Does Gender Matter: A Multi-Institutional Analysis of Viscoelastic Profiles for 1565 Trauma Patients With Severe Hemorrhage

2021 ◽  
pp. 000313482110335
Author(s):  
Alison Smith ◽  
Juan Duchesne ◽  
Matthew Marturano ◽  
Shaun Lawicki ◽  
Kevin Sexton ◽  
...  
Keyword(s):  
Alpha Angle ◽  
Reaction Times ◽  
Maximum Amplitude ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Survival Difference ◽  
Severe Hemorrhage ◽  
Male Patients ◽  
Level I ◽  
Clot Formation Time

Background Viscoelastic tests including thromboelastography (TEG) and rotational thromboelastometry (ROTEM) are being used in patients with severe hemorrhage at trauma centers to guide resuscitation. Several recent studies demonstrated hypercoagulability in female trauma patients that was associated with a survival advantage. The objective of our study was to elucidate the effects of gender differences in TEG/ROTEM values on survival in trauma patients with severe hemorrhage. Methods A retrospective review of consecutive adult patients receiving massive transfusion protocol (MTP) at 7 Level I trauma centers was performed from 2013 to 2018. Data were stratified by gender and then further examined by TEG or ROTEM parameters. Results were analyzed using univariate and multi-variate analyses. Results A total of 1565 patients were included with 70.9% male gender (n = 1110/1565). Female trauma patients were older than male patients (43.5 ± .9 vs 41.1 ± .6 years, P = .01). On TEG, females had longer reaction times (6.1 ± .9 min vs 4.8 ± .2 min, P = .03), increased alpha angle (68.6 ± .8 vs 65.7 ± .4, P < .001), and higher maximum amplitude (59.8 ± .8 vs 56.3 ± .4, P < .001). On ROTEM, females had significantly longer clot time (99.2 ± 13.7 vs 75.1 ± 2.6 sec, P = .09) and clot formation time (153.6 ± 10.6 sec vs 106.9 ± 3.8 sec, P < .001). When comparing by gender, no difference for in-hospital mortality was found for patients in the TEG or ROTEM group ( P > .05). Multivariate analysis showed no survival difference for female patients (OR 1.11, 95% CI .83-1.50, P = .48). Conclusions Although a difference between male and females was found on TEG/ROTEM for certain clotting parameters, no difference in mortality was observed. Prospective multi-institutional studies are needed.

Children and Terror Casualties Receive Preference in ICU Admissions

2012 ◽  
Vol 6 (1) ◽  
pp. 14-19 ◽  
Author(s):  
Kobi Peleg ◽  
Michael Rozenfeld ◽  
Eran Dolev ◽  
Keyword(s):  
Traffic Accidents ◽  
Injury Severity ◽  
Road Traffic ◽  
Age Groups ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Severe Injuries ◽  
Level I ◽  
Hospital Emergency Departments ◽  
Trauma Type

ABSTRACTObjective: Trauma casualties caused by terror-related events and children injured as a result of trauma may be given preference in hospital emergency departments (EDs) due to their perceived importance. We investigated whether there are differences in the treatment and hospitalization of terror-related casualties compared to other types of injury events and between children and adults injured in terror-related events.Methods: Retrospective study of 121 608 trauma patients from the Israel Trauma Registry during the period of October 2000-December 2005. Of the 10 hospitals included in the registry, 6 were level I trauma centers and 4 were regional trauma centers. Patients who were hospitalized or died in the ED or were transferred between hospitals were included in the registry.Results: All analyses were controlled for Injury Severity Score (ISS). All patients with ISS 1-24 terror casualties had the highest frequency of intensive care unit (ICU) admissions when compared with patients after road traffic accidents (RTA) and other trauma. Among patients with terror-related casualties, children were admitted to ICU disproportionally to the severity of their injury. Logistic regression adjusted for injury severity and trauma type showed that both terror casualties and children have a higher probability of being admitted to the ICU.Conclusions: Injured children are admitted to ICU more often than other age groups. Also, terror-related casualties are more frequently admitted to the ICU compared to those from other types of injury events. These differences were not directly related to a higher proportion of severe injuries among the preferred groups.(Disaster Med Public Health Preparedness. 2012;6:14–19)

Assessment of Mortality in Older Trauma Patients Sustaining Injuries from Falls or Motor Vehicle Collisions Treated in Regional Level I Trauma Centers

2009 ◽  
Vol 249 (3) ◽  
pp. 488-495 ◽  
Author(s):  
John S. Sampalis ◽  
Robin Nathanson ◽  
Julie Vaillancourt ◽  
Andreas Nikolis ◽  
Moishe Liberman ◽  
...  
Keyword(s):  
Motor Vehicle ◽  
Regional Level ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Motor Vehicle Collisions ◽  
Vehicle Collisions ◽  
Level I

scholarly journals Complications of Trauma Patients Admitted to the ICU in Level I Academic Trauma Centers in the United States

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Stefania Mondello ◽  
Amy Cantrell ◽  
Domenico Italiano ◽  
Vincenzo Fodale ◽  
Patrizia Mondello ◽  
...  
Keyword(s):  
The United States ◽  
Population Based ◽  
Trauma Patients ◽  
Cns Injury ◽  
Modifiable Factors ◽  
Potential Risk Factors ◽  
Male Patients ◽  
Level I ◽  
Complications And Mortality ◽  
The Relationship

Background. The aims of this study were to evaluate the complications that occur after trauma and the characteristics of individuals who develop complications, to identify potential risk factors that increase their incidence, and finally to investigate the relationship between complications and mortality.Methods. We did a population-based retrospective study of trauma patients admitted to ICUs of a level I trauma center. Logistic regression analyses were performed to determine independent predictors for complications.Results. Of the 11,064 patients studied, 3,451 trauma patients developed complications (31.2%). Complications occurred significantly more in younger male patients. Length of stay was correlated with the number of complications(R=0.435,P<0.0001). The overall death rate did not differ between patients with or without complications. The adjusted odds ratio (OR) of developing complication for patients over age 75 versus young adults was 0.7(P<0.0001). Among males, traumatic central nervous system (CNS) injury was an important predictor for complications (adjusted OR 1.24).Conclusions. Complications after trauma were found to be associated with age, gender, and traumatic CNS injury. Although these are not modifiable factors, they may identify subjects at high risk for the development of complications, allowing for preemptive strategies for prevention.

Influence of needle gauge and venepuncture difficulty on thromboelastography in healthy cats

2018 ◽  
Vol 21 (8) ◽  
pp. 708-713 ◽  
Author(s):  
Duree Shin ◽  
Aryung Nam ◽  
Kun Ho Song ◽  
Kyoung Won Seo
Keyword(s):  
Jugular Vein ◽  
Alpha Angle ◽  
Maximum Amplitude ◽  
Clot Strength ◽  
Blood Samples ◽  
Study Results ◽  
Significant Difference ◽  
Whole Blood Samples ◽  
Difficulty Score ◽  
Clot Formation Time

Objectives The aim of this study was to evaluate the effect of two differently sized butterfly catheter needles and the effect of venepuncture difficulty on thromboelastography (TEG) results in healthy cats. Methods Twenty-four healthy cats were included. Blood samples were collected from the jugular vein by syringe aspiration via direct venepuncture with 21 G and 22 G butterfly needles. The venepuncture difficulty score was classified into four categories. The first 1.5 ml blood drawn from each subject was discarded before collecting a sample for TEG analysis. TEG analyses were performed on citrated whole blood samples from 17 clinically healthy cats, using assays with kaolin as activators. Among the TEG parameters, reaction time (R), clot formation time (κ), alpha angle (α), maximum amplitude (MA) and global clot strength (G) were recorded from each tracing. Results Seven cats were excluded from the study; results were obtained for the remaining 17 cats. There were no statistically significant differences between the use of two different needles for R ( P = 0.72), κ ( P = 0.74), α ( P = 0.99), MA ( P = 0.08) and G ( P = 0.09). Samples with difficulty scores ⩾1 were not significantly different from samples with difficulty scores of 0 for R ( P = 0.24), κ ( P = 0.65), α ( P = 0.65), MA ( P = 0.72) and G ( P = 0.77). Conclusions and relevance The results of TEG in clinically healthy cats do not differ significantly when using two different gauge needles. There was no significant difference in the TEG results according to venepuncture difficulty scoring.

Selective Use of Cardiopulmonary Bypass in Trauma Patients

2005 ◽  
Vol 71 (1) ◽  
pp. 46-50
Author(s):  
Christine Dauphine ◽  
Charles Mckay ◽  
Christian De Virgilio ◽  
Bassam Omari
Keyword(s):  
Cardiopulmonary Bypass ◽  
Los Angeles ◽  
Operative Management ◽  
Hemodynamic Instability ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Chest Injuries ◽  
Life Saving ◽  
Life Threatening ◽  
Level I

The need for cardiopulmonary bypass (CPB) in the treatment of trauma patients is controversial, and not all level I trauma centers have CPB readily available. Our purpose was to review the selective use of CPB in the management of trauma victims at a level I trauma center in Los Angeles County. We reviewed the records of all patients for whom the CPB team was called in from 1994 to 2002. Perfusionists were present for the initial operative management of 24 patients, 22 (92%) of which were male. Twelve patients had penetrating and nine had blunt injuries, two were severely hypothermic, and the last suffered embolization of a bullet to the pulmonary artery. Overall survival was 75 per cent. Sixteen (67%) patients required CPB due to the life-threatening nature of their injuries and/or hemodynamic instability; 11 (69%) survived. The remaining 8 patients were operated on with the CPB team present but on standby; 7 (88%) survived. Cardiopulmonary bypass could be life-saving in select trauma patients with major chest injuries. Hypothermia, acidemia, and shock can be reversed earlier while allowing increased time to gain adequate exposure and perform quality repairs. Level I trauma centers should have CPB capabilities immediately available.

The G60 Trauma Center: A Future Consideration?

2017 ◽  
Vol 83 (6) ◽  
pp. 547-553 ◽  
Author(s):  
Marko Bukur ◽  
Joshua Simon ◽  
Joseph Catino ◽  
Margaret Crawford ◽  
Ivan Puente ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Trauma Center ◽  
Injury Severity ◽  
Head Injuries ◽  
Major Complication ◽  
The Elderly ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Failure To Rescue ◽  
Level I

With a considerably increasing elderly population, we sought to determine whether the volume of elderly trauma patients treated impacted outcomes at two different Level I trauma centers. This is a retrospective review of all elderly patients (>60 years) at two state-verified Level I trauma centers over the past five years. The elderly trauma center (ETC) saw a greater proportion (52%) of elderly patients than the reference trauma center (30%, TC). Demographic and clinical characteristics were abstracted and stratified into ETC and TC groups for comparison. Primary outcomes were overall postinjury complication and mortality rates, as well as death after major complication (failure to rescue). ETC patients were older (78.6 vs 70.5), more likely to be admitted with severe head injuries (head abbreviated injury score ≥ 3, 50.0% vs 32%), had a greater overall injury burden (injury severity score > 16 41.4% vs 21.1%), and required intensive care unit admission (81.3% vs 64%) than the TC group. Need for operative intervention, mechanism of injury, and comorbidities were similar between the two groups. Overall complications were higher in trauma patients admitted to the TC (21.9% vs 14.3%), as well as failure to rescue (4.0% vs 1.8%). Adjusting for confounding factors, ETC had significantly lower chance of developing a postinjury complication (adjusted odds ratios [AOR] = 0.4, 95% confidence interval [CI] = [0.3, 0.5]), failure to rescue (AOR = 0.3, 95% CI = [0.1, 0.5]), and overall mortality (AOR = 0.3, 95% CI = [0.2, 0.4]). Improved outcomes were demonstrated in the Level I center treating a higher proportion of elderly patients. Exact etiology of these benefits should be determined for quality improvement in care of the injured geriatric patient.

The ‘Mortality Ascent’: Risk of Death for Hemodynamically-Unstable Trauma Patients at Level II vs Level I Trauma Centers Rises at 4 Hours and Peaks at 7 Hours after Admission

2016 ◽  
Vol 223 (4) ◽  
pp. e55
Author(s):  
Juan P. Herrera-Escobar ◽  
Arturo J. Rios-Diaz ◽  
Ritam Chowdhury ◽  
Cheryl K. Zogg ◽  
Lindsey Wolf ◽  
...  
Keyword(s):  
Trauma Patients ◽  
Trauma Centers ◽  
Risk Of Death ◽  
Level Ii ◽  
Level I

scholarly journals Primary admission and secondary transfer of trauma patients to Dutch level I and level II trauma centers: predictors and outcomes

2021 ◽  
Author(s):  
Claire R. L. van den Driessche ◽  
Charlie A. Sewalt ◽  
Jan C. van Ditshuizen ◽  
Lisa Stocker ◽  
Michiel H. J. Verhofstad ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Hospital Mortality ◽  
Trauma Center ◽  
Regression Models ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Logistic Regression Models ◽  
Level Ii ◽  
Secondary Transfer ◽  
Level I

Abstract Purpose The importance and impact of determining which trauma patients need to be transferred between hospitals, especially considering prehospital triage systems, is evident. The objective of this study was to investigate the association between mortality and primary admission and secondary transfer of patients to level I and II trauma centers, and to identify predictors of primary and secondary admission to a designated level I trauma center. Methods Data from the Dutch Trauma Registry South West (DTR SW) was obtained. Patients ≥ 18 years who were admitted to a level I or level II trauma center were included. Patients with isolated burn injuries were excluded. In-hospital mortality was compared between patients that were primarily admitted to a level I trauma center, patients that were transferred to a level I trauma center, and patients that were primarily admitted to level II trauma centers. Logistic regression models were used to adjust for potential confounders. A subgroup analysis was done including major trauma (MT) patients (ISS > 15). Predictors determining whether patients were primarily admitted to level I or level II trauma centers or transferred to a level I trauma center were identified using logistic regression models. Results A total of 17,035 patients were included. Patients admitted primarily to a level I center, did not differ significantly in mortality from patients admitted primarily to level II trauma centers (Odds Ratio (OR): 0.73; 95% confidence interval (CI) 0.51–1.06) and patients transferred to level I centers (OR: 0.99; 95%CI 0.57–1.71). Subgroup analyses confirmed these findings for MT patients. Adjusted logistic regression analyses showed that age (OR: 0.96; 95%CI 0.94–0.97), GCS (OR: 0.81; 95%CI 0.77–0.86), AIS head (OR: 2.30; 95%CI 2.07–2.55), AIS neck (OR: 1.74; 95%CI 1.27–2.45) and AIS spine (OR: 3.22; 95%CI 2.87–3.61) are associated with increased odds of transfers to a level I trauma center. Conclusions This retrospective study showed no differences in in-hospital mortality between general trauma patients admitted primarily and secondarily to level I trauma centers. The most prominent predictors regarding transfer of trauma patients were age and neurotrauma. These findings could have practical implications regarding the triage protocols currently used.

scholarly journals Do Transferred Patients Increase the Risk of Venous Thromboembolism in Trauma Centers?

2017 ◽  
Vol 83 (11) ◽  
pp. 1241-1245
Author(s):  
Brian K. Yorkgitis ◽  
Olubode A. Olufajo ◽  
David Metcalfe ◽  
Gally Reznor ◽  
Joaquim M. Havens ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Risk Factor ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Vte Prophylaxis ◽  
National Trauma ◽  
Level I ◽  
Transferred Patients

Trauma patients often require initial stabilization followed by transfer for ongoing trauma care. Thus, the administration of VTE prophylaxis is often delayed until admission to the receiving hospital. It is unclear if transfer status is a risk factor for VTE. The National Trauma Database v6.2 was used to identify patients admitted to Level I and II trauma centers. Exclusions included patients on anticoagulation, <18 years, known VTE before trauma, or pregnant. Patients transferred were compared with nontransferred patients. Analysis included 736,374 patients with 189,166 (25.69%) transferred patients within 24 hours of injury. Using weighted measures, VTE was identified in 11,619 (1.50%) patients. The VTE rate was significantly higher in the transferred group compared with the nontransferred group (1.73% vs 1.42%, P = 0.002) including deep venous thrombosis (1.39% vs 1.14%, P = 0.004) and pulmonary embolism (0.45% vs 0.39%, P = 0.003). Multivariable analyses adjusting for patient-level risk factors demonstrated that transfer was associated with a higher likelihood of VTE (aOR 1.18; 95% CI: 1.09–1.28, P ≤ 0.001), pulmonary embolism (aOR 1.21; 95% CI: 1.11–1.33, P ≤ 0.001), and deep venous thrombosis (aOR 1.17; 95% CI: 1.07–1.28, P = 0.0004). Transfer status of trauma patients is a risk factor for VTE. Accepting a transferred patient results in an increased VTE risk and may not be reflective of the quality of care at the receiving facility.

scholarly journals Patterns of alcohol and drug utilization in trauma patients during the COVID-19 pandemic at six trauma centers

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Constance McGraw ◽  
Kristin Salottolo ◽  
Matthew Carrick ◽  
Mark Lieser ◽  
Robert Madayag ◽  
...  
Keyword(s):  
Longitudinal Research ◽  
Blood Alcohol Concentration ◽  
Alcohol Concentration ◽  
Trauma Patients ◽  
Blood Alcohol ◽  
Trauma Centers ◽  
Chi Squared ◽  
Level I ◽  
The Impact ◽  
At Home

Abstract Background Since the national stay-at-home order for COVID-19 was implemented, clinicians and public health authorities worldwide have expressed growing concern about the potential repercussions of drug and alcohol use due to social restrictions. We explored the impact of the national stay-at-home orders on alcohol or drug use and screenings among trauma admissions. Methods This was a retrospective cohort study at six Level I trauma centers across four states. Patients admitted during the period after the onset of the COVID-19 restrictions (defined as March 16, 2020-May 31, 2020) were compared with those admitted during the same time period in 2019. We compared 1) rate of urine drug screens and blood alcohol screens; 2) rate of positivity for drugs or alcohol (blood alcohol concentration ≥ 10 mg/dL); 3) characteristics of patients who were positive for drug or alcohol, by period using chi-squared tests or Fisher’s exact tests, as appropriate. Two-tailed tests with an alpha of p < 0.05 was used on all tests. Results There were 4762 trauma admissions across the study period; 2602 (55%) in 2019 and 2160 (45%) in 2020. From 2019 to 2020, there were statistically significant increases in alcohol screens (34% vs. 37%, p = 0.03) and drug screens (21% vs. 26%, p < 0.001). Overall, the rate of alcohol positive patients significantly increased from 2019 to 2020 (32% vs. 39%, p = 0.007), while the rate of drug positive patients was unchanged (57% vs. 52%, p = 0.13). Of the 1025 (22%) patients who were positive for alcohol or drugs, there were significant increases in a history of alcoholism (41% vs. 26%, p < 0.001), and substance abuse (11% vs. 23%, p < 0.001) in the 2020 period. No other statistically significant differences were identified among alcohol or drug positive patients during COVID-19 compared to the same period in 2019. Conclusions Our first wave of COVID-19 data suggests that trauma centers were admitting significantly more patients who were alcohol positive, as well those with substance use disorders, potentially due to the impact of social restrictions and guidelines. Further longitudinal research is warranted to assess the alcohol and drug positive rates of trauma patients over the COVID-19 pandemic.

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