Evaluation of Prehospital and Emergency Department Systolic Blood Pressure as a Predictor of In-Hospital Mortality

2009 ◽  
Vol 75 (10) ◽  
pp. 1009-1014 ◽  
Author(s):  
Fariborz Lalezarzadeh ◽  
Paul Wisniewski ◽  
Katie Huynh ◽  
Maria Loza ◽  
Dev Gnanadev
Keyword(s):  
Emergency Department ◽  
Hospital Mortality ◽  
Trauma Registry ◽  
Strong Predictor ◽  
Trauma Patients ◽  
Risk Of Mortality ◽  
Blood Pressures ◽  
Activation Criterion ◽  
Trauma Activation

Hypotension is a trauma activation criterion validated by multiple studies. However, field systolic blood pressures (SBP) are still met with skepticism. How significant is the role of prehospital (PH) and emergency department (ED) SBP in the patient's overall condition? A review of the trauma registry over a 5-year period was conducted. PH SBPs were stratified into four categories: severe (SBP 80 mmHg or less), moderate (81-100 mmHg), mild hypotension (101-120 mmHg), and normotension (greater than 120 mmHg). These four groups were further subcategorized into the patients who were hypotensive, SBP 90 mmHg or less in the ED, versus those that were not (SBP greater than 90 mmHg). Data for 6964 patients were analyzed. Patients with PH SBP of 80 mmHg or less compared with patients who had PH SBP of greater than 80 mmHg had higher mortality (OR, 9; 95% CI, 6.45-12.84). Patients with both PH SBP 80 mmHg or less and ED SBP 90 mmHg or less had the highest risk of mortality (50%) and highest need for emergent operative intervention (54%). PH and ED hypotension is a strong predictor of in-hospital mortality and need for emergent surgical intervention in trauma patients. Field or ED blood pressures should serve as a significant marker of the patient's condition.

Emergency Department Length of Stay Is an Independent Predictor of Hospital Mortality in Trauma Activation Patients

2011 ◽  
Vol 70 (6) ◽  
pp. 1317-1325 ◽  
Author(s):  
Nathan T. Mowery ◽  
Stacy D. Dougherty ◽  
Amy N. Hildreth ◽  
James H. Holmes ◽  
Michael C. Chang ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Independent Predictor ◽  
Trauma Activation

scholarly journals Characteristics, injuries, and clinical outcomes of geriatric trauma patients in Japan: an analysis of the nationwide trauma registry database

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Yukari Miyoshi ◽  
Yutaka Kondo ◽  
Yohei Hirano ◽  
Tadashi Ishihara ◽  
Koichiro Sueyoshi ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Clinical Characteristics ◽  
Japanese Society ◽  
Trauma Registry ◽  
Economic Problem ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Age Group ◽  
Epidemiological Characteristics ◽  
Registry Database

Abstract Geriatric trauma is a major socio-economic problem, especially among the aging Japanese society. Geriatric people are more vulnerable to trauma than younger people; thus, their outcomes are often severe. This study evaluates the characteristics of geriatric trauma divided by age in the Japanese population. We evaluated trauma characteristics in patients (n = 131,088) aged ≥ 65 years by segregating them into 2 age-based cohorts: age 65–79 years (65–79 age group; n = 70,707) and age ≥ 80 years (≥ 80 age group; n = 60,381). Clinical characteristics such as patient background, injury mechanism, injury site and severity, treatment, and outcome were examined. Injuries among men were more frequent in the 65–79 age group (58.6%) than in the ≥ 80 age group (36.3%). Falls were the leading cause of trauma among the 65–79 age group (56.7%) and the ≥ 80 age group (78.9%). In-hospital mortality was 7.7% in the 65–79 age group and 6.6% in the ≥ 80 age group. High fall in the ≥ 80 age group showed 30.5% mortality. The overall in-hospital mortality was 11.8% (the 65–79 age group, 12.3%; the ≥ 80 age group, 11.2%). Most hospitalized patients were transferred to another hospital (the 65–79 age group, 52.5%; the ≥ 80 age group, 66.2%). We demonstrated the epidemiological characteristics of Japanese geriatric trauma patients. The overall in-hospital mortality was 11.8%, and fall injury in the ≥ 80 age group required caution of trauma care.

scholarly journals Comparison of APACHE II and three abbreviated APACHE II scores for predicting outcome among emergency trauma patients

2014 ◽  
Vol 60 (4) ◽  
pp. 381-386 ◽  
Author(s):  
Jorge Roberto Polita ◽  
Jussara Gomez ◽  
Gilberto Friedman ◽  
Sérgio Pinto Ribeiro
Keyword(s):  
Emergency Department ◽  
Hospital Mortality ◽  
Operating Characteristic ◽  
Laboratory Data ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Trauma Patients ◽  
Individual Data ◽  
Predicting Outcome ◽  
Similar Accuracy

Objective: to compare the ability of the APACHE II score and three different abbreviated APACHE II scores: simplified APACHE II (s-APACHE II), Rapid Acute Physiology score (RAPS) and Rapid Emergency Medicine score to evaluate in-hospital mortality of trauma patients at the emergency department (ED). Methods: retrospective analysis of a prospective cohort study. All patients' victims of trauma admitted to the ED, during a 5 months period. For all entries to the ED, APACHE II score was calculated. APACHE II system was abbreviated by excluding the laboratory data to calculate s-APACHE II score for each patient. Individual data were reanalyzed to calculate RAPS and REMS. APACHE II score and its subcomponents were collected, and in-hospital mortality was assessed. The area under the receiver operating characteristic (AUROC) curve was used to determine the predictive value of each score. Results: 163 patients were analyzed. In-hospital mortality rate was 10.4%. s-APACHE II, RAPS and REMS scores were correlated with APACHE II score (r2= 0.96, r2= 0.82, r2= 0.92; p < 0.0001). Scores had similar accuracy in predicting mortality ([AUROC 0.777 [95% CI 0.705 to 0.838] for APACHE II, AUROC 0.788 [95% CI 0.717 to 0.848] for s-APACHE II, AUROC 0.806 [95% CI 0.737 to 0.864] for RAPS, AUROC 0.761 [95% CI 0.688 to 0.824] for REMS. Conclusion: abbreviated APACHE II scores have similar ability to evaluate in-hospital mortality of emergency trauma patients in comparison to APACHE II score.

scholarly journals Success Of An Expedited Emergency Department Triage Evaluation System For Geriatric Trauma Patients Not Meeting Trauma Activation Criteria

2019 ◽  
Vol Volume 11 ◽  
pp. 241-247 ◽  
Author(s):  
Forrest B Fernandez ◽  
Adrian Ong ◽  
Anthony P Martin ◽  
C William Schwab ◽  
Tom Wasser ◽  
...  
Keyword(s):  
Emergency Department ◽  
Evaluation System ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Emergency Department Triage ◽  
Trauma Activation ◽  
Activation Criteria

scholarly journals Physician-led prehospital management is associated with reduced mortality in severe blunt trauma patients: A retrospective analysis of the Japanese nationwide trauma registry

2020 ◽  
Author(s):  
Akira Endo ◽  
Mitsuaki Kojima ◽  
Saya Uchiyama ◽  
Atsushi Shiraishi ◽  
Yasuhiro Otomo
Keyword(s):  
Propensity Score ◽  
Hospital Mortality ◽  
Blunt Trauma ◽  
Subgroup Analysis ◽  
Trauma Registry ◽  
Future Research ◽  
Trauma Patients ◽  
Trauma Management ◽  
Prehospital Management ◽  
Prehospital Time

Abstract Background: Although the results of previous studies suggested the effectiveness of physician-led prehospital trauma management, it has been uncertain because of the limited number of high-quality studies. Furthermore, the advantage of physician-led prehospital management might have been overestimated due to the shortened prehospital time by helicopter transportation in some studies. The present study aimed to evaluate the effect of physician-led prehospital management independent of prehospital time. Also, subgroup analysis was performed to explore the subpopulation that especially benefit from physician-led prehospital management. Methods: This retrospective cohort study analyzed the data of Japan’s nationwide trauma registry. Severe blunt trauma patients, defined by Injury Severity Score (ISS) ≥16, who were transported directly to a hospital between April 2009 and March 2019 were evaluated. In-hospital mortality was compared between groups dichotomized by the occupation of primary prehospital healthcare provider (i.e., physician or paramedic), using 1:4 propensity score-matched analysis. The propensity score was calculated using potential confounders including patient demographics, mechanism of injury, vital signs at the scene of injury, ISS, and total time from injury to hospital arrival. Subpopulations that especially benefit from physician-led prehospital management were explored by assessing interaction effects between physician-led prehospital management and patient characteristics. Results: A total of 30,551 patients (physician-led: 2,976, paramedic-led: 27,575) were eligible for analysis, of whom 2,690 propensity score-matched pairs (physician-led: 2,690, paramedic-led: 10,760) were generated and compared. Physician-led group showed significantly decreased in-hospital mortality than paramedic-led group (in-hospital mortality: 387 [14.4%] and 1,718 [16.0%]; odds ratio [95% confidence interval] = 0.88 [0.78–1.00], p = 0.044). Patients with age <65 years, ISS ≥25, Abbreviated Injury Scale in pelvis and lower extremities ≥3, and total prehospital time <60 min were likely to benefit from physician-led prehospital management. Conclusions: Physician-led prehospital trauma management was significantly associated with reduced in-hospital mortality independent of prehospital time. The findings of exploratory subgroup analysis would be useful for the future research to establish efficient dispatch system of physician team.

Adverse Events During Interhospital Transport: Physiologic Deterioration Associated With Pretransport Severity of Illness

PEDIATRICS ◽  
1989 ◽  
Vol 84 (1) ◽  
pp. 43-48 ◽  
Author(s):  
Robert K. Kanter ◽  
Joy M. Tompkins
Keyword(s):  
Hospital Mortality ◽  
Injury Severity ◽  
Severity Of Illness ◽  
Trauma Patients ◽  
Hospital Personnel ◽  
Transport Services ◽  
Risk Of Mortality ◽  
Interhospital Transport ◽  
Severity Scores ◽  
Risk Patients

The relationship between severity of illness or injury before interhospital transport and the incidence of physiologic deterioration during transport was studied in 117 pediatric patients. Transports were done by referring hospital personnel. Pretransport severity was expressed as the Pediatric Risk of Mortality score for all patients and as the Modified Injury Severity Score for trauma patients. For 71 patients with Pediatric Risk of Mortality scores less than 10, deterioration during transport occurred in 3 (4%) and hospital mortality occurred in 2 (3%). For 10 victims of trauma with Modified Injury Severity Scores less than 10, none had deterioration during transport or hospital mortality. The rare occurrence of serious problems related to transport in low-risk patients indicates that referring hospital personnel are capable of safely transporting such patients. The incidence of physiologic deterioration during transport was significantly greater (P &lt; .01) with greater pretransport severity of illness or injury. Failure to intubate the trachea was not a major preventable cause of deterioration. The most common preventable problem occurred for 6 of 79 patients with endotracheal tubes that became occluded with secretions, leading to cyanosis in 2 patients. Our data concerning high-risk patients with specified pretransport severity provide a basis for comparison for further evaluation of the benefit of specialized pediatric transport services.

The role of an emergency department observation unit in the management of trauma patients

1985 ◽  
Vol 2 (5) ◽  
pp. 325-333 ◽  
Author(s):  
Lily Conrad ◽  
Vincent Markovchick ◽  
James Mitchiner ◽  
Stephen V. Cantrill
Keyword(s):  
Emergency Department ◽  
Trauma Patients ◽  
Observation Unit

scholarly journals Red blood cell distribution width and outcome in trauma patients

2021 ◽  
Vol 121 (2) ◽  
pp. 221-228
Author(s):  
McKenzie Brown ◽  
Sean Nassoiy ◽  
Timothy Plackett ◽  
Fred Luchette ◽  
Joseph Posluszny
Keyword(s):  
Blood Cell ◽  
Hospital Mortality ◽  
Red Blood Cell ◽  
Trauma Patients ◽  
Cell Distribution ◽  
Distribution Width ◽  
Discharge Disposition ◽  
Trauma Service ◽  
Red Blood Cell Distribution

Abstract Context Red blood cell distribution width (RDW) has been used to predict mortality during infection and inflammatory diseases. It also been purported to be predictive of mortality following traumatic injury. Objective To identify the role of RDW in predicting mortality in trauma patients. We also sought to identify the role of RDW in predicting the development of sepsis in trauma patients. Methods A retrospective observational study was performed of the medical records for all adult trauma patients admitted to Loyola University Medical Center from 2007 to 2014. Patients admitted for fewer than four days were excluded. Admission, peak, and change from admission to peak (Δ) RDW were recorded to determine the relationship with in-hospital mortality. Patient age, development of sepsis during the hospitalization, admission to the intensive care unit (ICU), and discharge disposition were also examined. Results A total of 9,845 patients were admitted to the trauma service between 2007 and 2014, and a total of 2,512 (25.5%) patients fit the inclusion criteria and had both admission and peak values available. One-hundred twenty (4.6%) died while in the hospital. RDW values for all patients were (mean [standard deviation, SD]): admission 14.09 (1.88), peak 15.09 (2.34), and Δ RDW 1.00 (1.44). Admission, peak, and Δ RDW were not significant predictors of mortality (all p>0.50; hazard ratio [HR], 1.01–1.03). However, trauma patients who eventually developed sepsis had significantly higher RDW values (admission RDW: 14.27 (2.02) sepsis vs. 13.98 (1.73) no sepsis, p<0.001; peak RDW: 15.95 (2.55) vs. 14.51 (1.97), p<0.001; Δ RDW: 1.68 (1.77) vs. 0.53 (0.91), p<0.001). Conclusion Admission, peak, and Δ RDW were not associated with in-hospital mortality in adult trauma patients with a length of stay (LOS) ≥four days. However, the development of sepsis in trauma patients is closely linked to increased RDW values and in-hospital mortality.

scholarly journals Physician-led prehospital management is associated with reduced mortality in severe blunt trauma patients: A retrospective analysis of the Japanese nationwide trauma registry

2021 ◽  
Author(s):  
Akira Endo ◽  
Mitsuaki Kojima ◽  
Saya Uchiyama ◽  
Atsushi Shiraishi ◽  
Yasuhiro Otomo
Keyword(s):  
Propensity Score ◽  
Hospital Mortality ◽  
Blunt Trauma ◽  
Subgroup Analysis ◽  
Trauma Registry ◽  
Future Research ◽  
Trauma Patients ◽  
Trauma Management ◽  
Prehospital Management ◽  
Prehospital Time

Abstract Background: Although the results of previous studies suggested the effectiveness of physician-led prehospital trauma management, it has been uncertain because of the limited number of high-quality studies. Furthermore, the advantage of physician-led prehospital management might have been overestimated due to the shortened prehospital time by helicopter transportation in some studies. The present study aimed to evaluate the effect of physician-led prehospital management independent of prehospital time. Also, subgroup analysis was performed to explore the subpopulation that especially benefit from physician-led prehospital management.Methods: This retrospective cohort study analyzed the data of Japan’s nationwide trauma registry. Severe blunt trauma patients, defined by Injury Severity Score (ISS) ≥16, who were transported directly to a hospital between April 2009 and March 2019 were evaluated. In-hospital mortality was compared between groups dichotomized by the occupation of primary prehospital healthcare provider (i.e., physician or paramedic), using 1:4 propensity score-matched analysis. The propensity score was calculated using potential confounders including patient demographics, mechanism of injury, vital signs at the scene of injury, ISS, and total time from injury to hospital arrival. Subpopulations that especially benefit from physician-led prehospital management were explored by assessing interaction effects between physician-led prehospital management and patient characteristics.Results: A total of 30,551 patients (physician-led: 2,976, paramedic-led: 27,575) were eligible for analysis, of whom 2,690 propensity score-matched pairs (physician-led: 2,690, paramedic-led: 10,760) were generated and compared. Physician-led group showed significantly decreased in-hospital mortality than paramedic-led group (in-hospital mortality: 387 [14.4%] and 1,718 [16.0%]; odds ratio [95% confidence interval] = 0.88 [0.78–1.00], p = 0.044). Patients with age <65 years, ISS ≥25, Abbreviated Injury Scale in pelvis and lower extremities ≥3, and total prehospital time <60 min were likely to benefit from physician-led prehospital management.Conclusions: Physician-led prehospital trauma management was significantly associated with reduced in-hospital mortality independent of prehospital time. The findings of exploratory subgroup analysis would be useful for the future research to establish efficient dispatch system of physician team.

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