Prehospital Variables Alone Can Predict Mortality After Blunt Trauma: A Novel Scoring Tool

2021 ◽  
pp. 000313482110241
Author(s):  
Stephen Stopenski ◽  
Areg Grigorian ◽  
Kenji Inaba ◽  
Michael Lekawa ◽  
Kazuhide Matsushima ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Vital Signs ◽  
Weighted Average ◽  
Trauma Patients ◽  
Operating Characteristics ◽  
Improvement Program ◽  
Logistic Regression Models ◽  
Revised Trauma Score ◽  
Activation Criterion ◽  
Scoring Tool

Background We sought to develop a novel Prehospital Injury Mortality Score (PIMS) to predict blunt trauma mortality using only prehospital variables. Study Design The 2017 Trauma Quality Improvement Program database was queried and divided into two equal sized sets at random (derivation and validation sets). Multiple logistic regression models were created to determine the risk of mortality using age, sex, mechanism, and trauma activation criterion. The PIMS was derived using the weighted average of each independent predictor. The discriminative power of the scoring tool was assessed by calculating the area under the receiver operating characteristics (AUROC) curve. The PIMS ability to predict mortality was then assessed by using the validation cohort. The score was compared to the Revised Trauma Score (RTS) using the AUROC curve, including a subgroup of patients with normal vital signs. Results The derivation and validation groups each consisted of 163 694 patients. Seven independent predictors of mortality were identified, and the PIMS was derived with scores ranging from 0 to 20. The mortality rate increased from 1.4% to 43.9% and then 100% at scores of 1, 10, and 19, respectively. The model had very good discrimination with an AUROC of .79 in both the derivation and validation groups. When compared to the RTS, the AUROC were similar (.79 vs. .78). On subgroup analysis of patients with normal prehospital vital signs, the PIMS was superior to the RTS (.73 vs. .56). Conclusion The PIMS is a novel scoring tool to predict mortality in blunt trauma patients using prehospital variables. It had improved discriminatory power in blunt trauma patients with normal vital signs compared to the RTS.

Insurance Status and Ethnicity Impact Health Disparities in Rates of Advance Directives in Trauma

2021 ◽  
pp. 000313482110111
Author(s):  
Krista L. Haines ◽  
Benjamin P. Nguyen ◽  
Ioana Antonescu ◽  
Jennifer Freeman ◽  
Christopher Cox ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
End Of Life ◽  
Hospice Care ◽  
Private Insurance ◽  
Future Research ◽  
Trauma Patients ◽  
Improvement Program ◽  
Advanced Directives ◽  
Logistic Regression Models ◽  
Discharge Disposition

Introduction Advanced directives (ADs) provide a framework from which families may understand patient’s wishes. However, end-of-life planning may not be prioritized by everyone. This analysis aimed to determine what populations have ADs and how they affected trauma outcomes. Methods Adult trauma patients recorded in the American College of Surgeons Trauma Quality Improvement Program (TQIP) from 2013-2015 were included. The primary outcome was presence of an AD. Secondary outcomes included mortality, length of stay (LOS), mechanical ventilation, ICU admission/LOS, withdrawal of life-sustaining measures, and discharge disposition. Multivariable logistic regression models were developed for outcomes. Results 44 705 patients were included in the analyses. Advanced directives were present in 1.79% of patients. The average age for patients with ADs was 77.8 ± 10.7. African American (odds ratio (OR) .53, confidence intervals [CI] .36-.79) and Asian (OR .22, CI .05-.91) patients were less likely to have ADs. Conversely, Medicaid (OR 1.70, CI 1.06-2.73) and Medicare (OR 1.65, CI 1.25-2.17) patients were more likely to have ADs as compared to those with private insurance. The presence of ADs was associated with increased hospital mortality (OR 2.84, CI 2.19-3.70), increased transition to comfort measures (OR 2.87, CI 2.08-3.95), and shorter LOS (CO −.74, CI −1.26-.22). Patients with ADs had an increased odds of hospice care (OR 4.24, CI 3.18-5.64). Conclusion Advanced directives at admission are uncommon, particularly among African Americans and Asians. The presence of ADs was associated with increased mortality, use of mechanical ventilation, admission to the ICU, withdrawal of life-sustaining measures, and hospice. Future research should target expansion of ADs among minority populations to alleviate disparities in end-of-life treatment.

The DEPARTS Score: A Novel Tool for Predicting Discharge Disposition in Geriatric Trauma Patients

2021 ◽  
pp. 000313482110298
Author(s):  
Eric O. Yeates ◽  
Areg Grigorian ◽  
Catherine M. Kuza ◽  
Ninh T. Nguyen ◽  
Kenji Inaba ◽  
...  
Keyword(s):  
Acute Care ◽  
Weighted Average ◽  
Functional Health ◽  
Geriatric Trauma ◽  
Receiver Operating Curve ◽  
High Risk Population ◽  
Trauma Patients ◽  
Improvement Program ◽  
Discharge Disposition ◽  
Cord Injury

Background Geriatric trauma patients (GTPs) represent a high-risk population for needing post-acute care, such as skilled nursing facilities (SNFs) and long-term acute care hospitals (LTACs), due to a combination of traumatic injuries and baseline functional health. As there is currently no well-established tool for predicting these needs, we aimed to create a scoring tool that predicts disposition to SNFs/LTACs in GTPs. Methods The adult 2017 Trauma Quality Improvement Program database was divided at random into two equal sized sets (derivation and validation sets) of GTPs >65 years old. First, multiple logistic regression models were created to determine risk factors for discharge to a SNF/LTAC in admitted GTPs. Second, the weighted average and relative impact of each independent predictor was used to derive a DEPARTS ( Discharge of Elderly Patients After Recent Trauma to SNF/LTAC) score. We then validated the score using the area under the receiver-operating curve (AROC). Results Of 66 479 patients in the derivation set, 36 944 (55.6%) were discharged to a SNF/LTAC. Number of comorbidities, fall mechanism, spinal cord injury, long bone fracture, and major surgery were each independent predictors for discharge to SNF/LTAC, and a DEPARTS score was derived with scores ranging from 0 to 19. The AROC for this was .74. In the validation set, 66 477 patients also had a SNF/LTAC discharge rate of 55.7%, and the AROC was .74. Discussion The DEPARTS score is a good predictor of SNF/LTAC discharge for GTPs. Future prospective studies are warranted to validate its accuracy and clinical utility in preventing delays in discharge.

scholarly journals Comparative analysis of the frequency and the severity of diagnosed lesions between pedestrians struck by motor vehicles and other blunt trauma mechanisms victims

2015 ◽  
Vol 42 (4) ◽  
pp. 253-258 ◽  
Author(s):  
JOSÉ GUSTAVO PARREIRA ◽  
RAFAEL KRIEGER MARTINS ◽  
JULIO SLONGO ◽  
JACQUELINE A. GIANNINI PERLINGEIRO ◽  
SILVIA CRISTINE SOLDÁ ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Motor Vehicle ◽  
Flail Chest ◽  
Vital Signs ◽  
Motor Vehicles ◽  
Trauma Patients ◽  
Arterial Blood ◽  
Group A ◽  
Extremity Injuries ◽  
Mechanism Of Trauma

ABSTRACTObjective:to compare the frequency and the severity of diagnosed injuries between pedestrians struck by motor vehicles and victims of other blunt trauma mechanisms.Methods:retrospective analysis of data from the Trauma Registry, including adult blunt trauma patients admitted from 2008 to 2010. We reviewed the mechanism of trauma, vital signs on admission and the injuries identified. Severity stratification was carried using RTS, AIS-90, ISS e TRISS. Patients were assigned into group A (pedestrians struck by motor vehicle) or B (victims of other mechanisms of blunt trauma). Variables were compared between groups. We considered p<0.05 as significant.Results:a total of 5785 cases were included, and 1217 (21,0%) of which were in group A. Pedestrians struck by vehicles presented (p<0.05) higher mean age, mean heart rate upon admission, mean ISS and mean AIS in head, thorax, abdomen and extremities, as well as lower mean Glasgow coma scale, arterial blood pressure upon admission, RTS and TRISS. They also had a higher frequency of epidural hematomas, subdural hematomas, subarachnoid hemorrhage, brain swelling, cerebral contusions, costal fractures, pneumothorax, flail chest, pulmonary contusions, as well as pelvic, superior limbs and inferior limbs fractures.Conclusion:pedestrian struck by vehicles sustained intracranial, thoracic, abdominal and extremity injuries more frequently than victims of other blunt trauma mechanism as a group. They also presented worse physiologic and anatomic severity of the trauma.

Torso computed tomography in blunt trauma patients with normal vital signs can be avoided using non-invasive tests and close clinical evaluation

2019 ◽  
Vol 26 (6) ◽  
pp. 655-661 ◽  
Author(s):  
Elisa Reitano ◽  
Laura Briani ◽  
Fabrizio Sammartano ◽  
Stefania Cimbanassi ◽  
Margherita Luperto ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Blunt Trauma ◽  
Clinical Evaluation ◽  
Vital Signs ◽  
Trauma Patients ◽  
Non Invasive

scholarly journals Predictors of Mortality and Prehospital Monitoring Limitations in Blunt Trauma Patients

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Matej Strnad ◽  
Vesna Borovnik Lesjak ◽  
Vitka Vujanović ◽  
Tine Pelcl ◽  
Miljenko Križmarić
Keyword(s):  
Hospital Mortality ◽  
Regression Model ◽  
Blunt Trauma ◽  
Injury Severity ◽  
Vital Signs ◽  
Study Groups ◽  
Multivariate Logistic Regression Model ◽  
Hospital Death ◽  
Trauma Patients ◽  
Arterial Blood

This study aimed at determining predictors of in-hospital mortality and prehospital monitoring limitations in severely injured intubated blunt trauma patients. We retrospectively reviewed patients’ charts. Prehospital vital signs, Injury Severity Score (ISS), initial Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), arterial blood gases, and lactate were compared in two study groups: survivors (n=40) and nonsurvivors (n=30). There were no significant differences in prehospital vital signs between compared groups. Nonsurvivors were older (P=0.006), with lower initial GCS (P<0.001) and higher ISS (P<0.001), along with higher lactate (P<0.001) and larger base deficit (BD;P=0.006), whereas RTS (P=0.001) was lower in nonsurvivors. For predicting mortality, area under the curve (AUC) was calculated: for lactate 0.82 (P<0.001), for ISS 0.82 (P<0.001), and for BD 0.69 (P=0.006). Lactate level of 3.4 mmol/L or more was 82% sensitive and 75% specific for predicting in-hospital death. In a multivariate logistic regression model, ISS (P=0.037), GCS (P=0.033), and age (P=0.002) were found to be independent predictors of in-hospital mortality. The AUC for regression model was 0.93 (P<0.001). Increased levels of lactate and BD on admission indicate more severe occult hypoperfusion in nonsurvivors whereas vital signs did not differ between the groups.

Racial and Sex Disparities in Trauma Outcomes Based on Geographical Region

2020 ◽  
pp. 000313482096006
Author(s):  
William Q. Duong ◽  
Areg Grigorian ◽  
Cyrus Farzaneh ◽  
Jeffry Nahmias ◽  
Theresa Chin ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
Trauma Patients ◽  
Improvement Program ◽  
Trauma Outcomes ◽  
Risk Of Death ◽  
Hospital Access ◽  
Risk Of Mortality ◽  
Sex Disparities ◽  
Male Patients

Objectives Disparities in outcomes among trauma patients have been shown to be associated with race and sex. The purpose of this study was to analyze racial and sex mortality disparities in different regions of the United States, hypothesizing that the risk of mortality among black and Asian trauma patients, compared to white trauma patients, will be similar within all regions in the United States. Methods The Trauma Quality Improvement Program (2010-2016) was queried for adult trauma patients, separating by U.S. Census regions. Multivariable logistic regression analyses were performed for each region, controlling for known predictors of morbidity and mortality in trauma. Results Most trauma patients were treated in the South (n = 522 388, 40.7%). After risk adjustment, black trauma patients had a higher associated risk of death in all regions, except the Northeast, compared to white trauma patients. The highest associated risk of death for blacks (vs. whites) was in the Midwest (odds ratio [OR] 1.30, P < .001). Asian trauma patients only had a higher associated risk of death in the West (OR 1.39, P < .001). Male trauma patients, compared to women, had an increased associated risk of mortality in all four regions. Discussion This study found major differences in outcomes among different races within different regions of the United States. There was also both an increased rate and associated risk of mortality for male patients in all regions. Future prospective studies are needed to identify what regional differences in trauma systems including population density, transport times, hospital access, and other trauma resources explain these findings.

Repairing the injured bronchus in blunt chest trauma – A case series

Trauma ◽  
2021 ◽  
pp. 146040862098811
Author(s):  
Anith Nadzira Riduan ◽  
Narasimman Sathiamurthy ◽  
Benedict Dharmaraj ◽  
Diong Nguk Chai ◽  
Narendran Balasubbiah
Keyword(s):  
Blunt Trauma ◽  
Chest Trauma ◽  
Surgical Intervention ◽  
Case Series ◽  
Trauma Patients ◽  
Lung Collapse ◽  
Comprehensive Management ◽  
Lung Capacity ◽  
Management Algorithm ◽  
Operative Outcomes

Introduction Traumatic bronchial injury (TBI) is uncommon, difficult to diagnose and often missed. The incidence of TBI among blunt trauma patients is estimated to be around 0.5–2%. Bronchoplastic surgery is indicated in most cases to repair the tracheobronchial airway and preserve lung capacity. There is limited existing literature addressing the management of this condition in view of its rarity. The comprehensive management and outcomes of these patients are discussed. Methods The case notes of all patients who presented with persistent lung collapse due to trauma since July 2017 were reviewed retrospectively. Those patients requiring surgical intervention were included in the review. The mode of injury, clinical, radiological and bronchoscopy findings, concurrent injuries, type of surgery, length of stay (LOS) and operative outcomes were reviewed. Results Out of 11 patients who presented with persistent lung collapse post-blunt trauma, four (36%) were found to have structural bronchial disruption. All of them underwent successful repair of the injured bronchus, without the need of a pneumonectomy. The other seven patients were successfully treated conservatively. Conclusion The repair of the injured bronchus is essential in improving respiratory function and to prevent a pneumonectomy. Routine bronchoscopic evaluation should be performed for all suspected airway injuries as recommended in our management algorithm. Delayed presentations should not hinder urgent referral to thoracic centers for tracheobronchial reconstruction.

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