No Difference in Morbidity or Mortality Between Octogenarians and Other Geriatric Burn Trauma Patients

2021 ◽  
pp. 000313482110111
Author(s):  
Miriam Alpert ◽  
Areg Grigorian ◽  
Victor Joe ◽  
Theresa L Chin ◽  
Nicole Bernal ◽  
...  
Keyword(s):  
Mortality Risk ◽  
Injury Severity ◽  
Frailty Index ◽  
Total Body Surface Area ◽  
Past Study ◽  
Trauma Patients ◽  
Multivariable Logistic Regression Model ◽  
Improvement Program ◽  
Burn Trauma ◽  
Severity Scores

Background Geriatric burn trauma patients (age ≥65 years) have a 5-fold higher mortality rate than younger adults. With the population of the US aging, the number of elderly burn and trauma patients is expected to increase. A past study using the National Burn Repository revealed a linear increase in mortality for those >65 years old. We hypothesized that octogenarians with burn and trauma injuries would have a higher rate of in-hospital complications and mortality, than patients aged 65-79 years old. Methods The Trauma Quality Improvement Program (2010-2016) was queried for burn trauma patients. To detect mortality risk a multivariable logistic regression model was used. Results From 282 patients, there were 73 (25.9%) octogenarians and 209 (74.1%) aged 65-79 years old. The two cohorts had similar median injury severity scores (16 vs. 15 in octogenarians, P = .81), total body surface area burned ( P = .30), and comorbidities apart from an increased smoking (12.9% vs. 4.1%, P = .04) and decreased hypertension (52.2% vs. 65.8%, P = .04) in the younger cohort. Octogenarians had similar complications, including acute respiratory distress syndrome, pulmonary embolism, deep vein thrombosis ( P > .05), and mortality (15.1% vs. 10.5%, P = .30), compared to the younger cohort. Octogenarians were not associated with an increased mortality risk (odds ratio 1.51, confidence interval 0.24-9.56, P = .67). Discussion Among burn trauma patients ≥65 years, age should not be a sole predictor for mortality risk. Continued research is necessary in order to determine more accurate approaches to prognosticate mortality in geriatric burn trauma patients, such as the validation and refinement of a burn-trauma-related frailty index.

Injury and Mortality Profiles in Level II and III Trauma Centers

2021 ◽  
pp. 000313482096629
Author(s):  
Ali Farhat ◽  
Areg Grigorian ◽  
Ahmed Farhat ◽  
Theresa L. Chin ◽  
Megan Donnelly ◽  
...  
Keyword(s):  
Mortality Risk ◽  
Injury Severity ◽  
Trauma Centers ◽  
Median Length ◽  
Improvement Program ◽  
Level Ii ◽  
Risk Of Mortality ◽  
Severity Scores ◽  
American College Of Surgeons ◽  
Level I

Background While the benefit of admission to trauma centers compared to non-trauma centers is well-documented and differences in outcomes between Level-I and Level-II trauma centers are well-studied, data on the differences in outcomes between Level-II trauma centers (L2TCs) and Level-III trauma centers (L3TCs) are scarce. Objectives We sought to compare mortality risk between patients admitted to L2TCs and L3TCs, hypothesizing no difference in mortality risk for patients treated at L3TCs compared to L2TCs. Methods A retrospective analysis of the 2016 Trauma Quality Improvement Program (TQIP) database was performed. Patients aged 18+ years were divided into 2 groups, those treated at American College of Surgeons (ACS) verified L2TCs and L3TCs. Results From 74,486 patients included in this study, 74,187 (99.6%) were treated at L2TCs and 299 (.4%) at L3TCs. Both groups had similar median injury severity scores (ISSs) (10 vs 10, P < .001); however, L2TCs had a higher mean ISS (14.6 vs 11.9). There was a higher mortality rate for L2TC patients (6.0% vs 1.7%, P = .002) but no difference in associated risk of mortality between the 2 groups (OR .46, CI .14-1.50, P = .199) after adjusting predictors of mortality. L2TC patients had a longer median length of stay (5.0 vs 3.5 days, P < .001). There was no difference in other outcomes including myocardial infarction (MI) and cerebrovascular accident (CVA) ( P > .05). Discussion Patients treated at L2TCs had a longer LOS compared to L3TCs. However, after controlling for covariates, there was no difference in associated mortality risk between L2TC and L3TC patients.

Increased Mortality in Underinsured Penetrating Trauma Patients

2021 ◽  
pp. 000313482110249
Author(s):  
Leonardo Alaniz ◽  
John Billimek ◽  
Cesar Figueroa ◽  
Jeffry T. Nahmias ◽  
Cristobal Barrios
Keyword(s):  
Mortality Risk ◽  
Injury Severity ◽  
Private Insurance ◽  
Penetrating Trauma ◽  
Data Bank ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Multivariable Logistic Regression Model ◽  
Uninsured Patients ◽  
Increased Risk

Introduction It remains unclear whether an increased mortality risk in uninsured patients exists across Injury Severity Score (ISS) classifications. We hypothesized that penetrating trauma self-pay patients would have a similarly increased mortality risk across all ISS categories. Methods The National Trauma Data Bank (2013-2015) was queried for patients presenting with penetrating firearm, explosive, or stab wound injuries. 115 651 patients were identified and a stratified multivariable logistic regression model was used. Results In the >15 ISS group, self-pay patients had a lower median total hospital Length of Stay (LOS) (3 vs 8, P < .001), lower median Intensive Care Unit LOS (1 vs 3, P < .001), and lower median ventilator days (0 vs 1, P < .001). Self-pay patients had an increased risk for mortality compared to patients with private insurance in both the ≤15 ISS group (OR 2.68, P < .001) and >15 ISS group (OR 1.56, P < .001). Conclusion Uninsured patients have an increased mortality risk in both low and high ISS groups. A higher mortality risk among uninsured patients in the high ISS group can be explained by decreased resource availability and lower ICU days and ventilator time. However, more studies are needed to determine why there is an even greater mortality risk among uninsured patients with mild ISS.

Non-Selective Thoracic Computed Tomography in Trauma Patients Results in Injury Severity Score Inflation

2021 ◽  
pp. 000313482110249
Author(s):  
Leonardo Alaniz ◽  
Omaer Muttalib ◽  
Juan Hoyos ◽  
Cesar Figueroa ◽  
Cristobal Barrios
Keyword(s):  
Computed Tomography ◽  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Treatment Plan ◽  
Mortality Prediction ◽  
Trauma Patients ◽  
Mortality Benefit ◽  
Severity Scores ◽  
Score Inflation

Introduction Extensive research relying on Injury Severity Scores (ISS) reports a mortality benefit from routine non-selective thoracic CTs (an integral part of pan-computed tomography (pan-CT)s). Recent research suggests this mortality benefit may be artifact. We hypothesized that the use of pan-CTs inflates ISS categorization in patients, artificially affecting admission rates and apparent mortality benefit. Methods Eight hundred and eleven patients were identified with an ISS >15 with significant findings in the chest area. Patient charts were reviewed and scores were adjusted to exclude only occult injuries that did not affect treatment plan. Pearson chi-square tests and multivariable logistic regression were used to compare adjusted cases vs non-adjusted cases. Results After adjusting for inflation, 388 (47.8%) patients remained in the same ISS category, 378 (46.6%) were reclassified into 1 lower ISS category, and 45 (5.6%) patients were reclassified into 2 lower ISS categories. Patients reclassified by 1 category had a lower rate of mortality ( P < 0.001), lower median total hospital LOS ( P < .001), ICU days ( P < .001), and ventilator days ( P = 0.008), compared to those that remained in the same ISS category. Conclusion Injury Severity Score inflation artificially increases survival rate, perpetuating the increased use of pan-CTs. This artifact has been propagated by outdated mortality prediction calculation methods. Thus, prospective evaluations of algorithms for more selective CT scanning are warranted.

Evaluation of Microvascular Perfusion and Resuscitation after Severe Injury

2015 ◽  
Vol 81 (12) ◽  
pp. 1272-1278 ◽  
Author(s):  
Yann-Leei L. Lee ◽  
Jon D. Simmons ◽  
Mark N. Gillespie ◽  
Diego F. Alvarez ◽  
Richard P. Gonzalez ◽  
...  
Keyword(s):  
Injury Severity ◽  
Capillary Flow ◽  
Severe Trauma ◽  
Dark Field ◽  
Serum Lactate ◽  
Microvascular Perfusion ◽  
Trauma Patients ◽  
Sidestream Dark Field ◽  
Trauma Population ◽  
Severity Scores

Achieving adequate perfusion is a key goal of treatment in severe trauma; however, tissue perfusion has classically been measured by indirect means. Direct visualization of capillary flow has been applied in sepsis, but application of this technology to the trauma population has been limited. The purpose of this investigation was to compare the efficacy of standard indirect measures of perfusion to direct imaging of the sublingual microcirculatory flow during trauma resuscitation. Patients with injury severity scores >15 were serially examined using a handheld sidestream dark-field video microscope. In addition, measurements were also made from healthy volunteers. The De Backer score, a morphometric capillary density score, and total vessel density (TVD) as cumulative vessel area within the image, were calculated using Automated Vascular Analysis (AVA3.0) software. These indices were compared against clinical and laboratory parameters of organ function and systemic metabolic status as well as mortality. Twenty severely injured patients had lower TVD (X = 14.6 ± 0.22 vs 17.66 ± 0.51) and De Backer scores (X = 9.62 ± 0.16 vs 11.55 ± 0.37) compared with healthy controls. These scores best correlated with serum lactate (TVD R2 = 0.525, De Backer R2 = 0.576, P < 0.05). Mean arterial pressure, heart rate, oxygen saturation, pH, bicarbonate, base deficit, hematocrit, and coagulation parameters correlated poorly with both TVD and De Backer score. Direct measurement of sublingual microvascular perfusion is technically feasible in trauma patients, and seems to provide real-time assessment of micro-circulatory perfusion. This study suggests that in severe trauma, many indirect measurements of perfusion do not correlate with microvascular perfusion. However, visualized perfusion deficiencies do reflect a shift toward anaerobic metabolism.

Suburban geriatric trauma: the experiences of a level I trauma center

1995 ◽  
Vol 4 (5) ◽  
pp. 379-382 ◽  
Author(s):  
F DeKeyser ◽  
D Carolan ◽  
A Trask
Keyword(s):  
Trauma Center ◽  
Functional Outcomes ◽  
Injury Severity ◽  
The Elderly ◽  
Mortality Rates ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Younger Patients ◽  
Severity Scores ◽  
Trauma Scores

BACKGROUND: As the mean age of the US population increases, so does the incidence of geriatric trauma. Investigators have shown that the elderly have high morbidity and mortality rates associated with traumatic injuries. OBJECTIVE: To compare the severity of injury, mortality, and functional outcomes of geriatric patients with younger patients admitted to a suburban trauma center. METHOD: A convenience sample of trauma patients who were 65 years old or older was compared with trauma patients who were 35 to 45 and 55 to 64 years old. Demographic data, injury data, Injury Severity Scores, Revised Trauma Scores, length of stay, and functional ability outcomes were abstracted from a trauma registry in aggregate form and then analyzed. RESULTS: The sample consisted of 766 subjects (age 35-45, n = 223; age 55-64, n = 135; age 65 and older, n = 408) with a mean age of 64.6 years. A larger percentage of the elderly were victims of falls; younger trauma patients were more likely to be victims of motor vehicle crashes. Significant differences were found between age groups on Glasgow Coma Scale scores. Revised Trauma Scores, and length of stay. Significant differences were not found on Injury Severity Scores, mortality rates, or functional outcomes. CONCLUSIONS: Although anatomic injury severity of elderly patients was similar to that of younger patients, the elderly demonstrated greater physiologic compromise and longer hospital stays. Mortality rates were lower for the elderly group, but this result might be because a larger proportion of elderly patients were hospitalized with minor or moderate injuries.

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.

Decreased Length of Stay After Laparoscopic Diaphragm Repair for Isolated Diaphragm Injury After Penetrating Trauma

2020 ◽  
Vol 86 (5) ◽  
pp. 493-498
Author(s):  
Haris H. Chaudhry ◽  
Areg Grigorian ◽  
Michael E. Lekawa ◽  
Matthew O. Dolich ◽  
Ninh T. Nguyen ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Length Of Stay ◽  
Injury Severity ◽  
Penetrating Trauma ◽  
Bivariate Analysis ◽  
Trauma Patients ◽  
Improvement Program ◽  
Chi Square ◽  
Diaphragm Injury ◽  
Diaphragmatic Repair

Background Isolated diaphragm injury (IDI) occurs in up to 30% of penetrating left thoracoabdominal injuries. Laparoscopic abdominal procedures have demonstrated improved outcome including decreased postoperative pain and length of stay (LOS) compared to open surgery. However, there is a paucity of data on this topic for penetrating IDI. The aim of this study was to examine the prevalence and outcome of laparoscopic diaphragmatic repair versus open diaphragmatic repair (LDR vs ODR) of IDI. Methods The Trauma Quality Improvement Program (2010-2016) was queried for patients with IDI who underwent ODR versus LDR. A bivariate analysis using Pearson chi-square and Mann-Whitney test was performed to determine LOS among the two groups. Results From 2039 diaphragm injuries, 368 patients had IDI; 281 patients (76.4%) underwent ODR and 87 (23.6%) underwent LDR. Compared to LDR, the ODR patients were older (median, 31 vs 25 years, P < .001) and had a higher injury severity score (mean, 11.2 vs 9.6, P = .03) but had similar rates of intensive care unit LOS, unplanned return to the operating room, ventilator days, and complications ( P > .05). Patients undergoing ODR had a longer LOS (5 vs 4 days, P = .01), compared to LDR. There were no deaths in either group. Conclusions Trauma patients presenting with IDI undergoing ODR had a longer hospital LOS compared to patients undergoing LDR with no difference in complications or mortality. Therefore, we recommend when possible an LDR should be employed to decrease hospital LOS. Further research is needed to examine other benefits of laparoscopy such as postoperative pain, incisional hernia, and wound-related complications.

Coagulopathy Predicts Mortality in Pediatric Patients with Traumatic Brain Injury

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2891-2891 ◽  
Author(s):  
Bhavya S. Doshi ◽  
Shannon L. Meeks ◽  
Jeanne E Hendrickson ◽  
Andrew Reisner ◽  
Traci Leong ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Pediatric Patients ◽  
Injury Severity ◽  
Pediatric Trauma ◽  
Morbidity And Mortality ◽  
P Value ◽  
Trauma Patients ◽  
Severity Scores ◽  
Pediatric Tbi

Abstract Trauma is the leading cause of death in children ages 1 to 21 years of age. Traumatic brain injury (TBI) poses a high risk of both morbidity and mortality within the subset of pediatric trauma patients. Numerous adult studies have shown that coagulopathy is commonly observed in patients who have sustained trauma and that the incidence is higher when there is TBI. Previously, it was thought that coagulopathy related to trauma was dilutional (i.e. due to replacement of red cells and platelets without plasma) but more recent studies show that the coagulopathy in trauma is early and likely independent of transfusion therapy. Additionally, abnormal coagulation studies (PT, PTT, INR, platelet count, fibrinogen, and D-dimer) following TBI are associated with increased morbidity and mortality in adults. Although coagulopathy after traumatic brain injury in adults is well documented, the pediatric literature is fairly sparse. A recent study by Hendrickson et al in 2008 demonstrated that coagulopathy is both underestimated and under-treated in pediatric trauma patients who required blood product replacements. Here we present the results of a retrospective pilot study designed to assess coagulopathy in the pediatric TBI population. We analyzed all children admitted to our facility with TBI from January 2012 to December 2013. Patients were excluded if they had underlying diseases of the hemostatic system. All patients had baseline characteristics measured including: age, sex, mechanism of injury, Glasgow Coma Scale (GCS), injury severity score (ISS), initial complete blood count, DIC profile, hematological treatments including transfusions, ICU and hospital length of stay, ventilator days and survival status. Coagulation studies were defined as "abnormal" when they fell outside the accepted reference range of the pediatric hospital laboratory (PT 12.6-15.9, PTT 23.6-42.1 seconds, fibrinogen < 180 mg/dL units, platelets < 185 103/mL and hemoglobin < 11.5 g/dL). Survival was measured as survival at 30 days from admission or last known status at hospital discharge. One hundred and twenty patients met the inclusion criteria of the study and all were included in outcome analysis. Twenty-three of the 120 patients died (19.2%). Logistic regression analysis was used to compare survivors and non-survivors and baseline demographic data showed no difference in age or weight between the two groups with p-values of 0.1635 and 0.1624, respectively. Non-survivors had a higher ISS (30.26 vs 20.92, p-value 0.0004) and lower GCS (3 vs 5.8, p-value 0.0002) compared to survivors. Univariate analysis of coagulation studies to mortality showed statistically significant odds-ratios for ISS (OR 1.09, 95% CI 1.04-1.15), PT (OR 5.91, 95% CI 1.86-18.73), PTT (OR 6.48, 95% CI 2.04-20.52) and platelets (OR 5.63, 95% CI 1.74 – 18.21). Abnormal fibrinogen levels were not predictive of mortality (OR 2.56, 95% CI 0.96-6.79). These results are summarized in Table 1. Our results demonstrate that, consistent with adult studies, abnormal coagulation studies are also associated with increased mortality in pediatric patients. Higher injury severity scores and lower GCS scores are also predictive of mortality. Taken together, these results suggest that possible early correction of coagulopathy in severe pediatric TBI patients could improve outcomes for these patients. Table 1. OR 95% CI p-value ISS 1.09 1.04—1.15 .0009 PT > 15.9 sec 5.91 1.86—18.73 0.0026 PTT > 42.1 sec 6.48 2.04—20.52 0.0015 Fibrinogen < 180 mg/dL 2.56 0.96—6.79 0.0597 Platelets < 185 x 103/mL 5.63 1.74—18.21 0.0040 Disclosures No relevant conflicts of interest to declare.

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