Cannabis Use is Associated with Increased Mechanical Ventilation and Polysubstance Use in Trauma Patients

2019 ◽  
Vol 85 (2) ◽  
pp. 226-229 ◽  
Author(s):  
Kian Banks ◽  
Subarna Biswas ◽  
Monica Wong ◽  
Saskya Byerly ◽  
Damon Clark ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Los Angeles ◽  
Injury Severity ◽  
Univariate Analysis ◽  
Traumatic Injury ◽  
Penetrating Trauma ◽  
Cannabis Use ◽  
Trauma Patients ◽  
Icu Length Of Stay ◽  
Polysubstance Use

Recent policy changes in California regarding cannabis use underscore the need to study outcomes and prevalence of this drug in trauma. Our study aims to study the prevalence of cannabis use and associations with injury types and outcomes in Los Angeles County trauma patients. Data were reviewed from 21,276 adult patients from a Los Angeles countywide database spanning five years (2012–2016), who underwent urine toxicology testing in the ED after sustaining a traumatic injury. The percentage of trauma patients using marijuana increased from 36 to 43 per cent over the five-year period. On univariate analysis, cannabis-positive patients were significantly younger and more likely male, with lower median systolic blood pressure and heart rate on arrival in the ED. A higher proportion of cannabis users had penetrating trauma, and 48 per cent of cannabis users also tested positive for amphetamines, cocaine, opioids, or Phencyclidine. On multivariate analysis, cannabis was associated with an increase in need for mechanical ventilation after adjusting for age, admission Glasgow Coma Score, gender, polysubstance use, blunt or penetrating mechanism, and Injury Severity Score, and was not associated with increases in mortality or ICU length of stay.

Predictors of Mortality in Trauma Patients Aged 80 years or Older

2016 ◽  
Vol 82 (10) ◽  
pp. 926-929 ◽  
Author(s):  
Kyle Mock ◽  
Jessica Keeley ◽  
Ashkan Moazzez ◽  
David S. Plurad ◽  
Brant Putnam ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Injury Severity ◽  
Univariate Analysis ◽  
The United States ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Inhospital Mortality ◽  
Predictors Of Mortality ◽  
Trauma Outcome ◽  
Level 1 Trauma Center

The population of the United States is predicted to age dramatically over the next few decades; as such older patients will comprise an increasing proportion of the injured populations. Due to multiple comorbidities and frailty, the old and very old are at greater risk for mortality than younger patients. To identify predictors of inhospital mortality in these patients, we performed a retrospective cohort study at our Level 1 trauma center. Between April 2009 and October 2014, we identified 193 trauma patients aged 80 years and older admitted to the intensive care unit. The mean age was 86 years old (4.9) and a majority of patients were white (57%) and male (54%). Univariate analysis found Injury Severity Score ( P < 0.01), initial Glasgow Coma Scale ( P < 0.01), admission pH ( P = <0.01), admission lactate ( P < 0.01), the need for mechanical ventilation ( P < 0.01), and Geriatric Trauma Outcome Score ( P < 0.01) to be predictors of mortality. Multivariate analysis identified length of mechanical ventilation [odds ratio (OR) = 0.73, 95% confidence interval (CI) = 0.60–0.90, P < 0.01], admission lactate (OR = 1.74, 95% CI = 1.21–2.51, P < 0.01), and the need for mechanical ventilation (OR = 18.2, 95% CI = 3.33–99.8, P < 0.01) as independent predictors of mortality. These predictors can help guide clinical decisions and should prompt early discussion of goals of care. The association between mechanical ventilation and mortality is confounded by withdrawal of care.

Extreme Thrombocytosis in Trauma Patients: Are Antiplatelet Agents the Answer?

2009 ◽  
Vol 75 (10) ◽  
pp. 1020-1024 ◽  
Author(s):  
Zainab Saadi ◽  
Kenji Inaba ◽  
Galinos Barmparas ◽  
Ali Salim ◽  
Peep Talving ◽  
...  
Keyword(s):  
Los Angeles ◽  
Injury Severity ◽  
Medical Center ◽  
Penetrating Trauma ◽  
Antiplatelet Agents ◽  
Trauma Patients ◽  
Platelet Counts ◽  
Lengths Of Stay ◽  
Injured Patients

The purpose of this study was to review the incidence of extreme thrombocytosis (ExT) (platelet count 1,000,000/μL or greater) in trauma patients and to examine the role of antiplatelet agents in its treatment. The Los Angeles County Medical Center trauma registry was used to obtain injury demographics, medications, and daily platelet counts for injured patients 16 years of age or older admitted between July 2005 and February 2008. Of 6,985 total trauma patients admitted during the study period, 95 developed ExT (1.4%). Average age was 29 years (range, 16-63 years), 89 per cent were male, 44 per cent had penetrating trauma, and mean Injury Severity Score was 24 (range, 1-57). Of the 95 patients with ExT, 41 were treated with aspirin (43%) and 54 were not (57%). The two groups did not differ with regard to basic demographics, injury patterns, vitals on admission, or splenectomy rate (34 vs 20%, P = 0.13). After adjusting for maximum platelet counts and duration of ExT, there was no difference between the treated and untreated groups in terms of mortality, complications, and intensive care unit or hospital lengths of stay. The incidence of ExT is approximately 1.4 per cent in trauma patients. Antiplatelet therapy does not affect ExT patient outcome. Further prospective studies are warranted.

scholarly journals 186 Acute Kidney Injury in Skeletal Trauma Admissions to Intensive Care: An Under-Estimated Complication

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
O Brown ◽  
T Crisp ◽  
M Flatman ◽  
C Hing
Keyword(s):  
Acute Kidney Injury ◽  
Intensive Care ◽  
Injury Severity ◽  
Penetrating Trauma ◽  
Kidney Injury ◽  
Long Bone ◽  
Trauma Patients ◽  
Skeletal Trauma ◽  
Body Regions ◽  
Intensive Care Stay

Abstract Introduction Acute kidney injury (AKI) is associated with prolonged admission and 3.5 times increased mortality for trauma patients requiring intensive care (ICU) treatment. Blunt trauma confers greater risk of AKI than penetrating trauma, potentially related to long bone fracture. The relationship between skeletal trauma and AKI in ICU has not previously been investigated. Method Retrospective data was analysed from 202 consecutive adult patients admitted to ICU with skeletal trauma from 01/06/2018 to 01/06/2019. AKI was defined by creatinine rise &gt;1.5 times baseline. Results AKI was found in 70/202 (34.65%) patients aged 16-99 years, 138 males and 64 females. Mean limb Abbreviated Injury Scale (AIS) was significantly higher in AKI (AIS= 2.57 (SD 0.53) versus non-AKI AIS=2.38 (SD 0.61), p = 0.027). Other body regions and total Injury Severity Score (ISS) were non-significant. AKI was associated with a significantly worse Glasgow Outcome Score (AKI 3.28 (SD 1.52) versus 4.02 (SD 1.08) p &lt; 0.001), increased intensive care stay (AKI 7.03 (SD 8.30) days versus non-AKI 3.8 (SD 4.1) days p &lt; 0.001) and increased 30-day mortality (AKI 18/70 (25.71%) versus non-AKI 10/132 (7.58%) p &lt; 0.001) Conclusions Skeletal trauma patients have a high incidence of AKI, which was significantly correlated with severity of skeletal limb trauma but not overall ISS.

Clinical Characteristics of Trauma Patients Requiring Hydrocortisone Treatment for Refractory Hypotension

2017 ◽  
Vol 83 (8) ◽  
pp. 821-824
Author(s):  
Gina Kim ◽  
Jeffrey Young
Keyword(s):  
Hospital Mortality ◽  
Injury Severity ◽  
Traumatic Injury ◽  
Patient Characteristics ◽  
Data Repository ◽  
Trauma Patients ◽  
Lower Blood ◽  
Refractory Hypotension ◽  
The University ◽  
Stress Dose

Corticosteroids play an important role in responding to physiologic stress in the human body. However, its application in critical care remains heavily debated. The purpose of this study was to identify patient characteristics associated with receiving stress-dose steroids during the intensive care unit stay after traumatic injury and its effect on in-hospital mortality. Patients admitted to the University of Virginia trauma center between January 1, 2011, and December 31, 2015, were identified using our Trauma Registry. Stress dose steroids were defined as 100 mg IV hydrocortisone every eight hours. Patients who received stress-dose steroids were identified using the Clinical Data Repository. Patient characteristics associated with increased likelihood of receiving stress-dose steroids during admission were age >65, diabetes mellitus, congestive heart failure, burn injuries, Injury Severity Score >15, lower blood pressure (141/80 vs 125/76 mm Hg), and higher heart rate (87 vs 94/min). Patients who received stress-dose steroids were found to have increased mortality but not after controlling for the aforementioned patient factors associated with increased likelihood of receiving stress-dose steroids. The use of stress-dose steroids in critically ill patients with refractory hypotension does not appear to affect in-hospital mortality.

An Objective Study of the Impact of the Electronic Medical Record on Outcomes in Trauma Patients

2012 ◽  
Vol 78 (11) ◽  
pp. 1249-1254 ◽  
Author(s):  
Paul J. Schenarts ◽  
Claudia E. Goettler ◽  
Michael A. White ◽  
Brett H. Waibel
Keyword(s):  
Length Of Stay ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Injury Severity ◽  
Unit Length ◽  
Traumatic Injury ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Delay In Diagnosis ◽  
The Impact

It is commonly believed that the electronic medical record (EMR) will improve patient outcomes. However, there is scant published literature to support this claim and no studies in any surgical population. Our hypothesis was that the EMR would not improve objective outcome measures in patients with traumatic injury. Prospectively collected data from our university-based Level I trauma center was retrospectively reviewed. Demographic, injury severity as well as outcomes and complications data were compared for all patients admitted over a 20-month period before introduction of the EMR and a 20-month period after full, hospital-wide use of the EMR. Implementation of the EMR was associated with a decreased hospital length of stay, P = 0.02; intensive care unit length of stay, P = 0.001; ventilator days, P = 0.002; acute respiratory distress syndrome, P = 0.006, pneumonia, P = 0.008; myocardial infarction, P = 0.001; line infection, P = 0.03; septicemia, P = 0.000; renal failure, P = 0.000; drug complication, P = 0.001; and delay in diagnosis, P = 0.04. There was no difference in mortality, unexpected cardiac arrest, missed injury, pulmonary embolism/deep vein thrombosis, or late urinary tract infection. This is the first study to investigate the impact of the EMR in surgical patients. Although there was an improvement in some complications, the overall impact was inconsistent.

Venous Thromboembolism in Trauma Patients

2007 ◽  
Vol 73 (11) ◽  
pp. 1173-1180 ◽  
Author(s):  
Om P. Sharma ◽  
Michael F. Oswanski ◽  
Rusin J. Joseph ◽  
Peter Tonui ◽  
Libby Westrick Pa-C ◽  
...  
Keyword(s):  
Risk Factor ◽  
Venous Thromboembolism ◽  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Univariate Analysis ◽  
Trauma Patients ◽  
Vein Thrombosis ◽  
Cord Injury ◽  
Deep Vein

Serial venous duplex scans (VDS) were done in 507 trauma patients with at least one risk factor (RF) for venous thromboembolism (VTE) during a 2-year study period. Deep vein thrombosis (DVT) was detected in 31 (6.1%) patients. This incidence was 3.1 per cent in low (1–2 RFs), 3.4 per cent in moderate (3–5 RFs), and 7.7 per cent in high (≥6 RFs) VTE scores ( P = 0.172). Incidence was statistically different (3% vs 7.2%, P = 0.048) on reanalyzing patients in two risk categories, low-risk (1–4 RFs) and high-risk (≥5 RFs). Only 4 of 16 RFs had statistically higher incidence of DVT in patients with or without RFs: previous VTE (27.3% vs 5.6%, odds ratio (OR) 6.628, P = 0.024), spinal cord injury (22.6% vs 5%, OR 5.493, P = 0.001), pelvic fractures (11.4% vs 5.1%, OR 2.373, P = 0.042), and head injury with a greater than two Abbreviated Injury Score (10.5% vs 4.2%, OR 2.639, P = 0.014). On reanalyzing patients with ≥5 RFs vs <5RFs, obesity (14.3 vs 6.1%, P = 0.007), malignancy (5.6% vs 0.6%, P = 0.006), coagulopathy (10.8% vs 1.8%, P = 0.000), and previous VTE (3.2% vs 0%, P = 0.019) were significant on univariate analysis. Patients with DVT had 3.70 ± 1.75 RFs and a 9.61 ± 4.93 VTE score, whereas, patients without DVT had 2.66 ± 1.50 RFs and a 6.83 ± 3.91 VTE score ( P = 0.000). DVTs had a direct positive relationship with higher VTE scores, length of stay, and number of VDS (>1 r, P ≤ 0.001). Increasing age was a weak risk factor (0.03 r, P = 0.5). First two VDS diagnosed 77 per cent of DVTs. Patients with injury severity score of ≥15 and 25 had higher DVTs compared with the ones with lower injury severity score levels ( P ≤ 0.05). Pulmonary embolism was silent in 63 per cent and DVTs were asymptomatic in 68 per cent.

A Contemporary Analysis of Delayed Diagnoses After Traumatic Injury

2020 ◽  
pp. 000313482095145
Author(s):  
Justin S. Hatchimonji ◽  
Catherine E. Sharoky ◽  
Elinore J. Kaufman ◽  
Lucy W. Ma ◽  
Anna E. Garcia Whitlock ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Injury Severity ◽  
Traumatic Injury ◽  
Trauma Team ◽  
Trauma Patients ◽  
Extremity Injury ◽  
Factors Associated ◽  
Common Category ◽  
Multivariable Regression Model ◽  
Multivariable Regression

Background Factors associated with delayed injury diagnosis (DID) have been examined, but incompletely researched. Methods We evaluated demographics, mechanism, and measures of mental status and injury severity among 10 years’ worth of adult trauma patients at our center for association with DID in a multivariable regression model. Descriptions of DID injuries were reviewed to highlight characteristics of these injuries. Results We included 13 509 patients, 89 (0.7%) of whom had a recognized DID. In regression analysis, ISS (OR 1.04 per point, 95% CI 1.02-1.06) and number of injuries (OR 1.08 per injury, 95% CI 1.04-1.11) were associated with DID. Operative patients had twice the odds of DID (OR 2.02, 95% CI 1.18-3.44). The most common category of DID was orthopedic extremity injury (22/89). Conclusion DID is associated with injury severity and operative intervention. This suggests that the presence of an injury requiring operation may distract the trauma team from additional injuries.

Functional Status after Injury: A Longitudinal Study of Geriatric Trauma

2010 ◽  
Vol 76 (10) ◽  
pp. 1055-1058 ◽  
Author(s):  
Lorraine Kelley-Quon ◽  
Lillian Min ◽  
Eric Morley ◽  
Jonathan R. Hiatt ◽  
Henry Cryer ◽  
...  
Keyword(s):  
Functional Status ◽  
Injury Severity ◽  
Living Arrangement ◽  
Statistical Significance ◽  
Functional Decline ◽  
Traumatic Injury ◽  
Community Dwelling ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Trauma Population

We evaluated self-rated functional status measured longitudinally in the year after injury in a geriatric trauma population. The longitudinal (L) group included 37 of 60 eligible trauma patients aged 65 years or older admitted December 2006 to November 2007 for greater than 24 hours who completed a Short Functional Status questionnaire (SFS) at 3, 6, and 12 months after injury. The SFS yields scores of 0 to 5 (5 = independent in all five activities of daily living [ADLs]) and has been validated among community-dwelling elders. The control (C) group included 63 trauma patients aged 65 years or older admitted December 2007 to July 2009 for greater than 24 hours who reported their preinjury functional status using the SFS at hospital admission. We used characteristics and scores of the C group to impute preinjury ADL scores for the L group. The groups were similar in baseline characteristics (age, ethnicity, Injury Severity Score, Charlson Comorbidity Index, and living arrangement; P > 0.05). For the C group, the preinjury ADL score was 4.6 (SD = 0.9). For the L group, ADL scores declined at all intervals reaching statistical significance at 12 months. We conclude that in the year after traumatic injury, geriatric patients lost the equivalent of approximately one ADL, increasing their risk of further functional decline, loss of independence, and death.

Racial and Ethnic Differences in Limiting Life-Sustaining Treatment in Trauma Patients

2019 ◽  
Vol 36 (11) ◽  
pp. 974-979
Author(s):  
Kamil Hanna ◽  
James Palmer ◽  
Lourdes Castanon ◽  
Muhammad Zeeshan ◽  
Mohammad Hamidi ◽  
...  
Keyword(s):  
African Americans ◽  
Ethnic Groups ◽  
Ethnic Differences ◽  
Injury Severity ◽  
Traumatic Injury ◽  
Severe Trauma ◽  
Trauma Patients ◽  
Improvement Program ◽  
Racial And Ethnic Differences ◽  
Life Sustaining Treatment

Introduction: Differences in health care between racial and ethnic groups exist. The literature suggests that African Americans and Hispanics prefer more aggressive treatment at the end of life. The aim of this study is to assess racial and ethnic differences in limiting life-sustaining treatment (LLST) after trauma. Study Design: We performed a 2-year (2013-2014) retrospective analysis of Trauma Quality Improvement Program database. Patients with age ≥16 and Injury Severity Score (ISS) ≥ 16 were included. Outcome measures were the incidence and the predictors of LLST. Multivariable logistic regression was performed to control for confounding variables. Results: A total of 97 024 patients were identified. Mean age was 49 (21) years, 68% were male, 68% were white, and 14% were Hispanic. The overall incidence of LLST was 7.2%. Based on race, LLST was selected as consistent with goals of care more often in white when compared to African American individuals who experience serious traumatic injury (8.0% vs 4.5%; P < .001). Based on ethnicity, LLST was more often selected in non-Hispanics (7.5% vs 5.2%, P < .001) when compared to Hispanics. On regression analysis, the independent predictors of LLST were white race (odds ratio [OR]: 2.7 [1.6–4.4], P = .02), non-Hispanic ethnicity (OR: 1.9 [1.4-4.6]; P = .03), severe head injury (OR: 1.7 [1.1-3.2]; P = .04), and ISS (OR: 3.1 [2.4-5.1]; P < .01). Conclusions: Differences exist in selecting LLST between different racial and ethnic groups in severe trauma. African Americans and Hispanics are less likely to select LLST when compared to whites and non-Hispanics. Further studies are required to analyze the factors associated with selecting LLST in African Americans and Hispanics.

Patient Contact Time and Prehospital Interventions in Hypotensive Trauma Patients: Should We Reconsider the “ABC” Algorithm When Time Is of the Essence?

2020 ◽  
Vol 86 (8) ◽  
pp. 937-943
Author(s):  
Scott Ninokawa ◽  
Jessica Friedman ◽  
Danielle Tatum ◽  
Alison Smith ◽  
Sharven Taghavi ◽  
...  
Keyword(s):  
Injury Severity ◽  
Wound Care ◽  
Penetrating Trauma ◽  
Trauma Patients ◽  
Abc Algorithm ◽  
New Injury Severity Score ◽  
Urban Level ◽  
Level 1 ◽  
Needle Decompression ◽  
Level 1 Trauma Center

Introduction There is disagreement in the trauma community concerning the extent to which emergency medical services (EMS) should perform on-scene interventions. Additionally, in recent years the “ABC” algorithm has been questioned in hypotensive patients. The objective of this study was to quantify the delay introduced by different on-scene interventions. Methods A retrospective analysis of hypotensive trauma patients brought to an urban level 1 trauma center by EMS from 2007 to 2018 was performed, and patients were stratified by mechanism of injury and new injury severity score (NISS). Independent samples median tests were used to compare median on-scene times. Results Among 982 trauma patients, median on-scene time was 5 minutes (interquartile range 3-8). In penetrating trauma patients ( n = 488) with NISS of 16-25, intubation significantly increased scene time from 4 to 6 minutes ( P < .05). In penetrating trauma patients with NISS of 10-15, wound care significantly increased scene time from 3 to 6 minutes ( P < .05). Tourniquet use, interosseous (IO) access, intravenous (IV) access, and needle decompression did not significantly increase scene time. Conclusion Understanding that intubation increases scene time in penetrating trauma, while IV and IO access do not, alterations to the traditional “ABC” algorithm may be warranted. Further investigation of prehospital interventions is needed to determine which are appropriate on-scene.

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