratory data were recorded for up to 5 days before ventilator-associated pneumonia events and for 5 days following these events. Results: Patients who required insulin therapy for persistent hyperglycemia related to a new ventilator-associated pneumonia event had a longer period of intensive care unit stay and a higher intensive care unit mortality rate than patients who did not require insulin for blood glucose control ( p < 0.008 and <0.001 respectively). In addition, older age, administration of parenteral nutrition, and elevated mean blood glucose level parameters on the day following the day of diagnosis of a new ventilator-associated pneumonia episode were found to be independent risk factors for intensive care unit mortality. Conclusion: Our study suggests that persistent hyperglycemia in nondiabetic critically ill patients, even treated by early insulin therapy, is an adverse prognostic factor of considerable clinical significance.

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