Is Hypothermia Simply a Marker of Shock and Injury Severity or an Independent Risk Factor for Mortality in Trauma Patients? Analysis of a Large National Trauma Registry

Procalcitonin (PCT) and presepsin (PSEP) are useful biomarkers for diagnosing sepsis; however, elevated PCT and PSEP levels may be observed in conditions other than sepsis. We hypothesised that PCT and PSEP levels could increase after severe traumatic injuries. Trauma patients with an Injury Severity Score of ≥16 from October 2013 to September 2015 were enrolled in our study. We examined PCT and PSEP levels and their positive rates on days 0 and 1. PCT and PSEP levels on days 0 and 1 were compared. Risk factors for increasing sepsis biomarker levels were identified by multivariate logistic regression analyses. In this study, 75 patients were included. PCT levels on days 0 and 1 were 0.1±0.4 and 1.8±6.3 ng/ml, respectively (P=0.02). PSEP levels on days 0 and 1 were 221±261 and 222±207 pg/ml, respectively (P=0.98). As per multivariate logistic regression analyses, packed red blood cell (PRBC) transfusion was the only independent risk factor for higher PCT levels on day 1 (P=0.04). Using PCT to diagnose sepsis in trauma patients on day 1 requires caution. PRBC transfusion was found to be a risk factor for increasing PCT levels. On the other hand, PSEP levels were not affected by trauma during the early phases.

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The Effect of Older Blood on Mortality, Need for ICU Care, and the Length of ICU Stay after Major Trauma

The American Surgeon ◽

10.1177/000313480507100918 ◽

2005 ◽

Vol 71 (9) ◽

pp. 781-785 ◽

Cited By ~ 18

Author(s):

Zuri Murrell ◽

Jason S. Haukoos ◽

Brant Putnam ◽

Stanley R. Klein

Keyword(s):

Risk Factor ◽

Length Of Stay ◽

Hospital Mortality ◽

Independent Risk Factor ◽

Injury Severity ◽

Multiple Organ ◽

Independent Effect ◽

Trauma Patients ◽

Packed Red Blood Cells ◽

Icu Stay

The purpose of this study was to determine if the quantity and age of blood is an independent risk factor for in-hospital mortality, need for intensive care unit (ICU) care, and an increased length of stay in the ICU. This was a retrospective cohort study performed at a level I trauma center between 2001 and 2003. Consecutive trauma patients who received at least 1 unit of packed red blood cells (PRBCs) were included. The number of units of PRBCs transfused and the ages of each unit of PRBCs were recorded. Other variables including the patient's age, sex, Trauma-Related Injury Severity Score (TRISS), and whether the blood was leukopoor were collected. End points included in-hospital mortality, need for ICU care, and the length of stay in the ICU (in days). Multivariable logistic and Poisson regression analyses were performed to model the independent effect of the dose of aged blood (defined as the product of the average age of all units received and the total number of units received) with respect to each end point while controlling for age, TRISS, the total number of units administered, and the proportion of blood that was leukopoor. During the study period, 275 patients were studied. Patients who received older blood had a significantly longer ICU stay (RR 1.15, 95% CI: 1.11–1.20), possibly reflecting a higher level of organ dysfunction. Patients who received older blood, however, did not have a significantly higher in-hospital mortality rate (OR 1.21, 95% CI: 0.87–1.69) or a significantly higher need for ICU care (OR 1.20, 95% CI: 0.87–1.64). The quantity of aged blood is an independent risk factor for length of ICU care. This may be a proxy indicator for multiple organ failure. Further research is required to define which patients may benefit from newer blood.

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Helicopter Transport Use for Trauma Patients Is Decreasing Significantly Nationwide but Remains Overutilized

The American Surgeon ◽

10.1177/000313481808401019 ◽

2018 ◽

Vol 84 (10) ◽

pp. 1630-1634 ◽

Cited By ~ 2

Author(s):

Navpreet K. Dhillon ◽

Nikhil T. Linaval ◽

Kavita A. Patel ◽

Christos Colovos ◽

Ara Ko ◽

...

Keyword(s):

Injury Severity ◽

Data Bank ◽

The United States ◽

Trauma Patients ◽

Effective Utilization ◽

National Trauma ◽

National Trauma Data Bank ◽

Minor Injuries ◽

Helicopter Transportation ◽

Rapid Transfer

Rapid transfer of trauma patients to a trauma center for definitive management is essential to increase survival. The utilization of helicopter transportation for this purpose remains heavily debated. The purpose of this study was to characterize the trends in helicopter transportations of trauma patients in the United States over the last decade. Subjects with a primary mode of either ground or helicopter transportation were selected from the National Trauma Data Bank datasets 2007 to 2015. Over this period, the proportion of patients transported by a helicopter decreased significantly in a linear fashion from 17 per cent in 2007 to 10.2 per cent in 2015 ( P < 0.001). The overall mortality of this population was 7.6 per cent and remained unchanged over the study period ( P = 0.545). Almost 3 of 10 subjects (29.4%) transported by a helicopter had an Injury Severity Score <9. The proportion of elderly (>65 years) patients requiring helicopter transportation increased by 69.1 per cent, whereas their associated mortality decreased by 21.5 per cent. The use of a helicopter for the transportation of trauma patients has significantly decreased over the last decade without any significant change in mortality, possibly indicating more effective utilization of available resources. Overtriage of patients with minor injuries remained relatively unchanged.

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Venous Thromboembolism in Trauma Patients

The American Surgeon ◽

10.1177/000313480707301121 ◽

2007 ◽

Vol 73 (11) ◽

pp. 1173-1180 ◽

Cited By ~ 13

Author(s):

Om P. Sharma ◽

Michael F. Oswanski ◽

Rusin J. Joseph ◽

Peter Tonui ◽

Libby Westrick Pa-C ◽

...

Keyword(s):

Risk Factor ◽

Venous Thromboembolism ◽

Injury Severity Score ◽

Severity Score ◽

Injury Severity ◽

Univariate Analysis ◽

Trauma Patients ◽

Vein Thrombosis ◽

Cord Injury ◽

Deep Vein

Serial venous duplex scans (VDS) were done in 507 trauma patients with at least one risk factor (RF) for venous thromboembolism (VTE) during a 2-year study period. Deep vein thrombosis (DVT) was detected in 31 (6.1%) patients. This incidence was 3.1 per cent in low (1–2 RFs), 3.4 per cent in moderate (3–5 RFs), and 7.7 per cent in high (≥6 RFs) VTE scores ( P = 0.172). Incidence was statistically different (3% vs 7.2%, P = 0.048) on reanalyzing patients in two risk categories, low-risk (1–4 RFs) and high-risk (≥5 RFs). Only 4 of 16 RFs had statistically higher incidence of DVT in patients with or without RFs: previous VTE (27.3% vs 5.6%, odds ratio (OR) 6.628, P = 0.024), spinal cord injury (22.6% vs 5%, OR 5.493, P = 0.001), pelvic fractures (11.4% vs 5.1%, OR 2.373, P = 0.042), and head injury with a greater than two Abbreviated Injury Score (10.5% vs 4.2%, OR 2.639, P = 0.014). On reanalyzing patients with ≥5 RFs vs <5RFs, obesity (14.3 vs 6.1%, P = 0.007), malignancy (5.6% vs 0.6%, P = 0.006), coagulopathy (10.8% vs 1.8%, P = 0.000), and previous VTE (3.2% vs 0%, P = 0.019) were significant on univariate analysis. Patients with DVT had 3.70 ± 1.75 RFs and a 9.61 ± 4.93 VTE score, whereas, patients without DVT had 2.66 ± 1.50 RFs and a 6.83 ± 3.91 VTE score ( P = 0.000). DVTs had a direct positive relationship with higher VTE scores, length of stay, and number of VDS (>1 r, P ≤ 0.001). Increasing age was a weak risk factor (0.03 r, P = 0.5). First two VDS diagnosed 77 per cent of DVTs. Patients with injury severity score of ≥15 and 25 had higher DVTs compared with the ones with lower injury severity score levels ( P ≤ 0.05). Pulmonary embolism was silent in 63 per cent and DVTs were asymptomatic in 68 per cent.

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Farm Injuries: Animal Most Common, Machinery Most Lethal: An NTDB Study

The American Surgeon ◽

10.1177/000313481908500737 ◽

2019 ◽

Vol 85 (7) ◽

pp. 752-756

Author(s):

Karl Damroth ◽

Rachel Damroth ◽

Asad Chaudhary ◽

Anfin Erickson ◽

Liam Heneghan ◽

...

Keyword(s):

Injury Severity ◽

Data Bank ◽

Trauma Patients ◽

Age Group ◽

Fatality Rate ◽

P Values ◽

Injury Type ◽

National Trauma ◽

National Trauma Data Bank ◽

Farm Injuries

To characterize both emergency room (ER) and hospital discharge dispositions of patients presenting with farm-related injuries. The 2012 National Trauma Data Bank was queried in August 2017 for injuries occurring on a farm. Patients were stratified by gender, age group, race, Injury Severity Score (ISS), and injury type. We performed logistic regression analysis to correlate parameters with likelihood of discharge home or death. P values < 0.05 were considered significant. Five thousand six hundred thirty-one patients were identified, the majority of whom were male (72%) and white (85%). The most common mechanisms of injury included animal-related (29%), followed by falls, vehicles, and other causes. The highest ISSs were seen in vehicular injuries (11% ISS of 251) and the greatest fatality rate was seen in machinery injuries (4%). Four thousand seven hundred fifty-three (84%) patients were admitted to the hospital, and 4056 (72%) were discharged home from the ER or after hospitalization. One hundred thirty patients (2%) died of their farm-related injury. Most patients presenting to the ER with farm-related injuries survive, are admitted to the hospital, and are ultimately discharged home. Few patients die of their injuries. Animal injury is most common and machinery injury most lethal of farm trauma patients presenting to the ER.

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Association between Insurance Status and Hospital Length of Stay following Trauma

The American Surgeon ◽

10.1177/000313481608200324 ◽

2016 ◽

Vol 82 (3) ◽

pp. 281-288 ◽

Cited By ~ 9

Author(s):

Brian R. Englum ◽

Xuan Hui ◽

Cheryl K. Zogg ◽

Muhammad Ali Chaudhary ◽

Cassandra Villegas ◽

...

Keyword(s):

Length Of Stay ◽

Injury Severity ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Insurance Status ◽

Trauma Patients ◽

Uninsured Patients ◽

National Trauma ◽

Insured Patients ◽

The Relationship

Previous research has demonstrated that nonclinical factors are associated with differences in clinical care, with uninsured patients receiving decreased resource use. Studies on trauma populations have also shown unclear relationships between insurance status and hospital length of stay (LOS), a commonly used metric for evaluating quality of care. The objective of this study is to define the relationship between insurance status and LOS after trauma using the largest available national trauma dataset and controlling for significant confounders. Data from 2007 to 2010 National Trauma Data Bank were used to compare differences in LOS among three insurance groups: privately insured, publically insured, and uninsured trauma patients. Multivariable regression models adjusted for potential confounding due to baseline differences in injury severity and demographic and clinical factors. A total of 884,493 patients met the inclusion criteria. After adjusting for the influence of covariates, uninsured patients had significantly shorter hospital stays (0.3 days) relative to privately insured patients. Publicly insured patients had longer risk-adjusted LOS (0.9 days). Stratified differences in discharge disposition and injury severity significantly altered the relationship between insurance status and LOS. In conclusion, this study elucidates the association between insurance status and hospital LOS, demonstrating that a patient's ability to pay could alter LOS in acute trauma patients. Additional research is needed to examine causes and outcomes from these differences to increase efficiency in the health care system, decrease costs, and shrink disparities in health outcomes.

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Did Amendments to the Ontario Highway Traffic Act in 2009-2010 Affect the Proportion of Alcohol-Related Motor Vehicle Collisions Seen at a Level I Trauma Centre over a 10-year Period?

CJEM ◽

10.1017/cem.2016.343 ◽

2016 ◽

Vol 19 (2) ◽

pp. 106-111

Author(s):

Meghan Garnett ◽

Tanya Charyk Stewart ◽

Michael R Miller ◽

Rodrick Lim ◽

Kristine Van Aarsen ◽

...

Keyword(s):

Injury Severity ◽

Trauma Registry ◽

Motor Vehicle ◽

Trauma Centre ◽

Trauma Patients ◽

Highway Traffic ◽

Motor Vehicle Collisions ◽

Vehicle Collisions ◽

Level I ◽

Legislative Amendments

AbstractObjectivesTo determine if changes to the Ontario Highway Traffic Act (OHTA) in 2009 and 2010 had an effect on the proportion of alcohol-related motor vehicle collisions (MVCs) presenting to a trauma centre over a 10-year period.MethodsA retrospective review of the trauma registry at a Level I trauma centre in southwestern Ontario was undertaken. The trauma registry is a database of all trauma patients with an injury severity score (ISS) ≥12 and/or who had trauma team activation. Descriptive statistics were calculated. Interrupted time series analyses with ARIMA modeling were performed on quarterly data from 2004-2013.ResultsA total of 377 drivers with a detectable serum ethanol concentration (SEC) were treated at our trauma centre over the 10-year period, representing 21% of all MVCs. The majority (330; 88%) were male. The median age was 31 years, median SEC was 35.3 mmol/L, and median ISS was 21. A total of 29 (7.7%) drinking drivers died from their injuries after arriving to hospital. There was no change in the proportion of drinking drivers after the 2009 amendment, but there was a significant decline in the average SEC of drinking drivers after changes to the law. There was no difference in the proportion of drinking drivers ≤21 years after introduction of the 2010 amendment for young and novice drivers.ConclusionsThere was a significance decline in the average SEC of all drinking drivers after the 2009 OHTA amendment, suggesting that legislative amendments may have an impact on drinking before driving behaviour.

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Epidemiology of Traumatic Esophageal Injury: An Analysis of the National Trauma Data Bank

The American Surgeon ◽

10.1177/000313481908500422 ◽

2019 ◽

Vol 85 (4) ◽

pp. 342-349 ◽

Cited By ~ 1

Author(s):

Alexander A. Xu ◽

Janis L. Breeze ◽

Jessica K. Paulus ◽

Nikolay Bugaev

Keyword(s):

Injury Severity Score ◽

Severity Score ◽

Injury Severity ◽

Traumatic Injury ◽

Data Bank ◽

Esophageal Injury ◽

Trauma Patients ◽

Adult Age ◽

National Trauma ◽

National Trauma Data Bank

Existing literature on traumatic injury of the esophagus (TIE) is limited. We aimed to describe the clinical characteristics and outcomes of TIE. We reviewed the National Trauma Data Bank for the years 2010–2015. We described the demographics, characteristics, and outcomes of adult (age ≥16 years) TIE patients and also compared those factors in blunt versus penetrating TIE. The association between TIE and mortality was analyzed using multivariable logistic regression. Thousand four hundred eleven adult TIE patients were identified (37 per 100,000 trauma patients, 95% confidence intervals (CI): 35, 39). TIE patients were younger (38 vs 52 years), more likely to be male (81% vs 62%), and more severely injured (Injury Severity Score ≥ 25: 45% vs 7%) than patients without TIE (all P < 0.001). TIE was observed 16 times more frequently with penetrating injuries (257 per 100,000, 95% CI: 240, 270) than with blunt injuries (16 per 100,000, 95% CI: 15, 18). Inhospital TIE mortality was 19 per cent. TIE patients had greater risk of mortality than other trauma patients, after adjusting for age, gender, and Injury Severity Score (odds ratio = 1.4, 95% CI: 1.1, 1.7). Mortality in blunt and penetrating TIE did not differ. Although extremely rare, TIE is independently associated with a marked increase in mortality, even after adjusting for other risk factors.

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Blood Transfusion is an Independent Predictor of Mortality after Blunt Trauma

The American Surgeon ◽

10.1177/000313480707300101 ◽

2007 ◽

Vol 73 (1) ◽

pp. 1-5 ◽

Cited By ~ 17

Author(s):

Anthony Charles ◽

Almaasa Shaikh ◽

Madonna Walters ◽

Susan Huehl ◽

Richard Pomerantz

Keyword(s):

Logistic Regression ◽

Blood Transfusion ◽

Blunt Trauma ◽

Injury Severity ◽

Trauma Registry ◽

Blunt Injury ◽

Trauma Patients ◽

Trauma Population ◽

Transfusion Requirements ◽

Level 2

Allogeneic blood transfusion is associated with increased morbidity and mortality. The authors evaluated the affect of blood transfusion, independent of injury severity on mortality. The authors conducted a retrospective review of all patients, age ≥18 years with blunt injury admitted to their Level 2 trauma center from 1994 to 2004 by query of the NTRACS trauma registry. Initial systolic blood pressure and heart rate determined the shock index. Logistic regression was used to model the affect of blood transfusion on mortality. Transfusion requirements were categorized as follows: A, 0 U; B, 1 to 2 U; C, 3 to 5 U; D, ≥6 U blood. In this sample of 8215 blunt trauma patients, 324 patients received blood transfusion. Mortality rates between the transfused and nontransfused groups were 15.12 per cent and 1.84 per cent ( P < 0.000) respectively. In the logistic regression model, transfusion category B did not have a significant affect on the odds of death ( P = 0.176); the affect of transfusing 3 to 5 U and ≥6 U had a mortality odds ratio of 3.22 ( P = 0.002) and 4.87 ( P = 0.000) respectively. Transfusing ≥2U blood was strongly associated with mortality in this blunt trauma population. There must be a continuous attempt to limit blood transfusion when feasible and physiologically appropriate.

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