Vasopressor Use during Emergency Trauma Surgery

2014 ◽  
Vol 80 (5) ◽  
pp. 472-478 ◽  
Author(s):  
Robert M. Van Haren ◽  
Chad M. Thorson ◽  
Evan J. Valle ◽  
Gerardo A. Guarch ◽  
Jassin M. Jouria ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Mortality Rate ◽  
Odds Ratio ◽  
Injury Severity ◽  
Trauma Surgery ◽  
Vital Signs ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Vasopressor Use ◽  
Injured Patients

Most evidence suggests early vasopressor use is associated with death after trauma, but no previous study has focused on patients requiring emergency operative intervention (OR). We test the hypothesis that vasopressors are harmful in this population. Records from 746 patients requiring OR from July 2009 to March 2013 were retrospectively reviewed and stratified based on vasopressor use (epinephrine [EPI], phenylephrine, ephedrine, norepinephrine, dobutamine, vasopressin) or no vasopressor use. Vasopressors were administered to 225 patients (30%) during OR; 59 patients (8%) received multiple vasopressors. Patients who received vasopressors were older, more severely injured, had worse vital signs, and increased mortality rate (all P < 0.001). EPI was independently associated with mortality (odds ratio, 6.88; P = 0.001). If patients who received EPI were excluded, there was no difference in mortality between those who received vasopressors alone or in combination and those that did not (5 vs 6%, P = 0.523), although multiple markers of injury severity were worse. We conclude that vasopressor use is relatively common in the most severely injured patients requiring OR and is associated with mortality. EPI is most often used for cardiac arrest, whereas other vasopressors are used for their vasoconstrictive properties. This suggests that, except for EPI, vasopressors during OR are not independently associated with mortality.

scholarly journals Early Versus Late Spine Surgery in Severely Injured Patients—Which Is the Appropriate Timing for Surgery?

2021 ◽  
pp. 219256822198929
Author(s):  
Arnaldo Sousa ◽  
Cláudia Rodrigues ◽  
Luís Barros ◽  
Pedro Serrano ◽  
Ricardo Rodrigues-Pinto
Keyword(s):  
Mortality Rate ◽  
Spinal Fractures ◽  
Simplified Acute Physiology Score ◽  
Neurological Injury ◽  
Spine Fractures ◽  
Severely Injured ◽  
Intubation Time ◽  
Severely Injured Patients ◽  
Level Of Evidence ◽  
Injured Patients

Study Design: Retrospective cohort study conducted at tertiary spinal trauma referral center. Objective: We aimed to determine if early definitive management of spine fractures in patients admitted to the Intensive Care Unit (ICU) shortens the intubation time and the length of stay (LOS), without increasing mortality. Methods: The medical records of all patients admitted to the ICU and submitted to surgical stabilization of spine fractures were reviewed over a 10-year period. Time to surgery, number of fractured vertebrae, degree of neurological injury, Simplified Acute Physiology Score (SAPS II), ASA score and associated trauma were evaluated. Surgeries performed on the first 72 hours after trauma were defined as “early surgeries.” Intubation time, LOS on ICU, overall LOS and mortality rate were compared between patients operated early and late. Results: Fifty patients were included, 21 with cervical fractures, 23 thoracic and 6 lumbar. Baseline characteristics did not differ between patients in both groups. Patients with early surgical stabilization had significantly shorter intubation time, ICU-LOS and overall LOS, with no differences in terms of mortality rate. After multivariate adjustments overall LOS was significantly shorter in patients operated earlier. Conclusions: Early spinal stabilization (<72 hours) of severely injured patients is beneficial and shortens the intubation time, ICU-LOS and overall LOS, with no differences in terms of mortality rate. Although some patients may require a delay in treatment due to necessary medical stabilization, every reasonable effort should be made to treat patients with unstable spinal fractures as early as possible. Level of Evidence of the Study: Level III.

Delays in Transfer of Elderly Less-injured Trauma Patients Can Have Deadly Consequences

2014 ◽  
Vol 80 (11) ◽  
pp. 1132-1135 ◽  
Author(s):  
Peter E. Fischer ◽  
Paul D. Colavita ◽  
Gregory P. Fleming ◽  
Toan T. Huynh ◽  
A. Britton Christmas ◽  
...  
Keyword(s):  
Trauma Center ◽  
Injury Severity ◽  
Trauma Patients ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Local Trauma ◽  
Level 1 ◽  
Poor Outcomes ◽  
Injured Patients ◽  
Level 1 Trauma Center

Transfer of severely injured patients to regional trauma centers is often expedited; however, transfer of less-injured, older patients may not evoke the same urgency. We examined referring hospitals’ length of stay (LOS) and compared the subsequent outcomes in less-injured transfer patients (TP) with patients presenting directly (DP) to the trauma center. We reviewed the medical records of less-injured (Injury Severity Score [ISS] 9 or less), older (age older than 60 years) patients transferred to a regional Level 1 trauma center to determine the referring facility LOS, demographics, and injury information. Outcomes of the TP were then compared with similarly injured DP using local trauma registry data. In 2011, there were 1657 transfers; the referring facility LOS averaged greater than 3 hours. In the less-injured patients (ISS 9 or less), the average referring facility LOS was 3 hours 20 minutes compared with 2 hours 24 minutes in more severely injured patients (ISS 25 or greater, P < 0.05). The mortality was significantly lower in the DP patients (5.8% TP vs 2.6% DP, P = 0.035). Delays in transfer of less-injured, older trauma patients can result in poor outcomes including increased mortality. Geographic challenges do not allow for every patient to be transported directly to a trauma center. As a result, we propose further outreach efforts to identify potential causes for delay and to promote compliance with regional referral guidelines.

Despite Trauma Center Closures, Trauma System Regionalization Reduces Mortality and Time to Definitive Care in Severely Injured Patients

2017 ◽  
Vol 83 (6) ◽  
pp. 591-597 ◽  
Author(s):  
Jack C. He ◽  
David Schechtman ◽  
Debra L. Allen ◽  
Jillian J. Cremona ◽  
Jeffrey A. Claridge
Keyword(s):  
Median Time ◽  
Injury Severity ◽  
Trauma System ◽  
Relative Reduction ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Trauma Outcomes ◽  
Hospital Systems ◽  
Injured Patients ◽  
Patient Subgroups

The Northern Ohio Trauma System (NOTS), consisting of multiple hospital systems, was established in 2010 to improve trauma outcomes. This study assessed its impact on mortality and time to definitive care, focusing especially on the severely injured patients. NOTS trauma registry was queried for all trauma activations from 2008 to 2013. The years between 2008–2009 and 2011–2013 were designated as pre- and post-NOTS, respectively. Data from 2010 was excluded as a transitional year. Two trauma centers (TCs) closed in 2010. Predetermined patient subgroups were analyzed. A total of 27,843 patients were examined. Mean age was 46 and 64 per cent were male. Median Injury Severity Score (ISS) was five, and 87 per cent sustained blunt injuries. Of these, 10,641 patients were pre-NOTS and 17,202 were post-NOTS. Comparing the two groups, mortality decreased from 5 to 4 per cent post-NOTS (P < 0.001); median time to definitive care increased by 12 minutes post-NOTS. Multivariate logistic regression showed that NOTS implementation was an independent predictor for survival (P = 0.008), whereas time to definitive care was not. Subgroup analyses demonstrated mortality reductions post-NOTS for all subgroups except patients with penetrating injuries, where mortality remained the same despite an increase in ISS. Patients with ISS ≥15 had a 23 per cent relative reduction in mortality, and their median time to definitive care decreased by 12 minutes. Implementation of a collaborative, regional trauma system was associated with mortality reduction and shortened time to definitive care in the severely injured patients. These findings highlight the importance of collaboration in the future development of regional trauma systems.

Relationship between injury severity and lactate levels in severely injured patients

2003 ◽  
Vol 29 (8) ◽  
pp. 1300-1305 ◽  
Author(s):  
Ognjen Cerović ◽  
Vesna Golubović ◽  
Ana Špec-Marn ◽  
Boriana Kremžar ◽  
Gaj Vidmar
Keyword(s):  
Injury Severity ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Lactate Levels ◽  
Injured Patients

scholarly journals Interobserver variability of injury severity assessment in polytrauma patients: does the anatomical region play a role?

2021 ◽  
Vol 26 (1) ◽  
Author(s):  
Eftychios Bolierakis ◽  
Sylvia Schick ◽  
Kai Sprengel ◽  
Kai Oliver Jensen ◽  
Frank Hildebrand ◽  
...  
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Interobserver Variability ◽  
Severity Assessment ◽  
Severely Injured ◽  
X Rays ◽  
Severely Injured Patients ◽  
Anatomical Region ◽  
Injured Patients

Abstract Background The Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS) are widely used to assess trauma patients. In this study, the interobserver variability of the injury severity assessment for severely injured patients was analyzed based on different injured anatomical regions, and the various demographic backgrounds of the observers. Methods A standardized questionnaire was presented to surgical experts and participants of clinical polytrauma courses. It contained medical information and initial X-rays/CT-scans of 10 cases of severely injured patients. Participants estimated the severity of each injury based on the AIS. Interobserver variability for the AIS, ISS, and New Injury Severity Score (NISS) was calculated by employing the statistical method of Krippendorff's α coefficient. Results Overall, 54 participants were included. The major contributing medical specialties were orthopedic trauma surgery (N = 36, 67%) and general surgery (N = 13, 24%). The measured interobserver variability in the assessment of the overall injury severity was high (α ISS: 0.33 / α NISS: 0.23). Moreover, there were differences in the interobserver variability of the maximum AIS (MAIS) depending on the anatomical region: αhead and neck: 0.06, αthorax: 0.45, αabdomen: 0.27 and αextremities: 0.55. Conclusions Interobserver agreement concerning injury severity assessment appears to be low among clinicians. We also noted marked differences in variability according to injury anatomy. The study shows that the assessment of injury severity is also highly variable between experts in the field. This implies the need for appropriate education to improve the accuracy of trauma evaluation in the respective trauma registries.

scholarly journals The Relationship between Hospital Volume and In-Hospital Mortality of Severely Injured Patients in Dutch Level-1 Trauma Centers

2021 ◽  
Vol 10 (8) ◽  
pp. 1700
Author(s):  
Charlie Sewalt ◽  
Esmee Venema ◽  
Erik van Zwet ◽  
Jan van Ditshuizen ◽  
Stephanie Schuit ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Trauma Center ◽  
Hospital Volume ◽  
Injury Severity ◽  
Severely Injured ◽  
Trauma Centers ◽  
Severely Injured Patients ◽  
Level 1 ◽  
Injured Patients ◽  
Level 1 Trauma Center

Centralization of trauma centers leads to a higher hospital volume of severely injured patients (Injury Severity Score (ISS) > 15), but the effect of volume on outcome remains unclear. The aim of this study was to determine the association between hospital volume of severely injured patients and in-hospital mortality in Dutch Level-1 trauma centers. A retrospective observational cohort study was performed using the Dutch trauma registry. All severely injured adults (ISS > 15) admitted to a Level-1 trauma center between 2015 and 2018 were included. The effect of hospital volume on in-hospital mortality was analyzed with random effects logistic regression models with a random intercept for Level-1 trauma center, adjusted for important demographic and injury characteristics. A total of 11,917 severely injured patients from 13 Dutch Level-1 trauma centers was included in this study. Hospital volume varied from 120 to 410 severely injured patients per year. Observed mortality rates varied between 12% and 24% per center. After case-mix correction, no statistically significant differences between low- and high-volume centers were demonstrated (adjusted odds ratio 0.97 per 50 extra patients per year, 95% Confidence Interval 0.90–1.04, p = 0.44). The variation in hospital volume of the included Level-1 trauma centers was not associated with the outcome of severely injured patients. Our results suggest that well-organized trauma centers with a similar organization of care could potentially achieve comparable outcomes.

scholarly journals Which Risk Factors Predict Knee Ligament Injuries in Severely Injured Patients?—Results from an International Multicenter Analysis

2020 ◽  
Vol 9 (5) ◽  
pp. 1437 ◽  
Author(s):  
Christian D. Weber ◽  
Lucian B. Solomon ◽  
Rolf Lefering ◽  
Klemens Horst ◽  
Philipp Kobbe ◽  
...  
Keyword(s):  
Risk Factors ◽  
Knee Injury ◽  
Injury Severity ◽  
Knee Injuries ◽  
Severely Injured ◽  
Ligament Injuries ◽  
Severely Injured Patients ◽  
Injury Group ◽  
Injured Patients ◽  
Knee Dislocations

Introduction: Ligament injuries around the knee joint and knee dislocations are rare but potentially complex injuries associated with high-energy trauma. Concomitant neurovascular injuries further affect their long-term clinical outcomes. In contrast to isolated ligamentous knee injuries, epidemiologic data and knowledge on predicting knee injuries in severely injured patients is still limited. Methods: The TraumaRegister DGU® (TR-DGU) was queried (01/2009–12/2016). Inclusion criteria for selection from the database: maximum abbreviated injury severity ≥ 3 points (MAIS 3+). Participating countries: Germany, Austria, and Switzerland. The two main groups included a “control” and a “knee injury” group. The injury severity score (ISS) and new ISS (NISS) were used for injury severity classification, and the abbreviated injury scale (AIS) was used to classify the severity of the knee injury. Logistic regression analysis was performed to evaluate various risk factors for knee injuries. Results: The study cohort included 139,462 severely injured trauma patients. We identified 4411 individuals (3.2%) with a ligament injury around the knee joint (“knee injury” group) and 1153 patients with a knee dislocation (0.8%). The risk for associated injuries of the peroneal nerve and popliteal artery were significantly increased in dislocated knees when compared to controls (peroneal nerve from 0.4% to 6.7%, popliteal artery from 0.3% to 6.9%, respectively). Among the predictors for knee injuries were specific mechanisms of injury: e.g., pedestrian struck (Odds ratio [OR] 3.2, 95% confidence interval [CI]: 2.69–3.74 p ≤ 0.001), motorcycle (OR 3.0, 95% CI: 2.58–3.48, p ≤ 0.001), and motor vehicle accidents (OR 2.2, 95% CI: 1.86–2.51, p ≤ 0.001) and associated skeletal injuries, e.g., patella (OR 2.3, 95% CI: 1.99–2.62, p ≤ 0.001), tibia (OR 1.9, 95% CI: 1.75–2.05, p ≤ 0.001), and femur (OR 1.8, 95% CI: 1.64–1.89, p ≤ 0.001), but neither male sex nor general injury severity (ISS). Conclusion: Ligament injuries and knee dislocations are associated with high-risk mechanisms and concomitant skeletal injuries of the lower extremity, but are not predicted by general injury severity or sex. Despite comparable ISS, knee injuries prolong the hospital length of stay. Delayed or missed diagnosis of knee injuries can be prevented by comprehensive clinical evaluation after fracture fixation and a high index of suspicion is advised, especially in the presence of the above mentioned risk factors.

scholarly journals Impact of Chest Trauma and Overweight on Mortality and Outcome in Severely Injured Patients

2020 ◽  
Vol 9 (9) ◽  
pp. 2752 ◽  
Author(s):  
Thurid Eckhardt ◽  
Klemens Horst ◽  
Philipp Störmann ◽  
Felix Bläsius ◽  
Martijn Hofman ◽  
...  
Keyword(s):  
Body Weight ◽  
Survival Benefit ◽  
Multivariate Regression ◽  
Chest Trauma ◽  
Injury Severity ◽  
Severely Injured ◽  
Regression Analyses ◽  
Severely Injured Patients ◽  
Multiple Factors ◽  
Injured Patients

The morbidity and mortality of severely injured patients are commonly affected by multiple factors. Especially, severe chest trauma has been shown to be a significant factor in considering outcome. Contemporaneously, weight-associated endocrinological, haematological, and metabolic deviations from the norm seem to have an impact on the posttraumatic course. Therefore, the aim of this study was to determine the influence of body weight on severely injured patients by emphasizing chest trauma. A total of 338 severely injured patients were included. Multivariate regression analyses were performed on patients with severe chest trauma (AIS ≥ 3) and patients with minor chest trauma (AIS < 3). The influence of body weight on in-hospital mortality was evaluated. Of all the patients, 70.4% were male, the median age was 52 years (IQR 36–68), the overall Injury Severity Score (ISS) was 24 points (IQR 17–29), and a median BMI of 25.1 points (IQR 23–28) was determined. In general, chest trauma was associated with prolonged ventilation, prolonged ICU treatment, and increased mortality. For overweight patients with severe chest trauma, an independent survival benefit was found (OR 0.158; p = 0.037). Overweight seems to have an impact on the mortality of severely injured patients with combined chest trauma. Potentially, a nutritive advantage or still-unknown immunological aspects in these patients affecting the intensive treatment course could be argued.

scholarly journals Acute trauma coagulopathy: prevalence and outcome in trauma patients presenting to the Emergency Department SMBB Trauma Centre, Civil Hospital Karachi.

2021 ◽  
Author(s):  
Fariha Ashraf ◽  
Mohammad Faisal Ibrahim ◽  
Rabia Feroz ◽  
Abdul Wasey ◽  
Muhammad Arsalan ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hospital Mortality ◽  
Injury Severity ◽  
Trauma Centre ◽  
P Value ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Acute Trauma ◽  
Civil Hospital ◽  
Injured Patients

Abstract PURPOSE To determine the prevalence of Acute Trauma Coagulopathy (ATC) in severely injured patients presenting to the emergency department of SMBB Trauma Centre of Civil Hospital Karachi and to investigate its impact on these patient's outcome. Early recognition using initial coagulation profile (PT/APTT) accompanied by adequate management of ATC and prevention of bleeding may substantially reduce mortality and improve outcomes in severely injured patients in resource limited environments. MATERIAL AND METHODS This descriptive cross sectional study was carried out in Surgical unit 4, Dr Ruth K.M. Pfau Civil hospital Karachi from 27 th July 2019 to 28 th January 2020. After approval from institutional review board, 80 patients aged between 14 to 60 years with injury severity score more than 15 were enrolled using non probability consecutive sampling technique and their coagulation profile (PT, APTT and INR) was done at presentation and followed for in hospital mortality. Data was collected and analyzed using SPSS 24. RESULTS In our study total 80 patients were enrolled, the mean age of patients was 27.28±12.18. Trauma coagulopathy was present in 12.5% patients. In hospital mortality was found to be 16.3%. The in hospital mortality was compared in patients with coagulopathy and patients without coagulopathy and p value was significant 0.00. Data stratification was significant for age with p value 0.016. Data stratification for gender, mode of injury, mechanism of injury, amount of fluid given at presentation and injury severity score was not significant. CONCLUSION Acute trauma coagulopathy is associated with increased risk of mortality.

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