Gastric Injury Increases Infections in Trauma Patients

2008 ◽  
Vol 74 (11) ◽  
pp. 1057-1061 ◽  
Author(s):  
David A. Edelman ◽  
Lydia Donoghue ◽  
Michael T. White ◽  
James G. Tyburski ◽  
Robert F. Wilson
Keyword(s):  
Infection Rate ◽  
Injury Severity ◽  
Adverse Outcome ◽  
Gastric Injury ◽  
Trauma Patients ◽  
Severity Scale ◽  
Colon Injury ◽  
Time Period ◽  
Multiple Injured ◽  
Independent Risk Factors

Some physicians feel gastric injury is not a significant contributing factor to the adverse outcome of trauma patients, but rather a marker of epigastric injury. We hypothesized the addition of a gastric injury to multiple injured trauma patients would increase infection rate. We conducted a retrospective study comparing 450 consecutive patients with full-thickness gastric injury with 983 patients without gastric injury during the same time period. Infection rate in patients with gastric injury was 44 per cent (200 of 455) and significantly higher than 36 per cent (357 of 983) seen without gastric injury (P = 0.006). Logistic regression revealed gastric injury was an independent risk factor for infection controlling for age, Injury Severity Scale, gender, mechanism of injury, shock, and associated injuries (P = 0.047). Requiring a transfusion, Injury Severity Scale, colon injury, age, pancreas injury, and emergency department shock were also independent risk factors for developing an infection. The addition of a gastric injury to a trauma patient appears to increase the risk for infection.

Management and Outcomes of Traumatic Colon Injury in Civilian and Military Patients

2011 ◽  
Vol 77 (12) ◽  
pp. 1685-1691 ◽  
Author(s):  
Chitra N. Sambasivan ◽  
Samantha J. Underwood ◽  
Reed B. Kuehn ◽  
S. D. Cho ◽  
Laszlo N. Kiraly ◽  
...  
Keyword(s):  
United States ◽  
Injury Severity ◽  
Primary Repair ◽  
Patient Characteristics ◽  
The United States ◽  
Trauma Patients ◽  
Colon Injury ◽  
Initial Management ◽  
Civilian Trauma ◽  
Level I

Divergent injury patterns may indicate the need for differing strategies in combat and civilian trauma patients. This study aims to compare outcomes of colon injury management in these two populations. Parallel retrospective reviews were conducted comparing warfighters (n = 59) injured downrange and subsequently transferred to the United States with civilians (n = 30) treated at a United States Level I trauma center. Patient characteristics, mechanisms of injury, treatment course, and complications were compared. The civilian (CP) and military (MP) populations did not differ in Injury Severity Score (MP 20 vs CP 26; P = 0.41). The MP experienced primarily blast injuries (51%) as opposed to blunt trauma (70%; P < 0.01) in the CP. The site of colon injury did not differ between groups ( P = 0.15). Initial management was via primary repair (53%) and resection and anastomosis (27%) in the CP versus colostomy creation (47%) and stapled ends (32%) in the MP ( P < 0.001). Ultimately, the CP and MP experienced equivalent continuity rates (90%). Overall complications (MP 68% vs CP 53%; P = 0.18) and mortality (MP 3% vs CP 3%; P = 0.99) did not differ between the two groups. The CP and MP experience different mechanisms and initial management of colon injury. Ultimately, continuity is restored in the majority of both populations.

Plasma ADAMTS13 Activity Associates with Injury Severity in Pediatric Trauma Patients

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3777-3777
Author(s):  
Jenny K. McDaniel ◽  
Ilan I Maizlin ◽  
Michelle C. Shroyer ◽  
Morgan E. Banks ◽  
Jean-Francois Pittet ◽  
...  
Keyword(s):  
Injury Severity ◽  
Pediatric Trauma ◽  
Initial Presentation ◽  
Trauma Patients ◽  
Adamts13 Activity ◽  
Acute Traumatic Coagulopathy ◽  
Time Period ◽  
Increased Risk ◽  
Significant Difference ◽  
Traumatic Coagulopathy

Abstract Background: Acute traumatic coagulopathy occurs in both pediatric and adult trauma patients and is associated with an increased risk of mortality. Trauma patients not only have increased risk for hemorrhagic complications, but also are at increased risk for thrombosis due to multiple factors including local tissue injury, inflammation, and immobility. The complex underlying pathophysiology of coagulation abnormalities associated with traumatic injury have yet to be fully elucidated. Additionally, there are significant differences in the hemostatic system of pediatric patients compared to adults. Objectives: The purpose of this study was to determine the levels of coagulation parameters including von Willebrand factor (VWF) antigen and ADAMTS13 activity in pediatric trauma patients and evaluate for possible association with injury severity and/or mortality. Methods: This study utilized plasma specimens collected from pediatric trauma patients that presented to our institution over a 2-year time period. The specimens were collected at initial presentation and 24 hours later. The injury severity was estimated using both the Glasgow Coma Scale (GCS) and Injury Severity Score (ISS). A cohort of control samples was obtained from pediatric patients for elective surgical procedures over the same time period. Plasma VWF antigen was determined by a sandwich ELISA; plasma ADAMTS13 activity was determined by FRETS-VWF73. The results were determined by nonparametric tests for the differences in median values. Results: A total of 106 trauma patient samples at initial time point, 78 trauma samples at 24 hour time point, and 54 control samples were obtained and utilized for study. There were statistically significant differences (p<0.05) in the plasma levels of VWF antigen, ADAMTS13 activity, and the ratio of ADAMTS13 activity to VWF antigen for the trauma patient samples at initial presentation when compared to controls (Table 1). At 24 hours, there were still statistically significant differences between ADAMTS13 activity and the ratio of ADAMTS13 activity to VWF antigen in trauma patients compared to controls, but there was no significant difference in VWF antigen between the two cohorts (Table 2). There was a significant difference between the decrease in ADAMTS13 activity and injury severity as estimated by ISS ³ 15 or GCS < 8 at both time points; however, ADAMTS13 activity was not statistically different in survivors vs. non-survivors. A higher VWF antigen level at initial presentation was the only factor found to be significantly different in non-survivors. Conclusions: This study demonstrates significant differences in plasma ADAMTS13 activity and VWF antigen in pediatric trauma patients compared to controls. In patients with more severe injuries as estimated by GCS and ISS, there was also a significant association with decreased levels of ADAMTS13 activity. These finding may underlie part of the prothrombotic propensity in microcirculation that occurs in patients post-trauma. Further investigation is warranted to better understand the mechanisms of acute traumatic coagulopathy and potential prognostic factors, and to determine the most effective interventions for acute traumatic coagulopathy in the pediatric population. Disclosures Zheng: Ablynx: Consultancy; Alexion: Research Funding.

scholarly journals Helicopter Emergency Ambulance Service (HEAS) Transfer: An Analysis of Trauma Patient Case-Mix, Injury Severity and Outcome

2007 ◽  
Vol 89 (5) ◽  
pp. 513-516 ◽  
Author(s):  
JTK Melton ◽  
S Jain ◽  
B Kendrick ◽  
SD Deo
Keyword(s):  
Emergency Department ◽  
Injury Severity ◽  
Ambulance Service ◽  
Case Mix ◽  
Trauma Patients ◽  
Patient Case ◽  
Average Hospital ◽  
Acute Setting ◽  
Time Period ◽  
Emergency Ambulance

INTRODUCTION A retrospective review of all patients transferred by helicopter ambulance to the Great Western Hospital over a 20-month period between January 2003 and September 2004 was undertaken to establish the case-mix of patients (trauma and non-trauma) transferred and the outcome. PATIENTS AND METHODS Details of all Helicopter Emergency Ambulance Service (HEAS) transfers to this unit in the study time period were obtained from the three HEAS providers in the area and case notes were reviewed. RESULTS There were 156 trauma patients transferred (total 193) in the study period with 111 cases identified for analysis with a mean age of 33 years (range, 1–92 years). Average Injury Severity Score on admission was 12 (range, 1–36). Forty-five patients were discharged home from the emergency department, 24 cases had operation, 10 patients required ICU care and 2 were pronounced dead in the emergency department. Average hospital stay following HEAS transfer was 2.97 days (range, 0–18 days). DISCUSSION Helicopter ambulance transfer in the acute setting is of debated value. Triage criteria are at fault if as many as 41% of patients transferred are being discharged home from casualty having incurred the financial cost of helicopter transfer. We suggest that the triage criteria for helicopter emergency transfer should be reviewed.

Damage Control Resuscitation Protocol and the Management of Open Abdomens in Trauma Patients

2014 ◽  
Vol 80 (8) ◽  
pp. 768-775 ◽  
Author(s):  
Matthew Bradley ◽  
Samuel Galvagno ◽  
Amit Dhanda ◽  
Carlos Rodriguez ◽  
Margaret Lauerman ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Injury Severity ◽  
Damage Control ◽  
Fascial Closure ◽  
Trauma Patients ◽  
Damage Control Resuscitation ◽  
Total Blood ◽  
Independent Risk Factors ◽  
Student’S T ◽  
Admission Glasgow Coma Scale

Although the use of damage control laparotomy (DCL) is well established, the effect of damage control resuscitation (DCR) on the management of open abdomens is relatively poorly studied. The aim of the present study was to determine the predictors for failure to achieve primary fascial closure (PFC) after DCL in the setting of a massive transfusion (MT) and DCR. This is a retrospective review over a 12-year period of all patients that underwent MT and DCL. Patients who achieved PFC were compared with those who did not (NPFC). Student's t tests were used to compare the two groups. A multiple logistic regression model was performed to identify independent risk factors for failure to attain PFC. Of 174 patients, 101 achieved PFC. Mean (6 standard deviation) age was 35.6 ± 14.9 years for PFC and 36.3 ± 14.0 years for NPFC ( P = 0.75). Admission Glasgow Coma Scale score was 11.4 ± 4.6 for PFC and 10.6 ± 5.0 for NPFC ( P = 0.25). Initial lactate (7.3 ± 3.8 vs 7.7 ± 4.1, P = 0.50), hemoglobin (11.3 ± 1.9 vs 11.0 ± 2.2, P = 0.43), systolic blood pressure (108 ± 44 vs 107 ± 35, P = 0.82), Injury Severity Score (34 ± 14 vs 36 ± 15, P = 0.32), and abdominal Abbreviated Injury Score (3.6 ± 1.1 vs 3.9 ± 1.0, P = 0.13) were similar between the two groups. There was no difference in total blood products administered at 24 hours (46 ± 26 vs 49 ± 29 units, P = 0.45). Logistic regression identified increasing volume of crystalloid at 24 hours (odds ratio, 0.86; 95% confidence interval, 0.74 to 0.99; P = 0.047), earlier operative year (2.1; 1.52 to 2.91; P < 0.001), and increased number of procedures (0.32, 0.18 to 0.58; P < 0.001) as independent predictors for failure to obtain PFC. Injury severity is not associated with failure to achieve PFC, whereas administration of large-volume crystalloid resuscitation, increasing number procedures, and earlier year of DCL are independent predictors for failure to achieve PFC. Application of DCR to DCL techniques results in an improvement in ability to achieve PFC.

The modified injury severity scale in pediatric multiple trauma patients

1980 ◽  
Vol 15 (6) ◽  
pp. 719-726 ◽  
Author(s):  
Thom Mayer ◽  
Michael E. Matlak ◽  
Dale G. Johnson ◽  
Marion L. Walker
Keyword(s):  
Multiple Trauma ◽  
Injury Severity ◽  
Trauma Patients ◽  
Severity Scale ◽  
Multiple Trauma Patients

scholarly journals Thromboembolic complications among multiple injured patients with pelvic injuries: identifying risk factors for possible patient-tailored prophylaxis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Tim Kirchner ◽  
Rolf Lefering ◽  
Richard Sandkamp ◽  
Helge Eberbach ◽  
Klaus Schumm ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Injury Severity ◽  
Acetabular Fractures ◽  
Thromboembolic Risk ◽  
Pelvic Injuries ◽  
Multiple Injured ◽  
Independent Risk Factors ◽  
Injured Patients ◽  
Multiple Injured Patients

Abstract Background Patients with pelvic and/or acetabular fractures are at high risk of developing thromboembolic (TE) complications. In our study we investigate TE complications and the potential negative effects of concomitant pelvic or acetabular injuries in multiple injured patients according to pelvic/acetabular injury severity and fracture classification. Methods The TraumaRegister DGU® was analyzed between 2010 and 2019. Multiple injured patients with pelvic and/or acetabular fractures with ISS ≥ 16 suffering from TE complications were identified. We conducted a univariate and multivariate analysis with TE events as independent variable to examine potential risk factors and contributing factors. Results 10.634 patients met our inclusion criteria. The overall TE incidence was 4.9%. Independent risk factors for the development of TE complications were sepsis, ≥ 10 operative interventions, mass transfusion (≥ 10 PRBCs), age ≥ 65 years and AISAbdomen ≥ 3 (all p < 0.001). No correlation was found for overall injury severity (ISS), moderate traumatic brain injury, additional injury to lower extremities, type B and C pelvic fracture according to Tile/AO/OTA and closed or open acetabular fracture. Conclusions Multiple injured patients suffering from pelvic and/or acetabular fractures are at high risk of developing thromboembolic complications. Independent risk factors for the development of thromboembolic events in our study cohort were age ≥ 65 years, mass transfusion, AISAbdomen ≥ 3, sepsis and ≥ 10 surgery procedures. Among multiple injured patients with acetabular or pelvic injuries the severity of these injuries seems to have no further impact on thromboembolic risk. Our study, however, highlights the major impact of early hemorrhage and septic complications on thromboembolic risk in severely injured trauma patients. This may lead to individualized screening examinations and a patient-tailored thromboprophylaxis in high-risk patients for TE. Furthermore, the number of surgical interventions should be minimized in these patients to reduce thromboembolic risk.

scholarly journals Relationship of the Severity of Maxillofacial Trauma Based on Facial Injury Severity Scale (FISS) Against the Severity of Head Injury

2019 ◽  
Vol 2 (1) ◽  
pp. 9-21
Author(s):  
Ary Rachmanto ◽  
Abda Arif
Keyword(s):  
Head Injury ◽  
Injury Severity ◽  
Bone Fractures ◽  
Head Injuries ◽  
Secondary Data ◽  
Maxillofacial Trauma ◽  
Trauma Patients ◽  
Facial Injury ◽  
Severity Scale ◽  
Cross Sectional

ABSTRACT Introduction. Facial bone fractures can be accompanied by life-threatening complications such as head injuries. Maxillofacial trauma increases with time. The maxillofacial facial injury severity scale (FISS) scoring system was introduced to assess the patient's severity, prognosis, and outcome. Maxillofacial FISS has predictive value on the severity of head injuries. Method. This research uses analytic observation method with cross sectional design approach. The population and sample were all maxillofacial trauma patients who had been treated at RSUP dr. Moehammad Hoesin Palembang from January-September 2018. Data is taken from secondary data, namely the patient's medical record. Results. The incidence of maxillofacial trauma at RSUP dr. Moehammad Hoesin Palembang is 95 cases. The most cases occurred in the age group <30 years (62.1%). Gender male (85.3%), the scene outside the city (52.6%). There were 21 maxillofacial trauma patients undergoing neurosurgery (22.1%). There was no relationship between FISS and the severity of head injury (p = 0.063), there was a significant relationship between FISS and neurosurgery (p = <0.001). Conclusion. There is a relationship between the severity of maxillofacial trauma based on the Facial Injury Severity Scale (FISS) score on the severity of the head injury.

Nocturnal Violence: Implications for Resident Trauma Operative Experiences

2012 ◽  
Vol 78 (6) ◽  
pp. 657-663 ◽  
Author(s):  
Colyn J. Watkins ◽  
Paul L. Feingold ◽  
Barry Hashimoto ◽  
Laura S. Johnson ◽  
Christopher J. Dente
Keyword(s):  
Trauma Center ◽  
Injury Severity ◽  
Penetrating Trauma ◽  
Time Of Day ◽  
Operative Intervention ◽  
Peak Time ◽  
Trauma Patients ◽  
Time Period ◽  
Work Hour ◽  
Level I

Trauma centers face novel challenges in resource allocation in an era of cost consciousness and work-hour restrictions. Studies have shown that time of day and day of week affect trauma admission volume; however, these studies were performed in cold climates. Data from 2000 to 2010 at a Level I trauma center were reviewed. Demographic, injury severity, and injury timing from 23,827 trauma patients were analyzed along with their emergency department disposition (operating room, intensive care unit, ward) and final outcome. Nighttime arrivals (NAs) accounted for 56.6 per cent and daytime arrivals accounted for 43.4 per cent of total admissions. The increase in NAs was most pronounced during the period from midnight to 6 AM on weekends ( P < 0.05). Also, the period from midnight to 6 AM on weekends showed a significantly increased proportion of penetrating trauma ( P < 0.01). Similarly, there was an increased rate of trauma arrivals needing emergent operative intervention in the period between midnight and 6 AM on weekends when compared with any other time period ( P < 0.01). In a southern Level I trauma center, patient volume varies nonrandomly with time. Emergent operative intervention is more likely between midnight and 6 AM, the peak time for penetrating trauma. Because resident operative experience is maximized at night and on weekends, coverage during these periods should remain a priority for residency programs.

HMGB1, nucleosomes and sRAGE as new prognostic serum markers after multiple trauma

2016 ◽  
Vol 40 (3) ◽  
Author(s):  
Juliane Barbara Stahl ◽  
Eduard F. Hoecherl ◽  
Jürgen Durner ◽  
Dorothea Nagel ◽  
Konrad Wolf ◽  
...  
Keyword(s):  
Multiple Trauma ◽  
Disease Severity ◽  
Injury Severity ◽  
Clinical Status ◽  
Area Under The Curve ◽  
High Mobility ◽  
Severe Trauma ◽  
Trauma Patients ◽  
Resuscitation Room ◽  
Multiple Injured

AbstractThe prognostic relevance of blood markers in multiple trauma is still a matter of controversial debate. Besides clinical scores new biomarkers indicating the disease severity and the prognosis during the first hours of therapy are highly needed to improve individual patient management.In prospectively collected sera of 164 patients, among them 115 with multiple trauma, the values of circulating nucleosomes, high-mobility-group-box protein 1 (HMGB1) and soluble receptor of advanced glycation end products (sRAGE) were determined at time of admission to the resuscitation room. Disease severity and clinical status were quantified by injury severity score (ISS) and Glasgow Coma Scale (GCS). As controls, 24 patients with femoral neck fractures and 25 patients with ankle fractures (AFs) were included.Patients with severe multiple trauma (SMT) showed significantly higher HMGB1 and sRAGE levels than patients with moderate trauma and single fractures. Interestingly, HMGB1 and nucleosomes (R=0.56; p<0.01) as well as HMGB1 and sRAGE (R=0.44; p<0.01) correlated significantly with each other. In multiple trauma patients, high HMGB1 and sRAGE levels were significantly associated with more severe trauma according ISS (both p<0.01) and more severe traumatic brain injury (TBI) (GCS≤8; both p<0.01). Thirteen of the multiple injured patients died during the first week after trauma. Non-surviving patients showed significantly higher values of HMGB1, nucleosomes, and sRAGE than survivors (p<0.01; p=0.01; p=0.02). Best prediction of first-week mortality was obtained in receiver operating characteristic (ROC) curves for HMGB1 that yielded an area under the curve (AUC) of 90.6%.HMGB1, nucleosomes and sRAGE are valuable biomarkers indicating trauma severity and prognosis of trauma patients.

scholarly journals High Prevalence of Sarcopenia in Older Trauma Patients: A Pilot Study

2020 ◽  
Vol 9 (7) ◽  
pp. 2046 ◽  
Author(s):  
Robert C. Stassen ◽  
Kostan W. Reisinger ◽  
Moaath Al-Ali ◽  
Martijn Poeze ◽  
Jan A. Ten Bosch ◽  
...  
Keyword(s):  
Muscle Mass ◽  
Injury Severity ◽  
Adverse Outcome ◽  
Univariate Analysis ◽  
Adverse Outcomes ◽  
Trauma Patients ◽  
Skeletal Mass ◽  
Number Of Patients ◽  
High Prevalence ◽  
Polytrauma Patients

Sarcopenia is related to adverse outcomes in various populations. However, little is known about the prevalence of sarcopenia in polytrauma patients. Identifying the number of patients at risk of adverse outcome will increase awareness to prevent further loss of muscle mass. We utilized data from a regional prospective trauma registry of all polytrauma patients presented between 2015 and 2019 at a single level-I trauma center. Subjects were screened for availability of computed tomography (CT)-abdomen and height in order to calculate skeletal mass index, which was used to estimate sarcopenia. Additional parameters regarding clinical outcome were assessed. Univariate analysis was performed to identify parameters related adverse outcome and, if identified, entered in a multivariate regression analysis. Prevalence of sarcopenia was 33.5% in the total population but was even higher in older age groups (range 60–79 years), reaching 82 % in patients over 80 years old. Sarcopenia was related to 30-day or in-hospital mortality (p = 0.032), as well as age (p < 0.0001), injury severity score (p = 0.026), and Charlson comorbidity index (p = 0.001). Log rank analysis identified sarcopenia as an independent predictor of 30-day mortality (p = 0.032). In conclusion, we observed a high prevalence of sarcopenia among polytrauma patients, further increasing in older patients. In addition, sarcopenia was identified as a predictor for 30-day mortality, underlining the clinical significance of identification of low muscle mass on a CT scan that is already routinely obtained in most trauma patients.

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