Improving Mortality Predictions in Trauma Patients Undergoing Damage Control Strategies

2011 ◽  
Vol 77 (6) ◽  
pp. 778-782 ◽  
Author(s):  
Carlos A. Ordoñez ◽  
Marisol Badiel ◽  
ÁLvaro I. SÁNchez ◽  
Marcela Granados ◽  
Alberto F. GarcÍA ◽  
...  
Keyword(s):  
Injury Severity ◽  
Damage Control ◽  
Characteristic Curve ◽  
Mortality Prediction ◽  
P Value ◽  
Trauma Patients ◽  
Clinical Model ◽  
Severity Scores ◽  
Revised Trauma Score ◽  
Trauma Score

The increased use of damage control surgery in complex trauma patients requires accurate prognostic indicators. We compared the discriminatory capacity of commonly used trauma and intensive care unit (ICU) scores, including revised trauma score, injury severity scores, trauma score-injury severity scores, acute physiology and chronic health evaluations II, and clinical and laboratory parameters, on 83 consecutive trauma patients admitted to the ICU, undergoing damage control. Logistic regressions were built for mortality prediction within 30 days. Performances of the models were assessed in terms of discrimination and calibration. Areas under the receiver operating characteristic curve from the models were compared. Overall mortality was 38.5 per cent. A “clinical” model was constructed including ICU admission pH and hypothermia (≤ 35 C °) and the number of packed red blood cells during the first 24 hours. This model was adjusted for age and demonstrated better discrimination for mortality prediction (areas under the receiver operating characteristic curve = 0.8054) than injury severity score ( P value = 0.049), abdominal trauma index ( P value = 0.049), and acute physiology and chronic health evaluations II ( P value = 0.001). There was no statistically significant difference in discrimination for mortality prediction between the “clinical” model and revised trauma score ( P value = 0.4) and trauma score-injury severity score ( P value = 0.4). We concluded that the combination of ICU admission pH and hypothermia and blood transfusions during 24 hours provided an excellent discriminatory capacity for mortality prediction in this complex patient population.

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.

scholarly journals Validation of the Pediatric Physiological and Anatomical Triage Score in Pediatric Patients with Burn Injuries

2019 ◽  
Vol 34 (s1) ◽  
pp. s61-s61 ◽  
Author(s):  
Chiaki Toida ◽  
Takashi Muguruma ◽  
Ichiro Takeuchi ◽  
Naoto Morimura
Keyword(s):  
Pediatric Patients ◽  
Injury Severity ◽  
Characteristic Curve ◽  
Vital Signs ◽  
Burn Injuries ◽  
Priority Ranking ◽  
Life Saving ◽  
Revised Trauma Score ◽  
Trauma Score ◽  
Accuracy Of Prediction

Introduction:Triaging plays an important role in providing suitable care to the largest number of casualties in a disaster setting. We developed the Pediatric Physiological and Anatomical Triage score (PPATS) as a new secondary triage method.Aim:This study was performed to validate the accuracy of the PPATS in pediatric patients with burn injuries.Methods:A retrospective review of pediatric patients with burn injuries younger than 15 years old registered in the Japan Trauma Databank from 2004 to 2016 was conducted. The PPATS, which was assigned scores from 0 to 22, was calculated based on vital signs, anatomical abnormalities, and need for life-saving intervention. The PPATS categorized the patients by their priority and defined the intensive care unit (ICU)-indicated patients as those with PPARSs more than 6. This study compared the accuracy of prediction of ICU-indicated patients between the PPATS and Triage Revised Trauma Score (TRTS).Results:Among 87 pediatric patients, 62 (71%) were admitted to the ICU. The median age was 3 years (interquartile range: 1 to 9 years old). The sensitivity and specificity of the PPATS were 74% and 36%, respectively. The area under the receiver-operating characteristic curve was not different between the PPTAS [0.51 (95% confidence interval: -0.51–1.48) and the TRTS [0.51 (-1.17–1.62), p=0.57]. Regression analysis showed a significant association between the PPATS and the Injury Severity Score (ISS) (r2=0.39, p<0.01). On the other hand, there is no association between the TRTS and the ISS (r2=0.00, p=0.79).Discussion:The accuracy of the PPATS was not superior to that of current secondary-triage methods. However, the PPATS had the advantage of objectively determining the triage priority ranking based on the severity of the pediatric patients with burn injuries.

Coagulopathy Predicts Mortality in Pediatric Patients with Traumatic Brain Injury

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2891-2891 ◽  
Author(s):  
Bhavya S. Doshi ◽  
Shannon L. Meeks ◽  
Jeanne E Hendrickson ◽  
Andrew Reisner ◽  
Traci Leong ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Pediatric Patients ◽  
Injury Severity ◽  
Pediatric Trauma ◽  
Morbidity And Mortality ◽  
P Value ◽  
Trauma Patients ◽  
Severity Scores ◽  
Pediatric Tbi

Abstract Trauma is the leading cause of death in children ages 1 to 21 years of age. Traumatic brain injury (TBI) poses a high risk of both morbidity and mortality within the subset of pediatric trauma patients. Numerous adult studies have shown that coagulopathy is commonly observed in patients who have sustained trauma and that the incidence is higher when there is TBI. Previously, it was thought that coagulopathy related to trauma was dilutional (i.e. due to replacement of red cells and platelets without plasma) but more recent studies show that the coagulopathy in trauma is early and likely independent of transfusion therapy. Additionally, abnormal coagulation studies (PT, PTT, INR, platelet count, fibrinogen, and D-dimer) following TBI are associated with increased morbidity and mortality in adults. Although coagulopathy after traumatic brain injury in adults is well documented, the pediatric literature is fairly sparse. A recent study by Hendrickson et al in 2008 demonstrated that coagulopathy is both underestimated and under-treated in pediatric trauma patients who required blood product replacements. Here we present the results of a retrospective pilot study designed to assess coagulopathy in the pediatric TBI population. We analyzed all children admitted to our facility with TBI from January 2012 to December 2013. Patients were excluded if they had underlying diseases of the hemostatic system. All patients had baseline characteristics measured including: age, sex, mechanism of injury, Glasgow Coma Scale (GCS), injury severity score (ISS), initial complete blood count, DIC profile, hematological treatments including transfusions, ICU and hospital length of stay, ventilator days and survival status. Coagulation studies were defined as "abnormal" when they fell outside the accepted reference range of the pediatric hospital laboratory (PT 12.6-15.9, PTT 23.6-42.1 seconds, fibrinogen < 180 mg/dL units, platelets < 185 103/mL and hemoglobin < 11.5 g/dL). Survival was measured as survival at 30 days from admission or last known status at hospital discharge. One hundred and twenty patients met the inclusion criteria of the study and all were included in outcome analysis. Twenty-three of the 120 patients died (19.2%). Logistic regression analysis was used to compare survivors and non-survivors and baseline demographic data showed no difference in age or weight between the two groups with p-values of 0.1635 and 0.1624, respectively. Non-survivors had a higher ISS (30.26 vs 20.92, p-value 0.0004) and lower GCS (3 vs 5.8, p-value 0.0002) compared to survivors. Univariate analysis of coagulation studies to mortality showed statistically significant odds-ratios for ISS (OR 1.09, 95% CI 1.04-1.15), PT (OR 5.91, 95% CI 1.86-18.73), PTT (OR 6.48, 95% CI 2.04-20.52) and platelets (OR 5.63, 95% CI 1.74 – 18.21). Abnormal fibrinogen levels were not predictive of mortality (OR 2.56, 95% CI 0.96-6.79). These results are summarized in Table 1. Our results demonstrate that, consistent with adult studies, abnormal coagulation studies are also associated with increased mortality in pediatric patients. Higher injury severity scores and lower GCS scores are also predictive of mortality. Taken together, these results suggest that possible early correction of coagulopathy in severe pediatric TBI patients could improve outcomes for these patients. Table 1. OR 95% CI p-value ISS 1.09 1.04—1.15 .0009 PT > 15.9 sec 5.91 1.86—18.73 0.0026 PTT > 42.1 sec 6.48 2.04—20.52 0.0015 Fibrinogen < 180 mg/dL 2.56 0.96—6.79 0.0597 Platelets < 185 x 103/mL 5.63 1.74—18.21 0.0040 Disclosures No relevant conflicts of interest to declare.

Scoring acuity hours and costs of nursing for trauma care

1993 ◽  
Vol 2 (6) ◽  
pp. 436-443 ◽  
Author(s):  
AE Bond ◽  
FO Thomas ◽  
RL Menlove ◽  
P MacFarlane ◽  
P Petersen
Keyword(s):  
Resource Utilization ◽  
Injury Severity ◽  
Scoring Systems ◽  
Cost Of Care ◽  
Trauma Patients ◽  
Nursing Educators ◽  
Revised Trauma Score ◽  
Trauma Scoring ◽  
Level I ◽  
Trauma Score

OBJECTIVE: To determine nursing resource utilization (acuity hours and dollars) by trauma patients based on analysis of a nursing acuity system and five trauma scoring systems. METHODS: Retrospective review of 448 trauma patients who required transport by aircraft to a level I trauma center. Values from the institution's automated nursing acuity system were compared with the Glasgow Coma Scale score, trauma score, revised trauma score, CRAMS score and injury severity score to obtain acuity hours and financial cost of care for trauma patients. RESULTS: Consistently, analysis of scores computed by five scoring instruments confirmed that nursing resource utilization is greatest for patients who are severely injured but likely to recover. For example, patients with a trauma score of 1 required 49 (+/- 66) mean acuity hours of care; those with a trauma score of 8 needed 189 (+/- 229) mean acuity hours; and those with a trauma score of 16 used 73 (+/- 120) mean acuity hours. Mean dollar costs were $980 (+/- 1293), $3812 (+/- 4518) and $1492 (+/- 2473), respectively. CONCLUSIONS: Nursing resource utilization can be determined for trauma patients by using an automated nursing acuity system and trauma scoring systems. Data acquired in this way provide a concrete basis for healthcare and reimbursement reform, for administrators who design nursing allocations and for nursing educators who prepare graduates to meet the needs of healthcare consumers.

scholarly journals Hubungan Pemberian Terapi Oksigen Sistem Aliran Rendah Dengan Status Fisiologis (Revised Trauma Score) Pada Pasien Trauma Di Rumah Sakit Umum Daerah Ulin Banjarmasin

2019 ◽  
Vol 10 (2) ◽  
pp. 665-674
Author(s):  
Ely Purnama ◽  
Hanura Aprilia
Keyword(s):  
Oxygen Therapy ◽  
Clinical Manifestations ◽  
Low Flow ◽  
Physiological Status ◽  
P Value ◽  
Trauma Patients ◽  
Chi Square ◽  
Cross Sectional ◽  
Revised Trauma Score ◽  
Trauma Score

Latar Belakang: Pemberian terapi oksigenasi sangat perlu dilakukan pada pasien trauma dengan manifestasi klinis pada umumnya adalah sesak nafas sampai penurunan kesadaran yang dapat mempengaruhi fungsi status fisiologis pasien trauma.Tujuan: Untuk mengetahui hubungan pemberian terapi oksigen sistem aliran rendah dengan status fisiologis (Revised Trauma Score) pada pasien trauma di RSUD Ulin Banjarmasin.Metode: Penelitian ini menggunakan metode korelasional, dengan desain Cross Sectional dan teknik pengambilan sampel dengan accidental sampling. Sampel penelitian berjumlah 43 orang. Teknik pengumpulan data menggunakan metode observasi dan perhitungan Revised Trauma Score dan dianalisis dengan menggunakan Uji Chi Square.Hasil: Ada hubungan pemberian terapi oksigen sistem aliran rendah dengan status fisiologis (Revised Trauma Score) pada pasien trauma di RSUD Ulin Banjarmasin yaitu dengan nilai p (0,000) a 0,05.Kesimpulan: Pemberian terapi oksigen sistem aliran rendah dengan nasal kanul mengarah pada status fisiologis ringan dan pemberian dengan sungkup muka non-rebreathing mengarah ke status fisiologis serius. Perlunya penelitian lanjutan dengan kontrol faktor yang dapat mempengaruhi status fisiologis dan spesifikasi trauma yang lebih fokus.Kata kunci: Terapi oksigen, status fisilogis (revised trauma score), TraumaBackground: Giving oxygenation therapy is very necessary to be done in trauma patients with clinical manifestations in general is shortness of breath to decreased consciousness that can affect the physiological status of trauma patients.Objective: To determine the relationship of low flow oxygen therapy with physiological status (Revised Trauma Score) in trauma patients in Ulin Hospital Banjarmasin.Method: This study uses a correlational method, with cross sectional design and sampling techniques with accidental sampling. The research sample consisted of 43 people. Data collection techniques using the method of observation and calculation of the Revised Trauma Score and analyzed using the Chi Square Test.Results: There is a relationship between low-flow oxygen therapy with physiological status (Revised Trauma Score) in trauma patients at Ulin Hospital Banjarmasin, with a p value (0,000) a 0.05.Conclusion: Giving low flow oxygen therapy system with nasal cannula leads to mild physiological status and administration with non-rebreathing facemasks leading to serious physiological status. The need for further research with control factors that can influence physiological status and trauma specifications are more focused.Keywords: Oxygen therapy, physiological status (revised trauma score), Trauma

Evaluation of Microvascular Perfusion and Resuscitation after Severe Injury

2015 ◽  
Vol 81 (12) ◽  
pp. 1272-1278 ◽  
Author(s):  
Yann-Leei L. Lee ◽  
Jon D. Simmons ◽  
Mark N. Gillespie ◽  
Diego F. Alvarez ◽  
Richard P. Gonzalez ◽  
...  
Keyword(s):  
Injury Severity ◽  
Capillary Flow ◽  
Severe Trauma ◽  
Dark Field ◽  
Serum Lactate ◽  
Microvascular Perfusion ◽  
Trauma Patients ◽  
Sidestream Dark Field ◽  
Trauma Population ◽  
Severity Scores

Achieving adequate perfusion is a key goal of treatment in severe trauma; however, tissue perfusion has classically been measured by indirect means. Direct visualization of capillary flow has been applied in sepsis, but application of this technology to the trauma population has been limited. The purpose of this investigation was to compare the efficacy of standard indirect measures of perfusion to direct imaging of the sublingual microcirculatory flow during trauma resuscitation. Patients with injury severity scores >15 were serially examined using a handheld sidestream dark-field video microscope. In addition, measurements were also made from healthy volunteers. The De Backer score, a morphometric capillary density score, and total vessel density (TVD) as cumulative vessel area within the image, were calculated using Automated Vascular Analysis (AVA3.0) software. These indices were compared against clinical and laboratory parameters of organ function and systemic metabolic status as well as mortality. Twenty severely injured patients had lower TVD (X = 14.6 ± 0.22 vs 17.66 ± 0.51) and De Backer scores (X = 9.62 ± 0.16 vs 11.55 ± 0.37) compared with healthy controls. These scores best correlated with serum lactate (TVD R2 = 0.525, De Backer R2 = 0.576, P < 0.05). Mean arterial pressure, heart rate, oxygen saturation, pH, bicarbonate, base deficit, hematocrit, and coagulation parameters correlated poorly with both TVD and De Backer score. Direct measurement of sublingual microvascular perfusion is technically feasible in trauma patients, and seems to provide real-time assessment of micro-circulatory perfusion. This study suggests that in severe trauma, many indirect measurements of perfusion do not correlate with microvascular perfusion. However, visualized perfusion deficiencies do reflect a shift toward anaerobic metabolism.

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