Continued Relevance of Initial Temperature Measurement in Trauma Patients

Objectives Hypothermia occurs in 30-50% of severely injured trauma patients and is associated with multiple metabolic derangements and worsened outcomes. However, hypothermia continues to be under-diagnosed which leads to inadequate triage and treatment in trauma patients. Our study set out to determine if hypothermia is an independent predictor of mortality in trauma patients. Methods We retrospectively reviewed data of all trauma activation patients over a 5-year period. Data were collected on patient demographics, initial core temperature, Glasgow Coma Scale (GCS) on presentation, and injury severity score (ISS). Patients were then stratified into groups based on presenting temperature, ISS, and GCS. Outcomes compared were mortality, blood products received, and intensive care unit (ICU) length of stay. Correlations and logistic regression were used to test the hypotheses. Results Survival and temperature data were reviewed on 15,567 patients. Initial temperature was not significantly associated with ICU length of stay or blood products transfused ( P = .21 and P = .08, respectively). However, odds ratio of mortality in hypothermic patients (<35°C) compared to normothermic patients (35-39°C) was 3.95 (95% CI 2.90-5.41). When controlling for GCS and ISS, separately, temperature remained an independent predictor of mortality. Conclusions Hypothermia is an independent risk factor for mortality in trauma patients. It remains crucial to obtain accurate presenting temperatures in trauma patients in order to triage and treat hypothermia. Based on our data, obtaining core temperatures and rapidly treating hypothermia continues to be a vital part of the secondary survey of trauma patients.

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Obesity Does Not Increase Morbidity and Mortality after Laparotomy for Trauma

The American Surgeon ◽

10.1177/000313481307900321 ◽

2013 ◽

Vol 79 (3) ◽

pp. 247-252 ◽

Cited By ~ 4

Author(s):

David H. Livingston ◽

Robert F. Lavery ◽

Anne N'Kanza ◽

Devashish Anjaria ◽

Ziad C. Sifri ◽

...

Keyword(s):

Length Of Stay ◽

Injury Severity ◽

Independent Predictor ◽

Wound Dehiscence ◽

Infectious Complications ◽

Morbidity And Mortality ◽

Trauma Patients ◽

Obese Patients ◽

Packed Red Blood Cells ◽

Prolonged Length

Obesity has been suggested to be a risk factor for increase morbidity and mortality after trauma and surgery. Trauma laparotomy provides an opportunity to assess the effect of body mass index (BMI) on patients subjected to both trauma and surgery. We hypothesized that obesity would have a deleterious effect on outcomes. A retrospective review was conducted of all patients 18 years of age or older undergoing laparotomy for trauma between July 2001 and June 2011. Patients were stratified according to BMI into the following four groups: underweight (16 to 22 kg/m2), normal (23 to 27 kg/m2), overweight (28 to 34 kg/m2), and obese (35 kg/m2 or higher). Data on the patient's hospital course included length of stay, mortality, respiratory failure, infectious complications, wound dehiscence, and organ failure. A total of 1,297 patients underwent laparotomy. Seven per cent of the study group was obese and 24 per cent was underweight. There was no difference among mean Injury Severity Score, percent of patients arriving in shock, and mean number of units of packed red blood cells administered during their hospital stay. Obese patients had longer intensive care unit and hospital lengths of stay. There were no differences in ventilator days or mortality. Using univariate statistics, obese patients had increased rates of respiratory and renal failure, bacteremia with and without septic shock, and abdominal wound dehiscence. Subjecting the data to logistic regression analysis, BMI was no longer an independent predictor of any complication. Although obese trauma patients do have increased infectious morbidity, wound dehiscence, and a prolonged length of stay, increased BMI is not an independent predictor of increased morbidity or mortality after trauma laparotomy.

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Hematologic Effects of Ethanol Consumption in Trauma Patients

Annals of Pharmacotherapy ◽

10.1177/106002809302700716 ◽

1993 ◽

Vol 27 (7-8) ◽

pp. 889-891 ◽

Cited By ~ 3

Author(s):

Brian L. Erstad ◽

Diana K. Harlander ◽

John A. Daller

Keyword(s):

Length Of Stay ◽

Outcome Measures ◽

Chart Review ◽

Injury Severity ◽

Medical Center ◽

Retrospective Chart Review ◽

Trauma Patients ◽

Blood Products ◽

Coagulation Abnormalities ◽

Transfusion Requirements

OBJECTIVE: To determine the effects of ethanol (EtOH) ingestion by trauma patients on the hematologic system as evidenced by coagulation abnormalities and transfusion requirements. DESIGN: Retrospective chart review. The injury severity score (ISS) was determined for each patient. Patients were grouped according to presence of EtOH (+EtOH) and absence of EtOH (-EtOH) with further subdivision based on an ISS ≤8 or ≥9. SETTING: University medical center. PATIENTS: All adult trauma patients admitted during a one-month period. MAIN OUTCOME MEASURES: The volume of resuscitation fluids (including blood products) administered, laboratory parameters indicative of bleeding, and length of stay. RESULTS: Of 104 evaluable patients, 38 had measurable EtOH concentrations, 46 had undetectable EtOH concentrations, and the remaining 20 patients had not been tested. Although isolated, statistically significant differences were found among groups for some of the outcome measures, there were no clinically important differences. CONCLUSIONS: EtOH ingestion prior to injury did not appear to cause significant alterations in the hematologic system of trauma patients, but a larger study is needed to confirm these findings.

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Delta Shock Index in the Emergency Department Predicts Mortality and Need for Blood Transfusion in Trauma Patients

The American Surgeon ◽

10.1177/000313481708301009 ◽

2017 ◽

Vol 83 (10) ◽

pp. 1059-1062 ◽

Cited By ~ 5

Author(s):

Morgan Schellenberg ◽

Aaron Strumwasser ◽

Daniel Grabo ◽

Damon Clark ◽

Kazuhide Matsushima ◽

...

Keyword(s):

Emergency Department ◽

Blood Transfusion ◽

Length Of Stay ◽

Injury Severity ◽

Study Groups ◽

Trauma Patients ◽

Shock Index ◽

Icu Length Of Stay ◽

Trauma Outcome ◽

Level I

Shock Index (SI = heart rate/systolic blood pressure) predicts outcomes among trauma patients. Studies have also shown that the change in SI between the field and Emergency Department (ED) arrival (Delta SI) predicts mortality in trauma. Given the lack of reliable prehospital data, Delta SI may more accurately prognosticate if used within the ED. All trauma patients arriving to our Level I trauma center in 2014 were reviewed. Patients were matched for age, gender, mechanism of injury, and injury severity score. SI and ED Delta SI were calculated. ED Delta SI >0.1 and ≤0.1 defined the study groups. Pregnant patients, pediatric patients, and patients with incomplete data were excluded. Outcomes included intensive care unit (ICU) length of stay, blood products, and mortality. A total of 2591 patients were identified (n = 1294 patients analyzed). After matching, patients with ED Delta SI >0.1 had greater mortality (6.6 vs 2.6%, P = 0.010), need for blood transfusion (1764 vs 565 cc, P < 0.001), and ICU length of stay (5.6 vs 3.8 days, P = 0.014) compared with patients with ED Delta SI ≤0.1. In conclusion, ED Delta SI >0.1 is associated with increased mortality, need for blood transfusion, and ICU length of stay. Delta SI may be superior to traditional SI for trauma outcome prognostication.

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A retrospective cohort study of 27,049 polytraumatized patients age 60 and above: identifying changes over 16 years

European Geriatric Medicine ◽

10.1007/s41999-021-00546-9 ◽

2021 ◽

Author(s):

Y. Kalbas ◽

M. Lempert ◽

F. Ziegenhain ◽

J. Scherer ◽

V. Neuhaus ◽

...

Keyword(s):

Length Of Stay ◽

Injury Severity ◽

Descriptive Analysis ◽

Patient Characteristics ◽

Severe Trauma ◽

Diagnostic Tools ◽

Trauma Patients ◽

Treatment Algorithms ◽

Injured Patients ◽

Over Time

Abstract Purpose The number of severely injured patients exceeding the age of 60 has shown a steep increase within the last decades. These patients present with numerous co-morbidities, polypharmacy, and increased frailty requiring an adjusted treatment approach. In this study, we establish an overview of changes we observed in demographics of older severe trauma patients from 2002 to 2017. Methods A descriptive analysis of the data from the TraumaRegister DGU® (TR-DGU) was performed. Patients admitted to a level one trauma center in Germany, Austria and Switzerland between 2002 and 2017, aged 60 years or older and with an injury severity score (ISS) over 15 were included. Patients were stratified into subgroups based on the admission: 2002–2005 (1), 2006–2009 (2), 2010–2013 (3) and 2014–2017 (4). Trauma and patient characteristics, diagnostics, treatment and outcome were compared. Results In total 27,049 patients with an average age of 73.9 years met the inclusion criteria. The majority were males (64%), and the mean ISS was 27.4. The proportion of patients 60 years or older [(23% (1) to 40% (4)] rose considerably over time. Trauma mechanisms changed over time and more specifically low falls (< 3 m) rose from 17.6% (1) to 40.1% (4). Altered injury patterns were also identified. Length-of-stay decreased from 28.9 (1) to 19.5 days (4) and the length-of-stay on ICU decreased from 17.1 (1) to 12.7 days (4). Mortality decreased from 40.5% (1) to 31.8% (4). Conclusion Length of stay and mortality decreased despite an increase in patient age. We ascribe this observation mainly to increased use of diagnostic tools, improved treatment algorithms, and the implementation of specialized trauma centers for older patients allowing interdisciplinary care.

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Does emergency medicine length of stay predict trauma outcomes at a Level 1 Trauma Center?

Journal of Hospital Administration ◽

10.5430/jha.v4n5p1 ◽

2015 ◽

Vol 4 (5) ◽

pp. 1 ◽

Cited By ~ 2

Author(s):

Erin Powers Kinney ◽

Kamal Gursahani ◽

Eric Armbrecht ◽

Preeti Dalawari

Keyword(s):

Length Of Stay ◽

Trauma Center ◽

Injury Severity ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Trauma Patients ◽

Hospital Capacity ◽

Significant Difference ◽

Level 1 ◽

Level 1 Trauma Center

Objective: Previous studies looking at emergency department (ED) crowding and delays of care on outcome measures for certain medical and surgical patients excluded trauma patients. The objectives of this study were to assess the relationship of trauma patients’ ED length of stay (EDLOS) on hospital length of stay (HLOS) and on mortality; and to examine the association of ED and hospital capacity on EDLOS.Methods: This was a retrospective database review of Level 1 and 2 trauma patients at a single site Level 1 Trauma Center in the Midwest over a one year period. Out of a sample of 1,492, there were 1,207 patients in the analysis after exclusions. The main outcome was the difference in hospital mortality by EDLOS group (short was less than 4 hours vs. long, greater than 4 hours). HLOS was compared by EDLOS group, stratified by Trauma Injury Severity Score (TRISS) category (< 0.5, 0.51-0.89, > 0.9) to describe the association between ED and hospital capacity on EDLOS.Results: There was no significant difference in mortality by EDLOS (4.8% short and 4% long, p = .5). There was no significant difference in HLOS between EDLOS, when adjusted for TRISS. ED census did not affect EDLOS (p = .59), however; EDLOS was longer when the percentage of staffed hospital beds available was lower (p < .001).Conclusions: While hospital overcrowding did increase EDLOS, there was no association between EDLOS and mortality or HLOS in leveled trauma patients at this institution.

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CORRELATION OF FACIAL INJURY SEVERITY SCALE (FISS) WITH LENGTH OF STAY, THE NEED FOR SURGERY AND THE INVOLVEMENT OF OTHER SPECIALISTS IN MAXILLOFACIAL TRAUMA PATIENTS AT H. ADAM MALIK GENERAL HOSPITAL MEDAN

10.36106/gjra/9407348 ◽

2019 ◽

pp. 1-3

Author(s):

Darwin Firmansyah Siregar ◽

Frank Bietra Buchari ◽

Utama Abdi Tarigan ◽

Aznan Lelo

Keyword(s):

Length Of Stay ◽

General Hospital ◽

Injury Severity ◽

The Body ◽

Maxillofacial Trauma ◽

Mandibular Fractures ◽

Trauma Patients ◽

Facial Injury ◽

Single Operator ◽

Surgery Department

Background: Facial Injury Severity Severity Score (FISS) has been used to assess the severity of facial injuries. However, FISS scores as a useful predictor of length of stay and changes between FISS scores and injuries to other parts of the body have not evaluated. In this study, we want to know the relationship between FISS score as the clinical assessment of maxillofacial trauma with the length of stay, the need for surgery, and the involvement of other specialist elds. Method: This research was conducted using analytical research through a retrospective approach by looking at the medical records of patients who suffered maxillofacial trauma at H. Adam Malik General Hospital Medan from June to August 2019. Result : From a total of 43 patients included in the study, there were 22 mandibular fractures, with mandibular angulus (29.0%), parasymphysis (22.4%), and mandibular corpus (21.5%). Thirty subjects (69.8%) needed surgery, and xation of the fracture and subjects without intervention were 13 (30.2%). Patients who needed surgical intervention, the average time needed for hospitalization was 10.98 + 7.72 days (p = 0.007). The most collaboration found with neurosurgeons specialists, 39.53% of subjects who performed the surgery. A total of 55.8% of surgeries performed by a single operator from the plastic surgery department. Relationship between the length of stay with FISS, obtained for FISS> 3 (OR 14.37) (p = 0.01), meaning that patients with FISS> 3 are likely to stay longer for 14 times. Subsequent results related to the need for surgery obtained signicant results (OR = 8.26, p = 0.026). signicant (p = 0.059). Conclusion: A FISS score signicantly affects the length of stay for a maxillofacial trauma patient. FISS score also affects the involvement of other specialists in maxillofacial trauma patients but not statistically signicant.

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Emergency Department Length of Stay Is an Independent Predictor of Hospital Mortality in Trauma Activation Patients

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0b013e3182175199 ◽

2011 ◽

Vol 70 (6) ◽

pp. 1317-1325 ◽

Cited By ~ 51

Author(s):

Nathan T. Mowery ◽

Stacy D. Dougherty ◽

Amy N. Hildreth ◽

James H. Holmes ◽

Michael C. Chang ◽

...

Keyword(s):

Emergency Department ◽

Length Of Stay ◽

Hospital Mortality ◽

Independent Predictor ◽

Trauma Activation

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Trauma Intensive Care Unit ‘Bouncebacks': Identifying Risk Factors for Unexpected Return Admission to the Intensive Care Unit

The American Surgeon ◽

10.1177/000313481408000827 ◽

2014 ◽

Vol 80 (8) ◽

pp. 778-782 ◽

Cited By ~ 2

Author(s):

A. Britton Christmas ◽

Elizabeth Freeman ◽

Angela Chisolm ◽

Peter E. Fischer ◽

Gaurav Sachdev ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Brain Injuries ◽

Injury Severity ◽

Hospital Costs ◽

Retrospective Chart Review ◽

Trauma Patients ◽

Respiratory Compromise ◽

Patient Demographics ◽

Hygiene Practices

Return transfer (RT) to the intensive care unit (ICU) negatively impacts patient outcomes, length of stay (LOS), and hospital costs. This study assesses the most common events necessitating RT in trauma patients. We performed a retrospective chart review of ICU RT from 2004 to 2008. Patient demographics, injuries and injury severity, reason for transfer, LOS, interventions, and outcomes data were collected. Overall, 158 patients required readmission to the ICU. Respiratory insufficiency/ failure (48%) was the most common reason for RT followed by cardiac (16%) and neurological (13%) events. The most commonly associated injuries were traumatic brain injuries (TBIs) (32%), rib fractures (30%), and pulmonary contusions (20%). Initial ICU LOS was 6.6 ± 8 days (range, 1 to 44 days) with 4.4 ± 7.8 ventilator days. Mean floor time before ICU RT was 5.7 ± 6.3 days (range, 0 to 33 days). Forty-nine patients (31%) required intubation and mechanical ventilation on RT. ICU RT incurred an additional ICU LOS of 8 ± 8.5 days (range, 1 to 40 days) and 5.2 ± 7.5 ventilator days. Mortality after a single RT was 10 per cent (n = 16). RT to the ICU most often occurs as a result of respiratory compromise, and patients with TBI are particularly vulnerable. Trauma pulmonary hygiene practices should be evaluated to determine strategies that could decrease RT.

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Intraabdominal Injury is Common in Blunt Trauma Patients who Sustain Spinal Cord Injury

The American Surgeon ◽

10.1177/000313480707301025 ◽

2007 ◽

Vol 73 (10) ◽

pp. 1035-1038

Author(s):

Ali Salim ◽

Marcus Ottochian ◽

Ryan J. Gertz ◽

Carlos Brown ◽

Kenji Inaba ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Length Of Stay ◽

Blunt Trauma ◽

Injury Severity ◽

Unit Length ◽

Hospital Length Of Stay ◽

Trauma Patients ◽

Cord Injury ◽

Intraabdominal Injury

The evaluation of the abdomen in patients with spinal cord injury (SCI) is challenging for obvious reasons. There are very little data on the incidence and complications of patients who sustain SCI with concomitant intraabdominal injury (IAI). To determine the incidence and outcomes of IAI in blunt trauma patients with SCI, a trauma registry and record review was performed between January 1998 and December 2005. Baseline demographic data, Injury Severity Score, and associated IAI were collected. Two groups were established and outcomes were analyzed based on the presence or absence of IAI. Intraabdominal and hollow viscus injures were found in 15 per cent and 6 per cent, respectively, of 292 patients with blunt SCI. The presence of intraabdominal injury varied according to the level of the SCI: 10 per cent of cervical, 23 per cent of thoracic, and 18 per cent of lumbar SCI. The overall mortality was 16 per cent. The presence of intraabdominal injury was associated with longer intensive care unit length of stay (13 versus 6 days, P < 0.01), hospital length of stay (23 versus 18 days, P < 0.05), higher complication rate (46% versus 33%, P = 0.09), and higher mortality (44% versus 11%, P < 0.01) when compared with patients with SCI without IAI. Intraabdominal injuries are common in blunt SCI. Liberal evaluation with computed tomography is necessary to identify injuries early.

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Placement of Surgical Feeding Tubes Among Patients With Severe Traumatic Brain Injury Requiring Exploratory Abdominal Surgery

The American Surgeon ◽

10.1177/0003134820923302 ◽

2020 ◽

Vol 86 (6) ◽

pp. 635-642

Author(s):

Peter I. Cha ◽

Ronald M. Jou ◽

David A. Spain ◽

Joseph D. Forrester

Keyword(s):

Length Of Stay ◽

Abdominal Surgery ◽

Injury Severity ◽

Unit Length ◽

Feeding Tube ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Fascial Closure ◽

Trauma Patients ◽

Percutaneous Endoscopic Gastrostomy Placement

Objectives The purpose of this study was to identify trauma patients who would benefit from surgical placement of an enteral feeding tube during their index abdominal trauma operation. Methods We performed a retrospective analysis of all patients admitted to 2 level I trauma centers between January 2013 and February 2018 requiring urgent exploratory abdominal surgery. Results Six-hundred and one patients required exploratory abdominal surgery within 24 hours of admission after trauma activation. Nineteen (3% of total) patients underwent placement of a feeding tube after their initial exploratory surgery. On multivariate analysis, an intracranial Abbreviated Injury Scale ≥4 (odds ratio [OR] = 9.24, 95% CI 1.09-78.26, P = .04) and a Glasgow Coma Scale ≤8 (OR = 4.39, 95% CI 1.38-13.95, P = .01) were associated with increased odds of requiring a feeding tube. All patients who required a feeding tube had an Injury Severity Score ≥15. While not statistically significant, patients with an open surgical feeding tube compared with interventional radiology/percutaneous endoscopic gastrostomy placement had lower median intensive care unit length of stay, fewer ventilator days, and shorter median total hospital length of stay. Conclusions Trauma patients with severe intracranial injury already requiring urgent exploratory abdominal surgery may benefit from early, concomitant placement of a feeding tube during the index abdominal operation, or at fascial closure.

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