scholarly journals Predictors of Mortality and Prehospital Monitoring Limitations in Blunt Trauma Patients

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Matej Strnad ◽  
Vesna Borovnik Lesjak ◽  
Vitka Vujanović ◽  
Tine Pelcl ◽  
Miljenko Križmarić
Keyword(s):  
Hospital Mortality ◽  
Regression Model ◽  
Blunt Trauma ◽  
Injury Severity ◽  
Vital Signs ◽  
Study Groups ◽  
Multivariate Logistic Regression Model ◽  
Hospital Death ◽  
Trauma Patients ◽  
Arterial Blood

This study aimed at determining predictors of in-hospital mortality and prehospital monitoring limitations in severely injured intubated blunt trauma patients. We retrospectively reviewed patients’ charts. Prehospital vital signs, Injury Severity Score (ISS), initial Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), arterial blood gases, and lactate were compared in two study groups: survivors (n=40) and nonsurvivors (n=30). There were no significant differences in prehospital vital signs between compared groups. Nonsurvivors were older (P=0.006), with lower initial GCS (P<0.001) and higher ISS (P<0.001), along with higher lactate (P<0.001) and larger base deficit (BD;P=0.006), whereas RTS (P=0.001) was lower in nonsurvivors. For predicting mortality, area under the curve (AUC) was calculated: for lactate 0.82 (P<0.001), for ISS 0.82 (P<0.001), and for BD 0.69 (P=0.006). Lactate level of 3.4 mmol/L or more was 82% sensitive and 75% specific for predicting in-hospital death. In a multivariate logistic regression model, ISS (P=0.037), GCS (P=0.033), and age (P=0.002) were found to be independent predictors of in-hospital mortality. The AUC for regression model was 0.93 (P<0.001). Increased levels of lactate and BD on admission indicate more severe occult hypoperfusion in nonsurvivors whereas vital signs did not differ between the groups.

scholarly journals Comparative analysis of the frequency and the severity of diagnosed lesions between pedestrians struck by motor vehicles and other blunt trauma mechanisms victims

2015 ◽  
Vol 42 (4) ◽  
pp. 253-258 ◽  
Author(s):  
JOSÉ GUSTAVO PARREIRA ◽  
RAFAEL KRIEGER MARTINS ◽  
JULIO SLONGO ◽  
JACQUELINE A. GIANNINI PERLINGEIRO ◽  
SILVIA CRISTINE SOLDÁ ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Motor Vehicle ◽  
Flail Chest ◽  
Vital Signs ◽  
Motor Vehicles ◽  
Trauma Patients ◽  
Arterial Blood ◽  
Group A ◽  
Extremity Injuries ◽  
Mechanism Of Trauma

ABSTRACTObjective:to compare the frequency and the severity of diagnosed injuries between pedestrians struck by motor vehicles and victims of other blunt trauma mechanisms.Methods:retrospective analysis of data from the Trauma Registry, including adult blunt trauma patients admitted from 2008 to 2010. We reviewed the mechanism of trauma, vital signs on admission and the injuries identified. Severity stratification was carried using RTS, AIS-90, ISS e TRISS. Patients were assigned into group A (pedestrians struck by motor vehicle) or B (victims of other mechanisms of blunt trauma). Variables were compared between groups. We considered p<0.05 as significant.Results:a total of 5785 cases were included, and 1217 (21,0%) of which were in group A. Pedestrians struck by vehicles presented (p<0.05) higher mean age, mean heart rate upon admission, mean ISS and mean AIS in head, thorax, abdomen and extremities, as well as lower mean Glasgow coma scale, arterial blood pressure upon admission, RTS and TRISS. They also had a higher frequency of epidural hematomas, subdural hematomas, subarachnoid hemorrhage, brain swelling, cerebral contusions, costal fractures, pneumothorax, flail chest, pulmonary contusions, as well as pelvic, superior limbs and inferior limbs fractures.Conclusion:pedestrian struck by vehicles sustained intracranial, thoracic, abdominal and extremity injuries more frequently than victims of other blunt trauma mechanism as a group. They also presented worse physiologic and anatomic severity of the trauma.

scholarly journals In-Hospital Mortality Risk of Transcatheter Arterial Embolization for Patients with Severe Blunt Trauma: A Nationwide Observational Study

2020 ◽  
Vol 9 (11) ◽  
pp. 3485
Author(s):  
Masayasu Gakumazawa ◽  
Chiaki Toida ◽  
Takashi Muguruma ◽  
Mafumi Shinohara ◽  
Takeru Abe ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Hospital Mortality ◽  
Blunt Trauma ◽  
Mortality Risk ◽  
Transcatheter Arterial Embolization ◽  
Injury Severity ◽  
Multivariate Logistic Regression Analysis ◽  
Arterial Embolization ◽  
Trauma Patients ◽  
Urgent Surgery

This study investigated the risk factors for in-hospital mortality of severe blunt trauma patients who underwent transcatheter arterial embolization (TAE). We analysed data from the Japan Trauma Data Bank from 2009 to 2018. Patients with severe blunt trauma and an Injury Severity Score (ISS) ≥ 16 who underwent TAE were enrolled. The primary analysis evaluated patient characteristics and outcomes, and variables with significant differences were included in the secondary multivariate logistic regression analysis. In total, 5800 patients (6.4%) with ISS ≥ 16 underwent TAE. There were significant differences in the proportion of male patients, transportation method, injury mechanism, injury region, Revised Trauma Score, survival probability values, and those who underwent urgent blood transfusion and additional urgent surgery. In multivariable regression analyses, higher age, urgent blood transfusion, and initial urgent surgery were significantly associated with higher in-hospital mortality risk [p < 0.001, odds ratio (OR), 95% confidence interval (CI): 1.01 (1.00–1.01); p < 0.001, 3.50 (2.55–4.79); and p = 0.001, 1.36 (1.13–1.63), respectively]. Inter-hospital transfer was significantly associated with lower in-hospital mortality risk (p < 0.001, OR = 0.56, 95% CI = 0.44–0.71). Treatment protocols for urgent intervention before and after TAE and a safe, rapid inter-hospital transport system are needed to improve mortality risks for severe blunt trauma patients.

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.

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.

Clinical Characteristics of Trauma Patients Requiring Hydrocortisone Treatment for Refractory Hypotension

2017 ◽  
Vol 83 (8) ◽  
pp. 821-824
Author(s):  
Gina Kim ◽  
Jeffrey Young
Keyword(s):  
Hospital Mortality ◽  
Injury Severity ◽  
Traumatic Injury ◽  
Patient Characteristics ◽  
Data Repository ◽  
Trauma Patients ◽  
Lower Blood ◽  
Refractory Hypotension ◽  
The University ◽  
Stress Dose

Corticosteroids play an important role in responding to physiologic stress in the human body. However, its application in critical care remains heavily debated. The purpose of this study was to identify patient characteristics associated with receiving stress-dose steroids during the intensive care unit stay after traumatic injury and its effect on in-hospital mortality. Patients admitted to the University of Virginia trauma center between January 1, 2011, and December 31, 2015, were identified using our Trauma Registry. Stress dose steroids were defined as 100 mg IV hydrocortisone every eight hours. Patients who received stress-dose steroids were identified using the Clinical Data Repository. Patient characteristics associated with increased likelihood of receiving stress-dose steroids during admission were age >65, diabetes mellitus, congestive heart failure, burn injuries, Injury Severity Score >15, lower blood pressure (141/80 vs 125/76 mm Hg), and higher heart rate (87 vs 94/min). Patients who received stress-dose steroids were found to have increased mortality but not after controlling for the aforementioned patient factors associated with increased likelihood of receiving stress-dose steroids. The use of stress-dose steroids in critically ill patients with refractory hypotension does not appear to affect in-hospital mortality.

scholarly journals Non-invasive Hemodynamic Monitoring in Prediction of the Outcome and Prognosis in Sepsis

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M S M Zaki ◽  
A A A Kassem ◽  
R H A Mohamed ◽  
N N M Guirguis
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Cardiac Index ◽  
Hospital Mortality ◽  
Hemodynamic Monitoring ◽  
Oxygen Delivery ◽  
Impedance Cardiography ◽  
Hospital Death ◽  
Arterial Blood ◽  
Causal Therapy

Abstract Background Complex disease syndromes such as sepsis require multimodal diagnostic and therapeutic approaches. Besides the diagnosis of septic shock and early causal therapy, one major challenge in its treatment remains the resuscitation and management of cardiocirculatory and respiratory dysfunction. As Pulmonary artery catheterization poses significant risks and requires specialized training. Technological advances allow for more readily available, noninvasive clinical measurements of hemodynamics. Impedance cardiography (ICG) offers the potential for safe, noninvasive hemodynamic monitoring that can be easily applied. Objective To evaluate the effect of cardiac index, mean arterial blood pressure, heart rate, and oxygen delivery as measured noninvasively by impedance cardiography (ICG) in prediction of the outcome and prognosis in sepsis. Patients and Methods This is a prospective, observational convenience trial of patients presenting to the ED or the ICU with severe sepsis or septic shock. The patients were part of a cohort that was followed at day 1, day 3 and day7, or until hospital discharge or in-hospital death. After Approval is obtained from the research ethics committee of anesthesia and intensive care department, Ain Shams University. Oral informed consent is obtained from the patient or designated surrogate before data collection begins. Results Twenty-three were enrolled; three were excluded due to an inability to complete data acquisition. The mean cardiac index in nonsurvivors (2.3 L / minÆm2, 95% CI = 2.1 to 2.6) was less than that for survivors (3.3, 95% CI = 2.9 to 3.5). Oxygen delivery as well as lactate were less in non-survivors group. A cardiac index of &lt; 2.5 L / minÆm2 had a sensitivity of 43% (95% CI = 18% to 71%), specificity of 93% (95% CI = 80% to 95%), for predicting in-hospital mortality. Conclusions Early, noninvasive measurement of the cardiac index in critically ill severe sepsis and septic shock patients can be performed in the ED for those who meet criteria for EGDT. There appears to be an association between an initial lower cardiac index as measured noninvasively and in-hospital mortality.

Massive Transfusion Protocol and Subsequent Development of Venous Thromboembolism: Statewide Analysis

2020 ◽  
pp. 000313482094890
Author(s):  
Eric H. Bradburn ◽  
Kwok M. Ho ◽  
Madison E. Morgan ◽  
Lauren D’Andrea ◽  
Tawnya M. Vernon ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Injury Severity ◽  
Massive Transfusion ◽  
Subsequent Development ◽  
Multivariate Logistic Regression Model ◽  
Trauma Patients ◽  
Vte Prophylaxis ◽  
Vein Thrombosis ◽  
Hemorrhagic Event ◽  
High Index Of Suspicion

Background Massive transfusion protocols (MTP) are a routine component of any major trauma center’s armamentarium in the management of exsanguinating hemorrhages. Little is known about the potential complications of those that survive a MTP. We sought to determine the incidence of venous thromboembolism (VTE) following MTP. We hypothesized that MTP would be associated with a higher risk of VTE when compared with a risk-adjusted control population without MTP. Methods The Pennsylvania Trauma Outcome Study database was retrospectively queried from 2015 to 2018 for trauma patients who developed VTE and survived until discharge at accredited trauma centers in Pennsylvania. Patient demographics, injury severity, and clinical outcomes were compared to assess differences in VTE development between MTP and non-MTP patients. A multivariate logistic regression model assessed the adjusted impact of MTP on VTE development. Results 176 010 patients survived until discharge, meeting inclusion criteria. Of those, 1667 developed a VTE (pulmonary embolism [PE]: 662 [0.4%]; deep vein thrombosis [DVT]: 1142 [0.6%]; PE and DVT: 137 [0.1%]). 1268 patients (0.7%) received MTP and, of this subset of patients, 171 (13.5%) developed a VTE during admission. In adjusted analysis, patients who had a MTP and survived until discharge had a higher odds of developing a VTE (adjusted odds ratio: 2.62; 95% CI: 2.13-3.24; P < .001). Discussion MTP is a harbinger for higher risk of VTE in those patients who survive. This may, in part, be related to the overcorrection of coagulation deficits encountered in the hemorrhagic event. A high index of suspicion for the development of VTE as well as aggressive VTE prophylaxis is warranted in those patients who survive MTP.

scholarly journals Traumatic brain injury with concomitant injury to the spleen: characteristics and mortality of a high-risk trauma cohort from the TraumaRegister DGU®

2020 ◽  
Author(s):  
Marius Marc-Daniel Mader ◽  
Rolf Lefering ◽  
Manfred Westphal ◽  
Marc Maegele ◽  
Patrick Czorlich
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Hospital Mortality ◽  
Injury Severity ◽  
Cohort Analysis ◽  
Independent Effect ◽  
Trauma Patients ◽  
Confounding Factors ◽  
Retrospective Cohort Analysis ◽  
Effect Of Splenectomy

Abstract Purpose Based on the hypothesis that systemic inflammation contributes to secondary injury after initial traumatic brain injury (TBI), this study aims to describe the effect of splenectomy on mortality in trauma patients with TBI and splenic injury. Methods A retrospective cohort analysis of patients prospectively registered into the TraumaRegister DGU® (TR-DGU) with TBI (AISHead ≥ 3) combined with injury to the spleen (AISSpleen ≥ 1) was conducted. Multivariable logistic regression modeling was performed to adjust for confounding factors and to assess the independent effect of splenectomy on in-hospital mortality. Results The cohort consisted of 1114 patients out of which 328 (29.4%) had undergone early splenectomy. Patients with splenectomy demonstrated a higher Injury Severity Score (median: 34 vs. 44, p < 0.001) and lower Glasgow Coma Scale (median: 9 vs. 7, p = 0.014) upon admission. Splenectomized patients were more frequently hypotensive upon admission (19.8% vs. 38.0%, p < 0.001) and in need for blood transfusion (30.3% vs. 61.0%, p < 0.001). The mortality was 20.7% in the splenectomy group and 10.3% in the remaining cohort. After adjustment for confounding factors, early splenectomy was not found to exert a significant effect on in-hospital mortality (OR 1.29 (0.67–2.50), p = 0.45). Conclusion Trauma patients with TBI and spleen injury undergoing splenectomy demonstrate a more severe injury pattern, more compromised hemodynamic status and higher in-hospital mortality than patients without splenectomy. Adjustment for confounding factors reveals that the splenectomy procedure itself is not independently associated with survival.

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