Is Blood Sugar the Next Lactate?

2006 ◽  
Vol 72 (7) ◽  
pp. 613-618 ◽  
Author(s):  
TherÈSe M. Duane ◽  
Tracey Dechert ◽  
Nicholas Dalesio ◽  
Luke G. Wolfe ◽  
Nicholas Dalesio ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Injury Severity Score ◽  
Blood Glucose Level ◽  
Blood Sugar ◽  
Severity Score ◽  
Injury Severity ◽  
Trauma Patients ◽  
Severely Injured ◽  
Infection Rates ◽  
Initial Blood

This study evaluates whether an initial blood glucose level is similarly predictive of injury severity and outcome as admission lactate in trauma patients. Between February 2004 and June 2005, we prospectively compared patients with presenting blood sugars of ≤150 mg/dL (LBS) with those with blood sugars >150 mg/dL (HBS). Fifty patients had BS above 150 mg/dL, whereas 176 patients were ≤150 mg/dL. These groups had similar demographics except for age. Injury Severity Score (ISS) of ≥15 was seen in 56.0 per cent of HBS patients versus 28.4 per cent of LBS patients (P = 0.0006). HBS patients had similar infection rates (12.0% HBS vs. 5.7% LBS, P = 0.13) but a higher mortality (30.0% HBS vs. 5.7% LBS, P < 0.0001). There was a linear relationship between ISS and BS (r2 = 0.18, P < 0.0001) and ISS and lactate (r2 = 0.17, P < 0.0001). Blood sugar trended with the lactate (r = 0.25, P = 0.0001). Hyperglycemic patients were more severely injured with higher mortality. BS correlated with lactate, and because it is easily obtainable, it may serve as a readily available predictor of injury severity and prognosis.

Comparison of the Prognostic Significance of Initial Blood Lactate and Base Deficit in Trauma Patients

2017 ◽  
Vol 126 (3) ◽  
pp. 522-533 ◽  
Author(s):  
Keyword(s):  
Logistic Regression ◽  
Injury Severity Score ◽  
Blood Lactate ◽  
Severity Score ◽  
Injury Severity ◽  
Prognostic Significance ◽  
Base Deficit ◽  
Trauma Patients ◽  
Operating Characteristics ◽  
Initial Blood

Abstract Background Initial blood lactate and base deficit have been shown to be prognostic biomarkers in trauma, but their respective performances have not been compared. Methods Blood lactate levels and base deficit were measured at admission in trauma patients in three level 1 trauma centers. This was a retrospective analysis of prospectively acquired data. The association of initial blood lactate and base deficit with mortality was tested using receiver operating characteristics curve, logistic regression using triage scores (Revised Trauma Score and Mechanism Glasgow scale and Arterial Pressure score), and Trauma Related Injury Severity Score as a reference standard. The authors also used a reclassification method. Results The authors evaluated 1,075 trauma patients (mean age, 39 ± 18 yr, with 90% blunt and 10% penetrating injuries and a mortality of 13%). At admission, blood lactate was elevated in 425 (39%) patients and base deficit was elevated in 725 (67%) patients. Blood lactate was correlated with base deficit (R2 = 0.54; P &lt; 0.001). Using logistic regression, blood lactate was a better predictor of death than base deficit when considering its additional predictive value to triage scores and Trauma Related Injury Severity Score. This result was confirmed using a reclassification method but only in the subgroup of normotensive patients (n = 745). Conclusions Initial blood lactate should be preferred to base deficit as a biologic variable in scoring systems built to assess the initial severity of trauma patients.

scholarly journals Kontribusi hiperglikemia dan hipoalbuminemia terhadap multiple organ dysfunction syndrome (MODS) pada pasien multitrauma

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Hendri . ◽  
Heber B. Sapan ◽  
Harsali F. Lampus
Keyword(s):  
Blood Glucose ◽  
Serum Albumin ◽  
Injury Severity Score ◽  
Blood Glucose Level ◽  
Sequential Organ Failure Assessment ◽  
Severity Score ◽  
Injury Severity ◽  
Fisher Exact Test ◽  
Exact Test ◽  
Failure Assessment

Abstract: Recent randomized prospective data suggest that early hyperglycemia and hypoalbuminemia are associated with MODS in multitrauma patients. This study was aimed to determine the contribution of early blood glucose elevation and decreased serum albumin in Trauma Emergency Department or ICU patients. We prospectively collected multitrauma patients with Injury Severity Score (ISS) ≥18, blood glucose, serum albumin, aged 14-81 years old, admitted to level I Trauma Centre at Prof. Dr. R. D. Kandou General Hospital Manado from September 2015 through July 2016. Sequential Organ Failure Assessment (SOFA) score was used to determine MODS during hospitalization. The X2 (Fisher exact) test was used to determine the level of significance and odd ratio was used to determine the risk estimation. There were 51 multitrauma patients in this study. The mean age was 31.73 years old; 41 males (80.4%) and 10 females (19.6%); blood glucose level >126 mg/dl occurred in 34 patients (66.7%) and ≤ 126 mg/dL occurred in 17 patients (33.3%). Serum albumin level <3.5 gr/dL occurred in 31 patients (60.8%) and ≥3,5 gr/dl occurred in 20 patients (39.2%). Conclusion: Early hyperglycemia (blood glucose level >126 mg/dL) and hypoalbuminemia (serum albumin <3.5 gr/dL) were associated with significantly higher MODS rates in multitrauma patients independently of injury characteristics. The present of early hyperglycemia and hypoalbuminemia may allow early identification of trauma patients who are at risk for MODS.Keywords: multitrauma, hyperglycemia, hypoalbuminemia, MODSAbstrak: Data prospektif secara random menunjukkan bahwa adanya hiperglikemia dan hipoalbuminemia dapat berisiko terhadap terjadinya MODS pada pasien dengan multitrauma. Penelitian ini bertujuan untuk menentukan kontribusi hiperglikemia dan hipoalbuminemia pada pasien yang dirawat di Instalasi Gawat Darurat maupun di ICU. Data diambil secara prospektif pada pasien multitrauma dengan Injury Severity Score (ISS) ≥18, kadar gula darah dan serum albumin, usia 14-81 tahun yang datang ke Pusat Trauma RSUP Prof Dr. R. D. Kandou Manado selama 11 bulan (September 2015 s/d Juli 2016). Digunakan Sequential Organ Failure Assessment (SOFA) skor untuk menentukan MODS selama dirawat. Data dianalisis dengan X2 atau Fisher exact test untuk tingkat signifikansi dan odd ratio untuk menentukan perkiraan tingkat kesalahan. Hasil penelitian mendapatkan total 51 pasien yang termasuk dalam kriteria inklusi. Rerata usia 31,73 tahun, laki-laki 41 pasien (80,4%) dan perempuan 10 pasien (19,6%). Kadar gula darah >126 mg/dl sebanyak 34 pasien (66,7%) dan kadar gula darah ≤126 mg/dl sebanyak 17 pasien (33,3%). Kadar albumin <3,5 gr/dl sebanyak 31 pasien (60,8%) dan kadar albumin ≥3,5 gr/dl sebanyak 20 pasien (39,2%). Simpulan: Hiperglikemia dengan kadar gula darah >126 mg/dl dan hipoalbuminemia dengan kadar albumin <3,5 gr/dl sangat berisiko untuk terjadi MODS pada pasien-pasien trauma namun tergantung dari beratnya cedera yang dialami. Adanya hiperglikemia dan hipoalbuminemia merupakan tanda awal terhadap risiko terjadinya MODS pada pasien multitrauma.Kata kunci: multitrauma, hiperglikemia, hipoalbuminemia, MODS

Blood Utilization at a Level I Trauma Center: Is this as Good as it Gets?

2009 ◽  
Vol 75 (8) ◽  
pp. 693-698
Author(s):  
Sebron W. Harrison ◽  
Russell L. Griffin ◽  
Jeffrey D. Kerby ◽  
Marisa B. Marques ◽  
Loring W. Rue ◽  
...  
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Trauma Center ◽  
Injury Severity ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Trauma Patients ◽  
Severely Injured ◽  
Level I ◽  
Rbc Transfusion

Recognition of the adverse effects of allogeneic blood resulted in the decreased use of red blood cell (RBC) transfusion in surgical practice in the 1990s. Our objective was to evaluate patterns of RBC transfusion utilization among trauma patients during the current decade. Blunt trauma patients admitted to a regional trauma center between 2000 and 2007 were identified (n = 16,011). Annual trends in RBC utilization were estimated (negative binomial regression for continuous dependent variables and logistic regression for dichotomous variables). Models were stratified by Injury Severity Score to adjust for injury severity. Although the proportion of patients receiving a blood transfusion within 48 hours of hospitalization significantly increased ( P < 0.0001), there was no significant change in the rate of units transfused ( P = 0.5152) among transfused patients. After stratification by Injury Severity Score, a significantly decreasing trend in the proportion of severely injured patients transfused was observed ( P = 0.0243). Annual variation in the relatively less injured groups was not significant. In the current decade, transfusion utilization at a Level I trauma center has demonstrated minimal variation on a year-to-year basis. Among the severely injured, the temporal decrease in relatively early utilization of RBC transfusion may reflect increasing inclination to accept a greater degree of anemia in higher acuity patients.

Non-Selective Thoracic Computed Tomography in Trauma Patients Results in Injury Severity Score Inflation

2021 ◽  
pp. 000313482110249
Author(s):  
Leonardo Alaniz ◽  
Omaer Muttalib ◽  
Juan Hoyos ◽  
Cesar Figueroa ◽  
Cristobal Barrios
Keyword(s):  
Computed Tomography ◽  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Treatment Plan ◽  
Mortality Prediction ◽  
Trauma Patients ◽  
Mortality Benefit ◽  
Severity Scores ◽  
Score Inflation

Introduction Extensive research relying on Injury Severity Scores (ISS) reports a mortality benefit from routine non-selective thoracic CTs (an integral part of pan-computed tomography (pan-CT)s). Recent research suggests this mortality benefit may be artifact. We hypothesized that the use of pan-CTs inflates ISS categorization in patients, artificially affecting admission rates and apparent mortality benefit. Methods Eight hundred and eleven patients were identified with an ISS >15 with significant findings in the chest area. Patient charts were reviewed and scores were adjusted to exclude only occult injuries that did not affect treatment plan. Pearson chi-square tests and multivariable logistic regression were used to compare adjusted cases vs non-adjusted cases. Results After adjusting for inflation, 388 (47.8%) patients remained in the same ISS category, 378 (46.6%) were reclassified into 1 lower ISS category, and 45 (5.6%) patients were reclassified into 2 lower ISS categories. Patients reclassified by 1 category had a lower rate of mortality ( P < 0.001), lower median total hospital LOS ( P < .001), ICU days ( P < .001), and ventilator days ( P = 0.008), compared to those that remained in the same ISS category. Conclusion Injury Severity Score inflation artificially increases survival rate, perpetuating the increased use of pan-CTs. This artifact has been propagated by outdated mortality prediction calculation methods. Thus, prospective evaluations of algorithms for more selective CT scanning are warranted.

Predictors of blunt diaphragm injury in Australia

Trauma ◽  
2021 ◽  
pp. 146040862110418
Author(s):  
Annelise M Cocco ◽  
Vignesh Ratnaraj ◽  
Benjamin PT Loveday ◽  
Kellie Gumm ◽  
Phillip Antippa ◽  
...  
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Major Trauma ◽  
Injury Severity ◽  
Rib Fractures ◽  
Organ Injury ◽  
Trauma Patients ◽  
Missed Injury ◽  
Diaphragm Injury ◽  
Trauma Service

Introduction Blunt diaphragm injury (BDI) is an uncommon, potentially fatal consequence of blunt torso injury. While associations between BDI and other factors such as mechanism of injury or other injuries have been described elsewhere, little recent research has been done in Australia into BDI. The aims of this study were to determine the incidence rate of BDI in our centre, identify how it was diagnosed, determine rates of missed injury and identify predictive factors for BDI. The hypothesis was that patients with BDI would significantly differ to those without BDI. Methods All major trauma patients with blunt torso injuries at our Level 1 major trauma service from 2010 to 2018 were included. Data for patient demographics, other injuries, diagnosis and treatment of BDI were extracted. Patients with BDI were compared with patients without BDI in order to identify differences that could be used to predict BDI in future patients. Results Of 5190 patients with a blunt torso injury, 51 (0.98%) had a BDI at a mean age of 53 ± 19.6 years, and median Injury Severity Score (ISS) of 27(IQR 21–38.5) compared with 5139 patients with a mean age of 48.2 ± 20.7 years and median ISS of 21.9(IQR 14–26) who did not have a BDI. The diagnosis of BDI was made at CT ( n = 35), surgery ( n = 14) or autopsy ( n = 2). Blunt diaphragm injury was missed on index imaging for 11 of 43 patients (25.6%). On multivariate analysis, each point increase in ISS (OR 1.03, p = 0.02); rib fractures (OR 4.65, p = 0.004); splenic injury (OR 2.60, p = 0.004); and liver injury (OR 2.78, p = 0.003) were independently associated with BDI. Conclusion Injury Severity Score, rib fractures and solid abdominal organ injury increase the likelihood of BDI. In patients with these injuries, BDI should be considered even in the presence of normal CT findings.

Proteinuria as a Predictor of Renal Dysfunction in Trauma Patients Receiving Intravenous Contrast

2011 ◽  
Vol 77 (9) ◽  
pp. 1194-1200 ◽  
Author(s):  
Justin J. Clark ◽  
Linda L. Wong ◽  
Fedor Lurie ◽  
Brad K. Kamitaki
Keyword(s):  
Injury Severity Score ◽  
Renal Dysfunction ◽  
Severity Score ◽  
Injury Severity ◽  
Fresh Frozen Plasma ◽  
Trauma Patients ◽  
Intravenous Contrast ◽  
Contrast Enhanced ◽  
Fresh Frozen ◽  
Enhanced Imaging

Trauma patients have unknown comorbidities, multiple injuries, and incomplete laboratory testing, yet require contrast-enhanced imaging to identify potentially life-threatening problems. Our goal was to characterize contrast-induced nephropathy (CIN) in this population. We retrospectively reviewed characteristics of 402 patients who presented to a Level II trauma center and received contrast-enhanced imaging. CIN was defined as creatinine rise of 0.5 mg/dL or greater or 25 per cent or greater from baseline within 48 hours. CIN occurred in 7.7 per cent and four patients required hemodialysis. Patients with CIN were older, had lower admission hemoglobin, higher Injury Severity Score, and received more blood products. Factors that predicted CIN included: male sex, age older than 46 years, body mass index less than 27 kg/m2, glomerular filtration rate less than 109 mL/min/1.73 m2, hemoglobin less than 12 mg/dL, hematocrit less than 36 per cent, proteinuria, 2 units or more of fresh-frozen plasma in 48 hours, and alcohol use. Odds ratio for developing CIN with two, five, or six of these factors was 3.39, 6.54, and 8.38, respectively. A match-controlled analysis for Injury Severity Score and age in patients with CIN versus non-CIN patients revealed the strongest predictor of CIN was proteinuria (relative risk, 2.5; confidence interval, 1.1 to 5.8). Although it is difficult to truly differentiate CIN from renal dysfunction related to injury severity in trauma patients, proteinuria may be an important factor in identifying nephropathy in this population.

Venous Thromboembolism in Trauma Patients

2007 ◽  
Vol 73 (11) ◽  
pp. 1173-1180 ◽  
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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