Using Arterial Pressure Index to Predict Arterial Injuries in Penetrating Trauma to the Upper Extremities

2021 ◽  
pp. 000313482110111
Author(s):  
Lily Tung ◽  
Mark J. Seamon ◽  
Elizabeth Dauer ◽  
Olamide Alabi ◽  
Jaime Benarroch‐Gampel ◽  
...  
Keyword(s):  
Arterial Pressure ◽  
Injury Severity ◽  
Penetrating Trauma ◽  
Gunshot Wounds ◽  
Trauma Patients ◽  
Vascular Injuries ◽  
Predictive Values ◽  
Lower Extremity Injuries ◽  
Pressure Index ◽  
Arterial Injuries

Background Upper extremity (UE) vascular injuries account for 18.4% of all traumatic vascular injuries. Arterial pressure index (API) use in lower extremity injuries to determine the need for further investigations is well established. However, due to collateral circulation in UEs, it is unclear if the same algorithm can be applied. The purpose of this study was to determine if APIs can be used to determine the need for computed tomography angiogram (CTA) in penetrating UE trauma. Methods All adult trauma patients with penetrating UE trauma and APIs from 2006 to 2016 were identified at 3 urban US level 1 trauma centers. Sensitivity, specificity, and positive and negative predictive values of APIs <.9 in detecting UE arterial injuries were calculated. Results During the 11-year study period, 218 patients met our inclusion criteria. Gunshot wounds comprised 76.6% and stab wounds 17.9%. Median injury severity score and API were 9 and 1, respectively. Seventy-two of our patients underwent evaluation with CTA. Of the injuries, the most common were thrombus or occlusion (46.7%), transection (23.1%), and dissection (15.4%), radiographically. Ultimately, 32 patients underwent surgical.

scholarly journals Incidence, Demographics, and Outcomes of Penetrating Trauma in Sweden During the Past Decade

2021 ◽  
Vol 12 ◽  
Author(s):  
Mattias Günther ◽  
Martin Dahlberg ◽  
Amir Rostami ◽  
Ali Azadali ◽  
Ulf P. Arborelius ◽  
...  
Keyword(s):  
Head Trauma ◽  
Interpersonal Violence ◽  
Injury Severity ◽  
Penetrating Trauma ◽  
Gunshot Wounds ◽  
Trauma Patients ◽  
National Council ◽  
Contributing Factors ◽  
Penetrating Injuries ◽  
Head Neck

Trauma injury is the sixth leading cause of death worldwide, and interpersonal violence is one of the major contributors in particular regarding injuries to the head and neck. The incidence, demographics, and outcomes of penetrating trauma reaching hospitals in Sweden are not known. We report the largest, nationwide epidemiological study of penetrating injuries in Sweden, using the Swedish Trauma Registry (SweTrau). A multi-center retrospective descriptive study of 4,776 patients was conducted with penetrating injuries in Sweden, between 2012 and 2018. Due to the increase in coverage of the SweTrau registry during the same period, we chose to analyze the average number of cases for the time intervals 2013–2015 and 2016–2018 and compare those trends to the reports of the Swedish National Council for Crime Prevention (Brå) as well. A total of 663 patients had Injury Severity Score (ISS) ≥ 15 at admission and were included in the study. Three hundred and sixty-eight (55.5%) were stab wounds (SW), 245 (37.0%) gunshot wounds (GSW), and 50 (7.5%) other traumas. A majority of the cases involved injuries to the head, neck, and face. SW increased from 145 during 2013–2015 to 184 during the second period of 2016–2018. The increase was greater for GSW from 92 to 141 during the same respective periods. This trend of increase over time was also seen in head, neck, and face injuries. The 30-day mortality was unaffected (48–47%) in GSW and trended toward lower in SW (24–21%) when comparing 2013–2015 with 2016–2018. Patients with head trauma had 45% mortality compared to 18% for non-head trauma patients. Head trauma also resulted in worse outcomes, only 13% had Glasgow outcome score (GOS) 5 compared to 27% in non-head trauma. The increasing number of cases of both SW and GSW corresponded well with reports from Brå although further studies also are needed to address deaths outside of hospitals and not registered at the SweTrau. The majority of cases had injuries to the head, neck, and face and were associated with higher mortality and poor outcomes. Further studies are needed to understand the contributing factors to these worse outcomes in Sweden and whether more targeted trauma care of these patients can improve outcomes.

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.

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.

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.

Extracorporeal Membrane Oxygenation Utilization in Blunt and Penetrating Traumatic Injuries: A Systematic Review

2021 ◽  
pp. 000313482110111
Author(s):  
Haley Ehrlich, BS ◽  
Charlie Bisbee, BS ◽  
Aleeza Ali ◽  
Dino Fanfan, BS ◽  
Sabrina Gill, BS ◽  
...  
Keyword(s):  
Systematic Review ◽  
Extracorporeal Membrane Oxygenation ◽  
Injury Severity ◽  
Meta Analysis ◽  
Survival Rates ◽  
Penetrating Trauma ◽  
Neurological Deficits ◽  
Trauma Patients ◽  
Membrane Oxygenation ◽  
Severity Scores

Background Extracorporeal membrane oxygenation (ECMO) has become an increasingly used treatment modality for severe respiratory insufficiency in trauma patients. Examining ECMO use specifically in blunt and penetrating traumas can aid in directing future protocols. We aim to evaluate the outcomes of ECMO use in both blunt and penetrating trauma patients through a systematic review of current literature. Methods An online search of 2 databases (PubMed and Google Scholar) was performed to analyze studies, which evaluated the use of ECMO in blunt and penetrating traumas. Preferred Reporting Items for Systematic Reviews and Meta-Analysis and Grading of Recommendations Assessment, Development and Evaluation guidelines were followed. Data extracted included mechanism of injury, injury severity scores (ISSs), complications, and mortality rates. Results The search demonstrated 9 studies that met our review inclusion criteria. A total of 207 patients were included, of which 64 (30.9%) were non-survivors and 143 (69.1%) were survivors. There was a total of 201 blunt traumas with 61 (30.3%) deaths, whereas penetrating traumas had 2 deaths (33.3%) out of 6 total patients. Complications reported included acute renal failure, hemorrhage at the cannula site, and transient neurological deficits. Most studies found better survival rates and less complications in younger patients and those with lower ISS. Conclusion Expanding the use of ECMO to include blunt and penetrating trauma patients provides the trauma surgeons with another crucial potentially lifesaving tool with an overall survival rate of 70%. Anticipating increased future use of ECMO in blunt and penetrating trauma patients, distinct protocols ought to be instilled to better address the care needed for these critically ill trauma patients.

Early Predictors of the Need for Emergent Surgery to Control Hemorrhage in Hypotensive Trauma Patients

2009 ◽  
Vol 75 (10) ◽  
pp. 986-990 ◽  
Author(s):  
Meghann Kaiser ◽  
Patrick Ahearn ◽  
Xuan-Mai Nguyen ◽  
Andrew Barleben ◽  
Marianne Cinat ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Injury Severity ◽  
Central Venous Access ◽  
Head Injuries ◽  
Penetrating Trauma ◽  
Venous Access ◽  
Trauma Patients ◽  
Clinical Predictors ◽  
Binary Logistic Regression Model ◽  
Emergent Surgery

Twenty-five to 30 per cent of hypotensive trauma patients require an emergent surgery, however, we have no reliable means to quickly determine that need. Our goal was to determine, via retrospective review, parameters available within minutes of arrival that predict the need for emergent surgery to control hemorrhage in hypotensive trauma patients. Inclusion criterion was initial systolic blood pressure (SBP) < 90 mm Hg in the emergency department (ED). Patients who were dead on arrival or underwent ED thoracotomy were excluded. Emergent surgery was defined as sternotomy, thoracotomy, laparotomy, or major neck vascular repair on day of admission. Potential clinical predictors were analyzed in a binary logistic regression model. Six hundred and thirty-nine hypotensive patients were identified and 193 excluded, leaving 446 with a mean age of 33 ± 19 years and Injury Severity Score of 22 ± 17. Thirty-two per cent suffered penetrating trauma, 30 per cent needed emergent surgery, and 19 per cent died. Independent predictors were: prolonged extrication (odds ratio (OR) 2.3), no loss of consciousness (OR 2.8), intubation (OR 1.7), central line placement (OR 1.7), and blood transfusion (OR 2.1, all P < 0.05). We concluded that hypotensive trauma patients without head injuries who require prolonged extrication, intubation, central venous access, and blood transfusion in the ED are more likely to need emergent surgery.

Patterns of Early Mortality after Trauma in a Neighborhood Urban Trauma Center: Can We Improve Outcomes?

2013 ◽  
Vol 79 (8) ◽  
pp. 764-767 ◽  
Author(s):  
Lindsay Berbiglia ◽  
Peter P. Lopez ◽  
Leah Bair ◽  
Adelaide Ammon ◽  
Gwyneth Navas ◽  
...  
Keyword(s):  
Chart Review ◽  
Injury Severity ◽  
Retrospective Chart Review ◽  
Gunshot Wounds ◽  
Common Mechanism ◽  
Trauma Patients ◽  
Hospital Arrival ◽  
Common Causes ◽  
Care Improvement ◽  
Uncontrolled Hemorrhage

Even with specialized trauma systems, a significant number of deaths occur within the early postinjury period. Our goal was to examine deaths within this period for cause and determine if care could improve outcomes. A retrospective chart review was performed on all patients who were dead on arrival or died within 4 hours of arrival between January 1, 2005, and December 31, 2011. Survival probabilities and Injury Severity Score (ISS) were calculated. Chart review and trauma review processes were used to determine cases with opportunities for care improvement. Two hundred eighty-nine patients were dead on arrival (DOA), and 176 patients died within 4 hours of arrival. The most common mechanism of injury was gunshot wounds (68.4%). The most common causes of death were uncontrolled hemorrhage (68.2%) and neurologic trauma (23.4%). Average ISS was 32. Twenty-nine patients had survival probability percentages over 50. Ten of 176 (5.7%) deaths were found to have opportunities for care improvement. In three cases (1.7%), errors contributed to death. The majority of trauma patients DOA or dying within 4 hours of hospital arrival have nonsurvivable injuries. Regular trauma review processes are invaluable in determining opportunities for care improvement. Autopsy information increases the reliability of the review process.

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.

scholarly journals Predictors of first pass success without hypoxemia in trauma patients requiring emergent rapid sequence intubation

2021 ◽  
Vol 6 (1) ◽  
pp. e000588
Author(s):  
Jason Randall West ◽  
Brandon P O'Keefe ◽  
James T Russell
Keyword(s):  
Injury Severity ◽  
Penetrating Trauma ◽  
Rapid Sequence Intubation ◽  
Facial Trauma ◽  
Trauma Patients ◽  
Level Of Evidence ◽  
Rapid Sequence ◽  
Severity Scores ◽  
First Pass ◽  
Gcs Score

ObjectiveThe predictors of first pass success (FPS) without hypoxemia among trauma patients requiring rapid sequence intubation (RSI) in the emergent setting are unknown.MethodsRetrospective study of adult trauma patients requiring RSI during a 5-year period comparing the trauma patients achieving FPS without hypoxemia to those who did not. The primary outcome was FPS without hypoxemia evaluated by multivariate logistic regression adjusting for the neuromuscular blocking agent used (succinylcholine or rocuronium), hypoxemia prior to RSI, Glasgow Coma Scale (GCS) scores, the presence of head or facial trauma, and intubating operator level of training.Results246 patients met our inclusion criteria. The overall FPS rate was 89%, and there was no statistical difference between those receiving either paralytic agent. 167 (69%) patients achieved FPS without hypoxemia. The two groups (those achieving FPS without hypoxemia and those who did not) had similar mean GCS, mean Injury Severity Scores, presence of head or facial trauma, the presence of penetrating trauma, intubating operator-level training, use of direct laryngoscopy, hypoxemia prior to RSI, heart rate per minute, mean systolic blood pressure, and respiratory rate. In the multivariate regression analysis, the use of succinylcholine and GCS score of 13–15 were found to have adjusted ORs of 2.1 (95% CI 1.2 to 3.8) and 2.0 (95% CI 1.0 to 3.3) for FPS without hypoxemia, respectively.ConclusionTrauma patients requiring emergency department RSI with high GCS score and those who received succinylcholine had higher odds of achieving FPS without hypoxemia, a patient safety goal requiring more study.Level of evidenceIV.Study typePrognostic.

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