Vital Signs Strongly Predict Massive Transfusion Need in Geriatric Trauma Patients

2016 ◽  
Vol 82 (7) ◽  
pp. 632-636 ◽  
Author(s):  
Scott C. Fligor ◽  
Mark E. Hamill ◽  
Katie M. Love ◽  
Bryan R. Collier ◽  
Dan Lollar ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Massive Transfusion ◽  
Early Recognition ◽  
Characteristic Curve ◽  
Vital Signs ◽  
Trauma Team ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Geriatric Population

Early recognition of massive transfusion (MT) requirement in geriatric trauma patients presents a challenge, as older patients present with vital signs outside of traditional thresholds for hypotension and tachycardia. Although many systems exist to predict MT need in trauma patients, none have specifically evaluated the geriatric population. We sought to evaluate the predictive value of presenting vital signs in geriatric trauma patients for prediction of MT. We retrospectively reviewed geriatric trauma patients presenting to our Level I trauma center from 2010 to 2013 requiring full trauma team activation. The area under the receiver operating characteristic curve was calculated to assess discrimination of arrival vital signs for MT prediction. Ideal cutoffs with high sensitivity and specificity were identified. A total of 194 patients with complete data were analyzed. Of these, 16 patients received MT. There was no difference between the MT and non-MT groups in sex, age, or mechanism. Systolic blood pressure, pulse pressure, diastolic blood pressure, and shock index all were strongly predictive of MT need. Interestingly, we found that heart rate does not predict MT. MT in geriatric trauma patients can be reliably and simply predicted by arrival vital signs. Heart rate may not reflect serious hemorrhage in this population.

The association between diastolic blood pressure and massive transfusion in severe trauma: a retrospective single-center study

2020 ◽  
pp. 1-14
Author(s):  
Dong Hun Lee ◽  
Hong Sug Kim ◽  
Byung Kook Lee ◽  
Yong Soo Cho ◽  
Tag Heo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Injury Severity ◽  
Massive Transfusion ◽  
Characteristic Curve ◽  
Multivariate Logistic Regression Analysis ◽  
Severe Trauma ◽  
Trauma Patients ◽  
Single Center Study ◽  
Blood Pressure Data

Abstract Objective: To evaluate the association between diastolic blood pressure and massive transfusion in severe trauma. Methods: The retrospective study was conducted at a tertiary emergency medical centre in Gwangju , Republic of Korea, and comprised data of severe trauma patients with injury severity score >15 presenting between January 2016 and December 2017. Multivariate logistic regression analysis was performed to evaluate the association between diastolic blood pressure and massive transfusion. Receiver operating characteristic curve analysis was performed to estimate the prognostic performance of diastolic blood pressure. Data was analysed using SPSS 18. Results: Of the 827 patients, 64(7.7%) underwent massive transfusion. After adjusting the confounders, diastolic blood pressure was found to be an independent factor in predicting massive transfusion (odds ratio: 0.965; 95% confidence interval: 0.956–0.975). Conclusion: Initially low diastolic blood pressure was found to be an independent predictor for massive transfusion in severe trauma cases. Key Words: Trauma, Diastolic blood pressure, Massive transfusion.

scholarly journals The Impact of Age and Receipt Antihypertensives to Systolic Blood Pressure and Shock Index at Injury Scene and in the Emergency Department to Predict Massive Transfusion in Trauma Patients

2020 ◽  
Author(s):  
Se Jin Park ◽  
Mi Jin Lee ◽  
Changho Kim ◽  
Haewon Jung ◽  
Seong Hun Kim ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Systolic Blood Pressure ◽  
Massive Transfusion ◽  
Geriatric Trauma ◽  
Red Blood Cell Transfusion ◽  
Trauma Patients ◽  
Shock Index ◽  
Cutoff Value ◽  
The Impact

Abstract Background : Systolic blood pressure (SBP) and shock index (SI) are accurate indicators of hemodynamic instability and the need for transfusion in trauma patients. We aimed to determine whether the utility and cutoff point for SBP and SI are affected by age or antihypertensives. Methods : This was a retrospective observational study of a level 1 trauma center between January 2017 and December 2018. We analyzed the utility and cutoff points of SBP and SI for predicting massive transfusion (MT) and 30-day mortality according to patients’ age and whether they were taking antihypertensives. Results : We analyzed 4681 trauma cases. There were 1949 patients aged 65 years or older (41.6%), and 1375 (29.4%) hypertensive patients. MT was given to 137 patients (2.9%). The 30-day mortality rate was 6.3% (n = 294). In geriatric trauma patients taking antihypertensives, prehospital SBP less than 110 mmHg was the cutoff value for predicting MT in multivariate logistic regression analyses; packed red blood cell transfusion volume decreased abruptly based on prehospital SBP of 110 mmHg. Emergency Department SI greater than 1.0 was the cutoff value for the prediction of MT in patients who were older than 65 years who were not taking antihypertensives. Conclusions : The triage of trauma patients is based on the identification of clinical features that are readily identifiable by first responders. However, age and medications may also affect accurate evaluation. In initial trauma management, we must apply SBP and SI differently depending on age, whether a patient is taking antihypertensives, and the time at which the indicators are measured.

Abstract 321: Pediatric Transfusion Score Predicts Transfusion Requirements for Children With Trauma

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Akira Komori ◽  
Toshikazu Abe ◽  
Gautam A Deshpande ◽  
Makoto Aoki ◽  
Toshio Naito
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Systolic Blood Pressure ◽  
Pediatric Trauma ◽  
Vital Signs ◽  
Area Under The Curve ◽  
Penetrating Trauma ◽  
Preschool Age ◽  
Trauma Patients ◽  
Transfusion Requirements

Introduction: Trauma is a leading cause of death in young populations. Transfusion is often a key life-saving element in cases of children with trauma. Nonetheless, clinicians may hesitate to use transfusion in children given the risks of complications. Hypothesis: A pediatric transfusion score can accurately predict 24-hour transfusion requirement in pediatric trauma patients. Methods: This is a retrospective cohort study using a nationwide registry of trauma patients (Japan Trauma Data Bank). All patients under 16 years of age with blunt or penetrating trauma between 2004 and 2015 were included. A pediatric transfusion score was developed based on previous literature and clinical relevance. One point was given for each of the following criteria: systolic blood pressure ≤ 90 mmHg; heart rate ≥ 120/min; Glasgow Coma Scale (GCS) < 15; and positive result on focused assessment with sonography for trauma (FAST) scan. For sensitivity analysis, age-adjusted pediatric transfusion score was also developed using cut off points for different age categories (infant, toddler, preschool age, school age, and adolescent). Results: Of the eligible 5,976 pediatric trauma patients, 550 patients had transfusion within 24 hours after trauma. In-hospital mortality rate was 2.6% (146/5,647). Transfusion increased from 7.7% (113/315) to 35.9% (437/5,661) in those with systolic blood pressure ≤ 90 mmHg (1 point); from 6.2% (280/4,526) to 18.6% (270/1,450) for heart rate ≥ 120/min (1 point); from 4.1% (113/3,220) to 15.1% (417/2,756) for altered mental status with GCS < 15 (1 point); and from 7.5% (403/5,404) to 25.7% (147/572) for FAST positivity (1 point). Pediatric transfusion scores of 0, 1, 2, 3, and 4 points were associated with transfusion rates of 2.2% (48/2,223), 7.5% (199/2,638), 20.3% (187/919), 53.9% (90/167), and 89.7% (26/29), respectively. The area under the curve (AUC) was 0.77 (95% CI, 0.75-0.79). For those without isolate head injury, it was 0.77 (95% CI, 0.75-0.80). After age adjustment, AUC was 0.76 (95% CI, 0.74-0.78). Conclusions: The pediatric transfusion score using vital signs and FAST may be helpful in predicting transfusion requirements within 24 hours for children with trauma.

scholarly journals FRI0618-HPR EFFECTS OF MUSIC THERAPY ON PAIN, ANXIETY, AND VITAL SIGNS IN CHRONIC INFLAMMATORY RHEUMATIC DISEASES PATIENTS DURING BIOLOGICAL DRUGS INFUSION

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 914.2-914
Author(s):  
S. Boussaid ◽  
M. Ben Majdouba ◽  
S. Jriri ◽  
M. Abbes ◽  
S. Jammali ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Music Therapy ◽  
Systolic Blood Pressure ◽  
Respiratory Rate ◽  
Vital Signs ◽  
Biological Therapies ◽  
Biological Drugs ◽  
Pain Anxiety ◽  
The Mean

Background:Music therapy is based on ancient cross-cultural beliefs that music can have a “healing” effect on mind and body. Research determined that listening to music can increase comfort and relaxation, relieve pain, lower distress, reduce anxiety, improve positive emotions and mood, and decrease psychological symptoms. Music therapy has been used greatly in various medical procedures to reduce associated anxiety and pain. Patients have a high level of anxiety when they are in the hospital, this is the case of patients with rheumatic diseases who consult regularly to have intravenous infusion of biological therapies.Objectives:The purpose of this study was to examine the effectiveness of music therapy on pain, anxiety, and vital signs among patients with chronic inflammatory rheumatic diseases during intravenous infusion of biological drugs.Methods:Fifty patients were divided into two groups: The experimental group G1 (n=25) received drug infusion while lestening to soft music (30 minutes); and the control group G2 (n=25) received only drug infusion. Measures include pain, anxiety, vital signs (blood pressure, heart rate and respiratory rate). The pain was measured using visual analogic scale (VAS). The state-trait anxiety inventory (STAI) was used for measuring anxiety, low anxiety ranges from 20 to 39, the moderate anxiety ranges from 40 to 59, and high anxiety ranges from 60 to 80. Vital signs (systolic blood pressure [SBP], diastolic blood pressure [DBP], heart rate [HR], and respiratory rate [RR]) were measured before, during and immediately after the infusion.Statistical package for social sciences (SPSS) was used for analysis.Results:The mean age in G1 was 44.45 years (26-72) with a sex ratio (M/F) of 0.8. Including the 25 patients, 12 had rheumatoid arthritis, 10 had ankylosing spondylitis and 3 had psoriatic arthritis. The mean disease duration was 8 years. In G2, the mean age was 46 years (25-70) with a sex ratio (M/F) of 0.75, 12 had rheumatoid arthritis, 11 had ankylosing spondylitis and 2 had psoriatic arthritis. The mean disease duration was 7.5 years. The biological drugs used were: Infliximab in 30 cases, Tocilizumab in 12 cases and Rituximab in 8 cases.Before the infusion, the patients of experimental group had a mean VAS of 5/10±3, a mean STAI of 50.62±6.01, a mean SBP of 13.6 cmHg±1.4, a mean DBP of 8.6 cmHg±1, a mean HR of 85±10 and a mean RR of 18±3. While in control group the mean VAS was 5.5±2, the mean STAI was 50.89±5.5, the mean SBP was 13.4±1.2, the mean DBP was 8.8±1.1, the mean HR was 82±8 and the mean RR was 19±2.During the infusion and after music intervention in G1, the mean STAI became 38.35±5 in G1 versus 46.7±5.2 in G2 (p value=0.022), the mean SBP became 12.1±0.5 in G1 versus 13±1 in G2 (p=0.035), the mean DBP became 8.1±0.8 in G1 versus 8.4±0.9 in G2 (p=0.4), the mean HR became 76±9 in G1 versus 78±7 in G2 (p=0.04) and the mean RR became 17.3±2.1 in G1 versus 18.2±1.7 in G2 (p=0.39).This study found a statistically significant decrease in anxiety, systolic blood pressure and heart rate in patients receiving music interventions during biological therapies infusion, but no significant difference were identified in diastolic blood pressure and respiratory rate.Conclusion:The findings provide further evidence to support the use of music therapy to reduce anxiety, and lower systolic blood pressure and heart rate in patients with rheumatic disease during biological therapies infusion.References:[1] Lin, C., Hwang, S., Jiang, P., & Hsiung, N. (2019).Effect of Music Therapy on Pain After Orthopedic Surgery -A Systematic review and Meta-Analysis. Pain Practice.Disclosure of Interests:None declared

scholarly journals Improvement in geriatric trauma outcomes in an evolving trauma system

2019 ◽  
Vol 4 (1) ◽  
pp. e000282 ◽  
Author(s):  
Amund Hovengen Ringen ◽  
Iver Anders Gaski ◽  
Hege Rustad ◽  
Nils Oddvar Skaga ◽  
Christine Gaarder ◽  
...  
Keyword(s):  
Trauma System ◽  
Trauma Team ◽  
The Elderly ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Age Group ◽  
Trauma Team Activation ◽  
Activation Rate ◽  
Time Periods ◽  
Activation Rates

BackgroundThe elderly trauma patient has increased mortality compared with younger patients. During the last 15 years, initial treatment of severely injured patients at Oslo University Hospital Ulleval (OUHU) has changed resulting in overall improved outcomes. Whether this holds true for the elderly trauma population needs exploration and was the aim of the present study.MethodsWe performed a retrospective study of 2628 trauma patients 61 years or older admitted to OUHU during the 12-year period, 2002–2013. The population was stratified based on age (61–70 years, 71–80 years, 81 years and older) and divided into time periods: 2002–2009 (P1) and 2010–2013 (P2). Multiple logistic regression models were constructed to identify clinically relevant core variables correlated with mortality and trauma team activation rate.ResultsCrude mortality decreased from 19% in P1 to 13% in P2 (p<0.01) with an OR of 0.77 (95 %CI 0.65 to 0.91) when admitted in P2. Trauma team activation rates increased from 53% in P1 to 72% in P2 (p<0.01) with an OR of 2.16 (95% CI 1.93 to 2.41) for being met by a trauma team in P2. Mortality increased from 10% in the age group 61–70 years to 26% in the group above 80 years. Trauma team activation rates decreased from 71% in the age group 61–70 years to 50% in the age group older than 80 years. Median ISS were 17 in all three age groups and in both time periods.DiscussionDevelopment of a multidisciplinary dedicated trauma service is associated with increased trauma team activation rate as well as survival in geriatric trauma patients. As expected, mortality increased with age, although inversely related to the likelihood of being met by a trauma team. Trauma team activation should be considered for all trauma patients older than 70 years.Level of evidenceLevel IV.

scholarly journals Comparative Study of Heart Rate, Blood Pressure and Selective Attention of Subjects Before and After Music

2019 ◽  
Vol 4 (1) ◽  
pp. 625-628
Author(s):  
Nisha Ghimire ◽  
Renu Yadav ◽  
Soumitra Mukhopadhyay
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Reaction Time ◽  
Comparative Study ◽  
Error Correction ◽  
Vital Signs ◽  
Stroop Test ◽  
Before And After ◽  
Paired T Test ◽  
After Error

Introduction: Studies have shown different views regarding the effect of music in vitals e.g Heart rate (HR), Blood pressure (BP) and atiention. The effect of preferred music with lyrics in vitals and reaction time in stroop test has not been performed in Nepalese students so, we conducted the study. Objective: To find out the change in HR, BP and reaction time in Stroop test before and after their preferred music with lyrics. Methodology Thirty male medical and paramedical students aged 25.27 ± 2.0 participated in study. The vital signs and reaction time in Stroop test before and after music was taken. Results Paired-t test was used to compare means before and after exposure to music. The means are expressed as Mean ± SD. Heart rate (HR) increased after exposure to music (66.33±9.51 Vs 67.2±8.44) (p<.05). The error in Stroop test was less after music (.66±.49 Vs.63±.66) (p<.05). The reaction time after error correction decreased post exposure to music (24.117±4.61Vs23.29±4.45) (p<.05). Conclusion The heart rate increased after exposure to music. The errors decreased after listening to music which also decreased reaction time.

Epinephrine syringe exchange events in a paediatric cardiovascular ICU: analysing the storm

2017 ◽  
Vol 28 (3) ◽  
pp. 409-415 ◽  
Author(s):  
Barbara-Jo Achuff ◽  
Jameson C. Achuff ◽  
Hwan H. Park ◽  
Brady Moffett ◽  
Sebastian Acosta ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Systolic Blood Pressure ◽  
Vital Signs ◽  
Syringe Exchange ◽  
Control Data ◽  
Flow Change ◽  
Exchange Event ◽  
The Hours ◽  
Pressure Perturbations

AbstractIntroductionHaemodynamically unstable patients can experience potentially hazardous changes in vital signs related to the exchange of depleted syringes of epinephrine to full syringes. The purpose was to determine the measured effects of epinephrine syringe exchanges on the magnitude, duration, and frequency of haemodynamic disturbances in the hour after an exchange event (study) relative to the hours before (control).Materials and methodsBeat-to-beat vital signs recorded every 2 seconds from bedside monitors for patients admitted to the paediatric cardiovascular ICU of Texas Children’s Hospital were collected between 1 January, 2013 and 30 June, 2015. Epinephrine syringe exchanges without dose/flow change were obtained from electronic records. Time, magnitude, and duration of changes in systolic blood pressure and heart rate were characterised using Matlab. Significant haemodynamic events were identified and compared with control data.ResultsIn all, 1042 syringe exchange events were found and 850 (81.6%) had uncorrupted data for analysis. A total of 744 (87.5%) exchanges had at least 1 associated haemodynamic perturbation including 2958 systolic blood pressure and 1747 heart-rate changes. Heart-rate perturbations occurred 37% before exchange and 63% after exchange, and 37% of systolic blood pressure perturbations happened before syringe exchange, whereas 63% occurred after syringe exchange with significant differences found in systolic blood pressure frequency (p<0.001), duration (p<0.001), and amplitude (p<0.001) compared with control data.ConclusionsThis novel data collection and signal processing analysis showed a significant increase in frequency, duration, and magnitude of systolic blood pressure perturbations surrounding epinephrine syringe exchange events.

scholarly journals Characterization of Dexmedetomidine Dosing and Safety in Neonates and Infants

2015 ◽  
Vol 20 (2) ◽  
pp. 112-118 ◽  
Author(s):  
Lauren M. Estkowski ◽  
Jennifer L. Morris ◽  
Elizabeth A. Sinclair
Keyword(s):  
Blood Pressure ◽  
Intensive Care Unit ◽  
Heart Rate ◽  
Intensive Care ◽  
Systolic Blood Pressure ◽  
Vital Signs ◽  
Pediatric Intensive Care ◽  
Neonates And Infants ◽  
To Receive

OBJECTIVES: To describe and compare off-label use and cardiovascular (CV) adverse effects of dexmedetomidine in neonates and infants in the pediatric intensive care unit (PICU). METHODS: Patients younger than 12 months with corrected gestational ages of at least 37 weeks who were receiving continuous infusion of dexmedetomidine at a tertiary pediatric referral center between October 2007 and August 2012 were assessed retrospectively. Patients were excluded if dexmedetomidine was used for procedural sedation, postoperative CV surgery, or if postanesthesia infusion weaning orders existed at the time of PICU admission. RESULTS: The median minimum dexmedetomidine dose was similar between infants and neonates at 0.2 mcg/kg/hr (IQR, 0.17–0.3) versus 0.29 mcg/kg/hr (IQR, 0.2–0.31), p = 0.35. The median maximum dose was higher for infants than neonates (0.6 mcg/kg/hr [IQR, 0.4–0.8] vs. 0.4 mcg/kg/hr [IQR, 0.26–0.6], p &lt; 0.01). Additional sedative use was more common in infants than neonates (75/99 [76%] vs. 15/28 [54%], p = 0.02). At least 1 episode of hypotension was noted in 34/127 (27%) patients and was similar between groups. An episode of bradycardia was identified more frequently in infants than neonates (55/99 [56%] vs. 2/28 [7%], p &lt; 0.01). Significant reduction in heart rate and systolic blood pressure was noted when comparing baseline vital signs to lowest heart rate and systolic blood pressure during infusion (p &lt; 0.01). CONCLUSIONS: Dexmedetomidine dose ranges were similar to US Food and Drug Administration–labeled dosages for intensive care unit sedation in adults. More infants than neonates experienced a bradycardia episode, but infants were also more likely to receive higher dosages of dexmedetomidine and additional sedatives.

Effects of passive music therapy on anxiety and vital signs in lung cancer patients undergoing peripherally inserted central catheter placement procedure

2020 ◽  
Vol 21 (6) ◽  
pp. 875-882
Author(s):  
Qianqian Mou ◽  
Xiuyun Wang ◽  
Huiqiong Xu ◽  
Xia Liu ◽  
Junying Li
Keyword(s):  
Lung Cancer ◽  
Blood Pressure ◽  
Heart Rate ◽  
Music Therapy ◽  
Cancer Patients ◽  
Vital Signs ◽  
Catheter Placement ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Lung Cancer Patients

Purpose: To evaluate the effects of passive music therapy on anxiety and vital signs among lung cancer patients at their first peripherally inserted central catheter placement procedure in China. Methods: A randomized controlled clinical trial was conducted in the cancer center of a hospital in Chengdu from May to December 2017. A total of 304 lung cancer patients who met the inclusion and exclusion criteria were recruited and randomly assigned to experimental ( n = 152) and control ( n = 152) group, respectively. The control group only received standard care, while the experimental group received standard care and passive music therapy during peripherally inserted central catheter placement (30–45 min) and after catheterization, until discharged from the hospital (twice a day, 30 min once). Measures include anxiety and vital signs (blood pressure, heart rate, and respiratory rate). Results: Repetitive measurement and analysis of variance showed that the patients in experimental group had a statistically significant decrease in anxiety, diastolic blood pressure, and heart rate over time compared to the control group, but no significant difference was identified in systolic blood pressure and respiratory rate. Conclusion: Passive music therapy can efficiently relieve the anxiety of lung cancer patients during peripherally inserted central catheter placement. It also can lower the patient’s diastolic blood pressure and slow down the heart rate. So, music therapy benefits patients with peripherally inserted central catheter.

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