Management of Major Blunt Renal Injury: A Twelve-Year Review at an Urban, Level I Trauma Hospital

2018 ◽  
Vol 84 (3) ◽  
pp. 451-454 ◽  
Author(s):  
D'Andrea K. Joseph ◽  
Daniel Daman ◽  
Rae Lynne Kinler ◽  
Karyl Burns ◽  
Lenworth Jacobs
Keyword(s):  
New England ◽  
Renal Injury ◽  
Injury Severity ◽  
Nonoperative Management ◽  
Hemodynamic Instability ◽  
Hospital Data ◽  
Urban Level ◽  
Level I ◽  
Research Consortium ◽  
Renal Injuries

The aim of this study was to describe the management of severe blunt renal injuries at a Level I trauma hospital. Data were collected through a record review of patients admitted from January 1, 2000, to December 31, 2011. These data were compiled as part of our hospital's participation in the Nonoperative Management of Grade IV and V Blunt Renal Injuries: A Research Consortium of New England Centers for Trauma Study. Thirty-six patients with severe blunt renal injuries were identified. Twenty-nine (80.6%) underwent nonoperative management (NOM) for their injuries. Seven (19.4%) received an immediate operation because of hemodynamic instability or CT findings of large hemoperitoneum or extravasation. No significant differences were observed on Injury Severity Score, Glasgow Coma Scale, injury grade, or systolic blood pressure on arrival to the emergency department. On arrival, the operative patients had higher heart rates and lower hematocrit and hemoglobin values relative to the NOM patients. The kidney was salvaged in three of the seven operative patients and was either saved or partially saved in all except one NOM patient. Three NOM patients died; none because of renal injuries. All other patients were successfully managed. None of the operative patients died. NOM management of high-grade renal injury was successful for these patients and should be considered in the management of grade IV and V blunt renal trauma.

Five-Year Retrospective Review of Blunt Renal Injuries at a Level I Trauma Center

2017 ◽  
Vol 83 (2) ◽  
pp. 148-156 ◽  
Author(s):  
Jessica Burns ◽  
Megan Brown ◽  
Zakaria I. Assi ◽  
Eric J. Ferguson
Keyword(s):  
Renal Injury ◽  
Trauma Center ◽  
Injury Severity ◽  
Exploratory Laparotomy ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Free Fluid ◽  
Specific Information ◽  
Septic Complications ◽  
Level I

We report the experience of a Level I trauma center in the management of blunt renal injury during a 5-year period, with special attention to those treated using angiography with embolization. The institutional trauma registry was queried for all patients with blunt renal injury between September 1, 2009 and August 30, 2014. Each injury was graded using the American Association for the Surgery of Trauma guidelines. Patients that underwent angiography with embolization were reviewed for case-specific information including imaging findings, treatment, materials used, clinical course, and mortality. The registry identified 48 blunt renal injury patients. Median Injury Severity Score was higher and hospital length of stay was significantly longer in those with blunt renal injury when compared with those without blunt renal injury (P < 0.001). The majority of patients with blunt renal injury were managed nonoperatively. Mortality was three out of 48 patients (5%). Nine patients underwent exploratory laparotomy. These operations were always performed for reasons other than the renal trauma (e.g., splenic injury, free fluid, free air). No patient underwent invasive renal operation. Six patients were treated using angiography with embolization. Of the six, one patient died of pulmonary septic complications. We conclude that selective nonoperative management is the mainstay of treatment for blunt renal injury. Angiography with embolization is a useful modality for cases of ongoing bleeding, and is typically preferable to nephrectomy in our experience.

Pre-hospital Management in Trauma Patients: a Comparison Between Austria and Germany

2021 ◽  
Author(s):  
Amelie Kanovsky ◽  
Christian Deininger ◽  
Florian Wichlas ◽  
Andreas Traweger ◽  
Rolf Lefering ◽  
...  
Keyword(s):  
Time Management ◽  
Injury Severity ◽  
Hemodynamic Instability ◽  
Hospital Treatment ◽  
Trauma Patients ◽  
Permissive Hypotension ◽  
Patient Demographics ◽  
Life Threatening ◽  
Mode Of Transportation ◽  
Level I

Abstract ObjectivesTo compare the pre-hospital treatment and intervention regimen for major trauma patients with comparable injury patterns between Austria (AUT) and Germany (GER). Patients and MethodsThis analysis is based on data retrieved from the TraumaRegister DGU®. Data included severely injured trauma patients with an Injury Severity Score (ISS) ≥ 16, an age ≥ 16, and who were primary admitted to an Austrian (n=4.186) or German (n=41.670) Level I Trauma Center from 2008 to 2017. Endpoints included pre-hospital times and interventions performed until final hospital admission. The analyzed data include patients’ demographics, mode of transportation, pre-hospital time management, hemodynamic stability, and various pre-hospital interventions.ResultsThe cumulative time for transportation from the site of accident to the hospital did not significantly differ between the countries (62 min. in AUT, 65 min. in GER). Overall, 53% of all trauma patients in AUT were transported to the hospital with a helicopter compared to 37% in GER (P<0.001). The rate of intubation - 48% in both countries, the number of chest tubes placed (5.7% GER, 4.9% AUT), and the frequency of administered catecholamines (13.4% GER, 12.3% AUT) was comparable (Φ=0.00). Hemodynamic instability upon arrival in the TC was higher in AUT, (20.6% vs. 14.7% in GER; P<0.001). A median of 500mL of fluid was administered in AUT, whereas in GER 1000mL were infused (P<0.001). Patient demographics did not reveal a relationship (Φ=0.00) and the majority of patients sustained a blunt trauma (96%). ConclusionA significant higher number of Helicopter EMS transports (HEMS) were carried out in AUT. This can be explained by the overall lack of a unified transport algorithm. The authors suggest implementing an international guideline to explicitly use the HEMS system for trauma patients only a) for the rescue/care of people who have had an accident or are in life-threatening situations, b) for the transport of emergency patients with ISS>16, c) for transport of rescue personnel to hard-to-reach regions or, d) for the transport of medicinal products. Further, the amount of administered fluid in the pre-clinical setting should follow the concept of permissive hypotension/ hypotensive resuscitation, however the data are still inconclusive and mandate further research.

Living on a Prayer: Religious Affiliation and Trauma Outcomes

2012 ◽  
Vol 78 (1) ◽  
pp. 66-68 ◽  
Author(s):  
Amal Khoury ◽  
Tolulope A. Oyetunji ◽  
Oluwaseyi Bolorunduro ◽  
Leia Harbour ◽  
Edward E. Cornwell ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Length Of Stay ◽  
Injury Severity ◽  
Religious Affiliation ◽  
Length Of Hospital Stay ◽  
Bivariate Analysis ◽  
Trauma Outcomes ◽  
All Cause Mortality ◽  
Urban Level ◽  
Level I

Research has shown that religious affiliation is associated with reduced all cause mortality. The aim of this study was to determine if religious affiliation predicts trauma-specific mortality and length of stay. Patients admitted to our urban Level I trauma center in 2008 were examined; the main study categorization was based on endorsement of a specific religious affiliation during a standard intake procedure. Bivariate and multivariate analysis was performed with in-hospital mortality and length of stay as the outcomes of interest, adjusting for demographic and injury severity characteristics. A total of 2303 patients were included in the study. Forty-six per cent endorsed a religious affiliation. Patients with a religious affiliation were more likely to be female, Hispanic, and older than those who reported no affiliation ( P < 0.001). There was no difference in length of hospital stay. On bivariate analysis those without religious affiliation were more likely to die ( P = 0.01), but this difference disappeared after adjusting for covariates. Although we could not identify a statistical association between religious affiliation and mortality on multivariate analysis, there was an association with injury severity suggesting religious patients were less severely injured.

Nonoperative Management of Blunt Hepatic Trauma: Comparison of Level I and II Trauma Centers

2021 ◽  
pp. 000313482110385
Author(s):  
Meghan Lewis ◽  
Dominik A. Jakob ◽  
Elizabeth R. Benjamin ◽  
Monica Wong ◽  
Marc D. Trust ◽  
...  
Keyword(s):  
Injury Severity ◽  
Blood Product ◽  
Nonoperative Management ◽  
Liver Trauma ◽  
Trauma Centers ◽  
Improvement Program ◽  
Thromboembolic Prophylaxis ◽  
Level Ii ◽  
Liver Injuries ◽  
Level I

Introduction Most blunt liver injuries are treated with nonoperative management (NOM), and angiointervention (AI) has become a common adjunct. This study evaluated the use of AI, blood product utilization, pharmacological venous thromboembolic prophylaxis (VTEp), and outcomes in severe blunt liver trauma managed nonoperatively at level I versus II trauma centers. Methods American College of Surgeons Trauma Quality Improvement Program (TQIP) study (2013-2016), including adult patients with severe blunt liver injuries (AIS score>/= 3) treated with NOM, was conducted. Epidemiological and clinical characteristics, severity of liver injury (AIS), use of AI, blood product utilization, and VTEp were collected. Outcomes included survival, complications, failure of NOM, blood product utilization, and length of stay (LOS). Results Study included 2825 patients: 2230(78.9%) in level I and 595(21.1%) in level II centers. There was no difference in demographics, clinical presentation, or injury severity between centers. Angiointervention was used in 6.4% in level I and 7.2% in level II centers (P=.452). Level II centers were less likely to use LMWH for VTEp (.003). There was no difference in mortality or failure of NOM. In level II centers, there was a significantly higher 24-hour blood product utilization (PRBC P = .015 and platelets P = .002), longer ventilator days (P = .012), and longer ICU (P< .001) and hospital LOS (P = .024). The incidence of ventilator-associated pneumonia was significantly higher in level II centers (P = .003). Conclusion Utilization of AI and NOM success rates is similar in level I and II centers. However, the early blood utilization, ventilator days, and VAP complications are significantly higher in level II centers.

Common Denominators in Death from Pediatric Back-Over Trauma

2011 ◽  
Vol 77 (10) ◽  
pp. 1420-1422 ◽  
Author(s):  
Rebecca Stark ◽  
Steven Lee ◽  
Angela Neville ◽  
Brant Putnah ◽  
Scott Bricker
Keyword(s):  
Family Member ◽  
Head Trauma ◽  
Injury Severity ◽  
Pediatric Population ◽  
Female Gender ◽  
Blunt Head Trauma ◽  
Revised Trauma Score ◽  
Urban Level ◽  
Level I ◽  
Trauma Injury

Low-speed “back-over” injuries comprise a small number of pediatric automobile versus pedestrian (AVP) trauma, however these injuries tend to be more severe and have a higher rate of mortality. The objective of this study was to determine environmental, mechanistic, and demographic factors common in pediatric back-over injuries resulting in death. Patients were identified from the trauma registry of an urban Level I trauma center over a 15-year period. Charts for all pediatric AVP injuries in ages 4 years and younger were reviewed. Mortalities due to back-over injuries were identified. For the study period reviewed (1995–2010) we identified 535 cases of auto versus pedestrian injury in children less than 4-years-old. Of these, 31 (5.79%) were mortalities. Among those 31 mortalities, six (19.3%) were identified as resulting from back-over trauma. Mean age was significantly lower in back-over injuries as compared with non back-over AVP trauma (1.33 ± 0.23 years, vs 3.5 ± 1.0 years, P = 0.001). We noted a trend toward female gender (67%) and Hispanic ethnicity (67%). All sustained massive blunt head trauma as the cause of death. There were no significant differences in Injury Severity Score or Revised Trauma Score in the back-over group. Environmental analysis revealed that cars were the perpetrating vehicle 50 per cent of the time, and sport utility vehicles, vans, or trucks 50 per cent of the time. In all cases, the accidents occurred in the patient's own driveway and by either a family member (67%) or acquaintance (33%). These data suggest that key characteristics of back-over trauma resulting in mortality include very young age, massive head trauma, injury occurring in the patient's own driveway, and with a family member or acquaintance behind the wheel. This may help identify points of injury prevention to decrease the number of victims of back-over trauma in the pediatric population.

scholarly journals Serial hemoglobin monitoring in adult patients with blunt solid organ injury: less is more

2020 ◽  
Vol 5 (1) ◽  
pp. e000446 ◽  
Author(s):  
Firas Madbak ◽  
Dustin Price ◽  
David Skarupa ◽  
Brian Yorkgitis ◽  
David Ebler ◽  
...  
Keyword(s):  
Injury Severity ◽  
Kidney Injury ◽  
Hemodynamic Instability ◽  
Organ Injury ◽  
Solid Organ ◽  
Solid Organ Injury ◽  
Level Of Evidence ◽  
Less Is More ◽  
Urban Level ◽  
Level 1 Trauma Center

BackgroundPatients who sustain blunt solid organ injury to the liver, spleen, or kidney and are treated nonoperatively frequently undergo serial monitoring of their hemoglobin (Hb). We hypothesized that among initially hemodynamically stable patients with blunt splenic, hepatic, or renal injuries treated without an operation, scheduled monitoring of serum Hb values may be unnecessary as hemodynamic instability, not merely Hb drop, would prompt intervention.MethodsWe performed a retrospective review of patients admitted to our urban Level 1 trauma center following blunt trauma with any grade III, IV, or V liver, spleen, or kidney injury from January 1, 2016 to December 31, 2016. Patients who were hemodynamically unstable and went directly to the operating room or interventional radiology were excluded. Patients who required any urgent or unplanned operative or angiographic intervention were compared with patients who did not require an intervention. Routine demographic and outcome variables were obtained and bivariate and multivariate regression statistics were performed using Stata V.10.ResultsA total of 138 patients were included in the study. Age (39.3 vs 41.4, p=0.51), mean injury severity score (26.7 vs 22.1, p=0.12), and admission Hb (11.9 vs 12.8, p=0.06) did not differ significantly between the two groups. The number of Hb draws (9.2 vs 10, p=0.69) and the associated change in Hb (3.7 vs 3.5, p=0.71) did not differ significantly between the two groups. Only splenic grade predicted need for urgent intervention (3.5 vs 2, p<0.001). All patients who required an operative or radiologic intervention did so based on change in hemodynamics or severity of splenic grade, per our institutional protocol, and not Hb trend.DiscussionAmong patients with blunt solid organ injury, a need for emergent intervention in the form of laparotomy or angioembolization occurs within the first hours of injury. Routine scheduled Hb measurements did not change management in our cohort.Level of evidenceLevel III.

The Price of Always Saying Yes: A Cost Analysis of Secondary Overtriage to an Urban Level I Trauma Center

2018 ◽  
Vol 84 (8) ◽  
pp. 1368-1375 ◽  
Author(s):  
Marko Bukur ◽  
Candace Teurel ◽  
Joseph Catino ◽  
Stanley Kurek
Keyword(s):  
Trauma Center ◽  
Injury Severity ◽  
Tissue Injury ◽  
Spinal Injury ◽  
Financial Burden ◽  
Trauma System ◽  
Soft Tissue Injury ◽  
Cost Savings ◽  
Urban Level ◽  
Level I

Level I trauma centers serve as a community resource, with most centers using an inclusive transfer policy that may result in overtriage. The financial burden this imparts on an urban trauma system has not been well examined. We sought to examine the incidence of secondary overtriage (SOT) at an urban Level I trauma center. This was a retrospective study from an urban Level I trauma center examining patients admitted as trauma transfers (TT) from 2010 to 2014. SOT was defined as patients not meeting the “Orange Book” transfer criteria and who had a length of stay of <48 hours. Average ED and transport charges were calculated for total transfer charges. A total of 2397 TT were treated. The number of TT increased over the study interval. The mean age of TT was 59.7 years (SD ± 26.4 years); patients were predominantly male (59.2%), white (83.2%), with at least one comorbidity (71.5%). Blunt trauma accounted for 96.8 per cent of admissions with a median Injury Severity Score of nine (IQR: 5–16). Predominant injuries were isolated closed head trauma (61.4%), skin/soft tissue injury (18.9%), and spinal injury (17.6%). SOT was 48.2 per cent and increased yearly (P < 0.001). The median trauma center charge for SOT was ($27,072; IQR: $20,089–34,087), whereas ED charges were ($40,440; IQR: $26,150–65,125), resulting in a total cost of $67,512/patient. A liberal TT policy results in a high SOT rate adding significant unnecessary costs to the health-care system. Efforts to establish transfer guidelines may allow for significant cost savings without compromising care.

You Cannot Go Home: Routine Concussion Evaluation is not Enough

2015 ◽  
Vol 81 (4) ◽  
pp. 395-403 ◽  
Author(s):  
Jennifer L. Hartwell ◽  
M. Chance Spalding ◽  
Brian Fletcher ◽  
M. Shay O'Mara ◽  
Chris Karas
Keyword(s):  
Ct Scan ◽  
Injury Severity ◽  
Neurocognitive Deficits ◽  
Inclusion Criteria ◽  
Neurocognitive Evaluation ◽  
Urban Level ◽  
Level I ◽  
Discharge Criteria ◽  
Head Computed Tomography

Traditional care of mild traumatic brain injury (MTBI) is to discharge patients from the emergency department (ED) if they have a Glasgow Coma Score (GCS) of 15 and a normal head computed tomography (CT) scan. However, this does not address short-term neurocognitive deficits. Our hypothesis is that a notable percentage of patients will need outpatient neurocognitive therapy despite a reassuring initial presentation. This is a retrospective review of patients with MTBI at an urban Level I trauma center. Inclusion criteria were a diagnosis of MTBI in patients 14 years old or older, GCS 15, negative head CT scan, a completed neurocognitive evaluation, blunt mechanism, and no confounding psychiatric comorbidities. Six thousand thirty-two patients were admitted over 18 months. Three hundred ninety-five patients met inclusion criteria. Average age was 38 years (range, 14 to 93 years), 64 per cent were male, and mean Injury Severity Score (ISS) was 8.1. Forty-one per cent were cleared for discharge without follow-up. Twenty-seven per cent required ongoing neurocognitive therapy. Three per cent were deemed unsafe for discharge home. Of the patients cleared for discharge, 88 per cent had positive/questionable loss of consciousness (LOC), whereas 81 per cent who required additional therapy had positive/questionable LOC ( P = 0.20). Age, gender, ISS, and alcohol use were compared between the groups and not found to be statistically different rendering them poor predictors for appropriate discharge from the ED. A surprisingly high percentage (27%) of patients who would have met traditional ED discharge criteria were found to have persistent deficits after neurocognitive testing and were referred for ongoing therapy. We provide evidence to suggest that we should take pause before discharging patients with MTBI without a cognitive evaluation.

Rib Fractures and Mortality: Breaking the Causal Relationship

2019 ◽  
Vol 85 (11) ◽  
pp. 1224-1227 ◽  
Author(s):  
Brittany Bankhead-Kendall ◽  
Sepeadeh Radpour ◽  
Kevin Luftman ◽  
Erin Guerra ◽  
Sadia Ali ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Injury Severity ◽  
Rib Fractures ◽  
Rib Fracture ◽  
Direct Result ◽  
P Value ◽  
Trauma Patients ◽  
Injury Score ◽  
Urban Level ◽  
Level I

Rib fractures have long been considered as a major contributor to mortality in the blunt trauma patient. We hypothesized that rib fractures can be an excellent predictor of mortality, but rarely contribute to cause death. We performed a retrospective study (2008–2015) of blunt trauma patients admitted to our urban, Level I trauma center with one or more rib fractures. Medical records were reviewed in detail. Rib fracture deaths were those from any respiratory sequelae or hemorrhage from rib fractures. There were 4413 blunt trauma patients who sustained one or more rib fractures and 295 (6.8%) died. Rib fracture patients who died had a mean Injury Severity Score = 38 and chest Abbreviated Injury Score = 3.4. Rib fractures were the cause of death in only 21 patients (0.5%). After excluding patients who were dead on arrival, patients dying as a result of their rib fractures were found to be older ( P < 0.0001) and had a higher admission respiratory rate ( P = 0.02). Multivariable logistic regression found that age ≥65 was the only variable independently associated with mortality directly related to rib fractures (odds ratio 4.1, 95% confidence interval = 1.3–13.3, P value < .0001). Mortality in patients with rib fractures is uncommon (7%), and mortality directly related to rib fractures is rare (0.5%). Older patients are four times more likely to die as a direct result of rib fractures and may require additional resources to avoid mortality.

Sign in / Sign up

Export Citation Format

Share Document