Activation of Massive Transfusion for Elderly Trauma Patients

2015 ◽  
Vol 81 (10) ◽  
pp. 945-949 ◽  
Author(s):  
Jason S. Murry ◽  
Andrea A. Zaw ◽  
David M. Hoang ◽  
Devorah Mehrzadi ◽  
Danielle Tran ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Glasgow Coma Scale ◽  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Massive Transfusion ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Coma Scale ◽  
Elderly Trauma Patients

Massive transfusion protocol (MTP) is used to resuscitate patients in hemorrhagic shock. Our goal was to review MTP use in the elderly. All trauma patients who required activation of MTP at an urban Level I trauma center from January 1, 2011 to December 31, 2013 were reviewed retrospectively. Elderly was defined as age ≥ 60 years. Sixty-six patients had MTP activated: 52 non-elderly (NE) and 14 elderly (E). There were no statistically significant differences between the two cohorts for gender, injury severity score, head abbreviated injury scale, emergency department Glasgow Coma Scale, initial hematocrit, intensive care unit length of stay, or hospital length of stay. Mean age for NE was 35 years and 73 years for E ( P < 0.01). Less than half (43%) of E patients with activation of MTP received 10 or more units of blood products compared with 69 per cent of the NE ( P = 0.07). Mortality rates were similar in the NE and the E (53% vs 50%, P = 0.80). After multivariate analysis with Glasgow Coma Scale, injury severity score, and blunt versus penetrating trauma, elderly age was not a predictor of mortality after MTP ( P = 0.35). When MTP is activated, survival to discharge in elderly trauma patients is comparable to younger patients.

Supermassive Transfusion: A 15-Year Single Center Experience and Outcomes

2018 ◽  
Vol 84 (10) ◽  
pp. 1617-1621 ◽  
Author(s):  
Alison J. Yu ◽  
Kenji Inaba ◽  
Subarna Biswas ◽  
Luis Alejandro De Leon ◽  
Monica Wong ◽  
...  
Keyword(s):  
Glasgow Coma Scale ◽  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Characteristic Curve ◽  
Univariate Analysis ◽  
Female Gender ◽  
Trauma Patients ◽  
Coma Scale ◽  
Single Center Experience

The objective of this study was to determine the survival outcome associated with large-volume blood transfusion after trauma. This was a retrospective study at a Level I trauma center from January 2000 to December 2014 that included trauma patients who received ≥25 units packed red blood cell (pRBC) within the first 24 hours of hospital admission. Univariate and multivariable logistic regressions identified risk factors for mortality. Receiver operating characteristic curve analysis evaluated the ability of pRBC volume to predict mortality. Among 74,065 adults (‡18 years old), 178 patients (0.24%) received ≥25 units of pRBC in the first 24 hours, of which 142 (79.8%) received 25 to 49 units, 28 (15.7%) received 50 to 74 units, and 8 (4.5%) received ≥75 units. Overall, 92.2 per cent were male, mean age 33.9 (614.0), mean Injury Severity Score 28.9 (614.3), and median Glasgow Coma Scale score 12 (3–15). The overall mortality was 65.2 per cent and 64.1 per cent for those receiving 25 to 49 units, 64.3 per cent for 50 to 74 units, and 87.5 per cent for ≥75 units. In univariate analysis, female gender was associated with lower mortality [odds ratio (OR) 0.24, P = 0.025]. Decreasing Glasgow Coma Scale (OR 0.82, P < 0.001), increasing Injury Severity Score (OR 1.07, P < 0.001), and thoracotomy (OR 3.91, P < 0.001) were associated with higher mortality. There was no transfusion cutoff that was significantly associated with higher mortality.

Hemodynamic Effects of Propofol for Induction of Rapid Sequence Intubation in Traumatically Injured Patients

2018 ◽  
Vol 84 (9) ◽  
pp. 1504-1508 ◽  
Author(s):  
Scott K. Dietrich ◽  
Mark A. Mixon ◽  
Ryan J. Rogoszewski ◽  
Stephanie D. Delgado ◽  
Vanessa E. Knapp ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Rapid Sequence Intubation ◽  
Trauma Patients ◽  
Rapid Sequence ◽  
Injured Patients

Present guidelines for emergency intubation in traumatically injured patients recommend rapid sequence intubation (RSI) as the preferred method of airway management but specific pharmacologic agents for RSI remain controversial. To evaluate hemodynamic differences between propofol and other induction agents when used for RSI in trauma patients. Single-center, retrospective review of trauma patients intubated in the emergency department. Patients were divided in two groups based on induction agent, propofol or nonpropofol. The primary outcome was incidence of hypotension within 30 minutes of intubation. Secondary outcomes included hospital length of stay and inhospital mortality. The study protocol was approved by the Institutional Review Board. Of the 744 patients identified, 83 were analyzed, 43 in the propofol group and 40 in the nonpropofol group. Groups were similar at baseline in terms of pre-RSI hemodynamics, injury mechanism, initial Glasgow Coma Score, and Injury Severity Score. On univariate analysis, although not statistically significant, postintubation hypotension was more common in patients who received propofol compared with those who did not, 39.5 per cent versus 22.5 per cent (P = 0.9). When adjusted for age, Injury Severity Score, and pre-RSI hemodynamics, the risk of hypotension among propofol-treated patients was significantly higher (OR = 3.64; 95% Confidence interval 1.16–13.24). There were no significant differences between groups in hospital length of stay or mortality. Propofol increases the odds of postintubation hypotension in traumatically injured patients. Considerable caution should be used when contemplating the use of propofol the for induction of injured patients requiring RSI because other agents possess more favorable hemodynamic profiles.

Risk for Contrast-Induced Nephropathy in Elderly Trauma Patients

2012 ◽  
Vol 78 (10) ◽  
pp. 1114-1117 ◽  
Author(s):  
Ryan Finigan ◽  
Jacqueline Pham ◽  
Rosemarie Mendoza ◽  
Michael Lekawa ◽  
Matthew Dolich ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Length Of Stay ◽  
Injury Severity ◽  
Unit Length ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Contrast Induced Nephropathy ◽  
History Of ◽  
Elderly Trauma Patients

The objective of this study was to determine if elderly trauma patients are at risk for contrast-induced nephropathy (CIN). A retrospective study was conducted identifying 362 patients 65 years and older in our Level I trauma center who received computerized tomography (CT) scans with intravenous contrast. CIN was defined as a 25 per cent increase in serum creatinine levels or a 0.5 mg/dL increase above baseline after CT. History of diabetes mellitus, hospital length of stay, intensive care unit length of stay, Injury Severity Score (ISS), and age were recorded. Eighteen per cent (21 of 118) of the patients had a peak in creatinine, 12 per cent (14 of 118) peaked and returned to baseline, and 6 per cent (7 of 118) peaked and stayed high. Pre-CT elevated creatinine, diabetes mellitus, increased hospital length of stay, ISS, and age show little association to CIN. The data suggest that CIN in elderly trauma patients is rare, regardless of history of diabetes mellitus, age, creatinine, high ISS, or result in higher length of stay. Therefore, there is little justification for the delay in diagnosis to assess a patient's renal susceptibility.

scholarly journals Change in Age Distribution of the Injuries and Comparison of Different Scoring Tools in Predicting Mortality Among Geriatric Trauma Patients

2020 ◽  
Author(s):  
Libing Jiang ◽  
Zhongjun Zheng ◽  
Mao Zhang
Keyword(s):  
Hospital Mortality ◽  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Survival Group ◽  
Elderly Trauma Patients ◽  
Scoring Tools ◽  
Death Group

Abstract Purpose: The aim of this study was to describe the age trend of trauma patients and to compare different scoring tools to predict in-hospital mortality in elderly trauma patients.Methods: National Trauma Database (NTDB) in the United States from 2005 to 2015 and the Trauma Register DGU® in German from 1994 to 2012 was searched to describe age change of trauma patients. Then we secondly analyzed the data published in http://datadryad.org/. According to the in-hospital survival status, patients were divided into survival group and non-survival group. Receiver Operating Characteristic Curve (ROC) analysis was used to evaluated the value of ISS (injury severity score); NISS (new injury severity score), APACHE Ⅱ (Acute Physiology and Chronic Health Evaluation Ⅱ), SPAS Ⅱ (simplified acute physiology score Ⅱ) and TRISS (Trauma and Injury Severity Score) in predicting in-hospital mortality among geriatric trauma patients.Results:The analysis of NTDB showed the percentage of geriatric trauma has increased from 0.18 to 0.30, 2005-2015. The analysis of DGU showed the mean age rose from 39.11 in 1993 to 51.10 in 2013, and the percentage of patients aged ≥60 rose from 16.5% to 37.5%. A total of 311 patients aged more than 65 years were secondly analyzed. One hundred and sixty-four (52.73%) patients died in the hospital. ISS, NISS, APACHE, and SAPS in the death group were significantly higher than those in the survival group, but TRISS in the death group was significantly lower than those in the survival group. The AUC of APACHE Ⅱ was 0.715, ISS was 0.807, NISS was 0.850, SPAS Ⅱ was 0.725, and TRISS was 0.828.Conclusion:The increasing number of trauma in the elderly is a challenge for current and future trauma management. Compared with APACHE and SAPS, ISS, NISS and TRISS are more suitable for predicting in-hospital mortality in elderly trauma patients.

Enterocutaneous Fistula Complicating Trauma Laparotomy: A Major Resource Burden

2009 ◽  
Vol 75 (1) ◽  
pp. 30-32 ◽  
Author(s):  
Pedro G.R. Teixeira ◽  
Kenji Inaba ◽  
Joseph Dubose ◽  
Ali Salim ◽  
Carlos Brown ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Injury Severity Score ◽  
Resource Utilization ◽  
Severity Score ◽  
Injury Severity ◽  
Enterocutaneous Fistula ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Hospital Charges ◽  
Hollow Viscus

Enterocutaneous fistula (ECF) is an uncommon and poorly studied postoperative complication. The objective of this study was to analyze the incidence and resource utilization of patients who developed an ECF after trauma laparotomy. All patients with an ECF occurring after trauma laparotomy at a Level I trauma center were identified through a review of both the Trauma Registry and the Morbidity and Mortality reports for a 9-year period ending in December 2006. Each ECF case was matched with a control (non-ECF) that did not develop this complication after laparotomy. The matching criteria were: age, gender, mechanism of injury, Injury Severity Score, Abbreviated Injury Score, and damage control laparotomy requiring an open abdomen. Outcomes analyzed were intensive care unit (ICU) and hospital length of stay, mortality, and total hospital charges. During the 9-year period, of 2373 acute trauma laparotomies performed, 36 (1.5%) patients developed an enterocutaneous fistula, and were matched to 36 controls. Patients with an ECF were 31 ± 12 years of age, were 97 per cent male, had a mean Injury Severity Score of 21 ± 10, and 75 per cent were penetrating. Eighty-nine per cent of the ECF patients had a hollow viscus injury. The most common was colon (69%), followed by small bowel (53%), duodenum (36%), and stomach (19%). Fifty-six per cent of the ECF patients had multiple hollow viscus injuries. The development of an ECF was associated with significantly increased ICU length of stay (28.5 ± 30.5 vs 7.6 ± 9.3 days, P = 0.004), hospital length of stay (82.1 ± 100.8 vs 16.2 ± 17.3 days, P < 0.001), and hospital charges ($539,309 vs $126,996, P < 0.001). In conclusion, the development of an enterocutaneous fistula after laparotomy for trauma resulted in a significant impact on resource utilization including longer ICU and hospital length of stay and higher hospital charges. Further investigation into the prevention and treatment of this costly complication is warranted.

Penetrating brain injury: a case of survival following blast fragmentation injuries to the head

2013 ◽  
Vol 99 (2) ◽  
pp. 55-56
Author(s):  
J McKinlay ◽  
JE Smith
Keyword(s):  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Head Injuries ◽  
Good Recovery ◽  
Coma Scale ◽  
Blast Fragmentation ◽  
Serious Injuries

AbstractWe present a case of penetrating head injuries caused by blast fragmentation, along with other serious injuries (including to the arms, face and neck), where a good recovery was made despite an Injury Severity Score (ISS) of 75. We suggest that survival and outcome are reliant on several factors and cannot be predicted from ISS, velocity of penetrating injury or presenting Glasgow Coma Scale (GCS) alone.

Time is of the Essence: Impact of a More Aggressive Chemical Venous Thromboembolism Prophylaxis Regimen on Trauma Patients

2021 ◽  
pp. 000313482110508
Author(s):  
Thomas J. Schroeppel ◽  
Lesley P. Clement ◽  
Alyssa A. Douville ◽  
Nathan H. Schmoekel ◽  
Jerry Stassinopoulos ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Length Of Stay ◽  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Statistical Significance ◽  
Linear Regression Analysis ◽  
Trauma Patients ◽  
Thromboembolism Prophylaxis ◽  
Vte Prophylaxis

Background Trauma patients are at high risk for venous thromboembolism (VTE). Opportunity for chemical VTE prophylaxis improvement was identified and practice was altered to start chemoprophylaxis on admission in most patients. The purpose of this study was to determine if early VTE prophylaxis is safe and reduces VTE. Methods The trauma registry was queried over a 12-month period for patients admitted greater than 1 day for traumatic injury. The study spanned 6 months on either side of instituting aggressive chemoprophylaxis. Patients were risk adjusted on demographics, Injury Severity Score, transfusions, procedure type, length of stay, and mortality. Pre-intervention patients were then compared to patients in the aggressive cohort with the primary outcome of VTE. Secondary outcomes included transfusions, mortality, and length of stay (LOS). Results 1597 patients were identified over the study period with 754 (47%) patients in the aggressive period. There were no differences in age, sex, Injury Severity Score, transfusions, procedures, or LOS between cohorts. Pre-algorithm patients were more likely to have penetrating mechanism (9.3% vs 6.6%; P = .009) and longer time to VTE prophylaxis (23.3 vs 13.9 hours; P < .001). No differences were noted in anticoagulant, VTE rate (2.0% vs 1.2%; P = .195), or mortality. Linear regression analysis identified time to chemical prophylaxis as significant predictor of VTE (β = 43.9, P < .001). Conclusions Early aggressive chemical VTE prophylaxis is safe without increasing transfusions. Venous thromboembolism rates were decreased, but did not reach statistical significance.

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