scholarly journals Initial free cortisol dynamics following blunt multiple trauma and traumatic brain injury: A clinical study

2019 ◽  
Vol 47 (3) ◽  
pp. 1185-1194
Author(s):  
T Kusmenkov ◽  
M Braunstein ◽  
HJ Schneider ◽  
M Bidlingmaier ◽  
WC Prall ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Multiple Trauma ◽  
Repeated Measures ◽  
Traumatic Injury ◽  
Trauma Centre ◽  
Trauma Patients ◽  
Total Cortisol ◽  
Free Cortisol ◽  
Multiple Trauma Patients

Objective To determine free and total cortisol serum concentrations in the first 24 h after trauma and to evaluate the influence of traumatic brain injury (TBI) on their dynamics. Methods This prospective cohort study enrolled patients who had experienced multiple trauma and were admitted to a level 1 trauma centre. The patients were divided in two groups based on the presence of TBI according to clinical and radiological findings. Blood was collected initially as well as at 12 h and 24 h after the traumatic injury. Total cortisol, corticosteroid binding globulin (CBG) and free cortisol levels were determined. Results The study analysed data from 49 patients (36 males and 13 females) with a mean ± SD age of 45.0 ± 16.0 years. Of these, 36 presented with TBI and 13 had multiple injuries without TBI. Patients with TBI showed significantly lower concentrations of total cortisol and free cortisol compared with patients without TBI. Repeated measures analysis revealed different concentration dynamics in patients with TBI, with no increase in cortisol after trauma. Conclusion Multiple trauma patients with TBI are at risk of acute impaired cortisol secretion and show an attenuated stress response as early as 12 h after injury.

Influence of traumatic brain injury on potassium and phosphorus homeostasis in critically ill multiple trauma patients

Nutrition ◽  
2010 ◽  
Vol 26 (7-8) ◽  
pp. 784-790 ◽  
Author(s):  
Kimberly A. Lindsey ◽  
Rex O. Brown ◽  
George O. Maish ◽  
Martin A. Croce ◽  
Gayle Minard ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Multiple Trauma ◽  
Critically Ill ◽  
Trauma Patients ◽  
Multiple Trauma Patients

scholarly journals Severe traumatic brain injury and hypotension is a frequent and lethal combination in multiple trauma patients in mountain areas – an analysis of the prospective international Alpine Trauma Registry

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Simon Rauch ◽  
◽  
Matilde Marzolo ◽  
Tomas Dal Cappello ◽  
Mathias Ströhle ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Multiple Trauma ◽  
Trauma Registry ◽  
Trauma Patients ◽  
Mountain Areas ◽  
Hospital Arrival ◽  
Severe Tbi ◽  
Multiple Trauma Patients ◽  
Group 1

Abstract Background Hypotension is associated with worse outcome in patients with traumatic brain injury (TBI) and maintaining a systolic blood pressure (SBP) ≥110 mmHg is recommended. The aim of this study was to assess the incidence of TBI in patients suffering multiple trauma in mountain areas; to describe associated factors, treatment and outcome compared to non-hypotensive patients with TBI and patients without TBI; and to evaluate pre-hospital variables to predict admission hypotension. Methods Data from the prospective International Alpine Trauma Registry including mountain multiple trauma patients (ISS ≥ 16) collected between 2010 and 2019 were analysed. Patients were divided into three groups: 1) TBI with hypotension, 2) TBI without hypotension and 3) no TBI. TBI was defined as Abbreviated Injury Scale (AIS) of the head/neck ≥3 and hypotension as SBP < 110 mmHg on hospital arrival. Results A total of 287 patients were included. Fifty (17%) had TBI and hypotension, 92 (32%) suffered TBI without hypotension and 145 (51%) patients did not have TBI. Patients in group 1 were more severely injured (mean ISS 43.1 ± 17.4 vs 33.3 ± 15.3 vs 26.2 ± 18.1 for group 1 vs 2 vs 3, respectively, p < 0.001). Mean SBP on hospital arrival was 83.1 ± 12.9 vs 132.5 ± 19.4 vs 119.4 ± 25.8 mmHg (p < 0.001) despite patients in group 1 received more fluids. Patients in group 1 had higher INR, lower haemoglobin and lower base excess (p < 0.001). More than one third of patients in group 1 and 2 were hypothermic (body temperature < 35 °C) on hospital arrival while the rate of admission hypothermia was low in patients without TBI (41% vs 35% vs 21%, for group 1 vs 2 vs 3, p = 0.029). The rate of hypothermia on hospital arrival was different between the groups (p = 0.029). Patients in group 1 had the highest mortality (24% vs 10% vs 1%, p < 0.001). Conclusion Multiple trauma in the mountains goes along with severe TBI in almost 50%. One third of patients with TBI is hypotensive on hospital arrival and this is associated with a worse outcome. No single variable or set of variables easily obtainable at scene was able to predict admission hypotension in TBI patients.

scholarly journals Prehospital Plasma Transfusion: What Does the Literature Show?

2021 ◽  
pp. 1-8
Author(s):  
Bryon P. Jackson ◽  
Jason L. Sperry ◽  
Mark H. Yazer
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Traumatic Injury ◽  
Limited Resource ◽  
Trauma Patients ◽  
Blood Products ◽  
Mortality Benefit ◽  
Transport Time ◽  
Cytokine Expression Profile ◽  
Transfusion Requirements

<b><i>Background:</i></b> Early initiation of blood products transfusion after injury has been associated with improved patient outcomes following traumatic injury. The ability to transfuse patients’ plasma in the prehospital setting provides a prime opportunity to begin resuscitation with blood products earlier and with a more balanced plasma:RBC ratio than what has traditionally been done. Published studies on the use of prehospital plasma show a complex relationship between its use and improved survival. <b><i>Summary:</i></b> Examination of the literature shows that there may be a mortality benefit from the use of prehospital plasma, but that it may be limited to certain subgroups of trauma patients. The likelihood of realizing these survival benefits appears to be predicted by several factors including the type of injury, length of transport time, presence of traumatic brain injury, and total number of blood products transfused, whether the patient required only a few products or a massive transfusion. When taken as a whole the evidence appears to show that prehospital plasma may have a mortality benefit that is most clearly demonstrated in patients with blunt injuries, moderate transfusion requirements, traumatic brain injury, and/or transport time greater than 20 min, as well as those who demonstrate a certain cytokine expression profile. <b><i>Key Messages:</i></b> The evidence suggests that a targeted use of prehospital plasma will most likely maximize the benefits from the use of this limited resource. It is also possible that prehospital plasma may best be provided through whole blood as survival benefits were greatest in patients who received both prehospital plasma and RBCs.

Low Total Cortisol Correlates Closely with Low Free Cortisol in Traumatic Brain Injury and Predicts Mortality and Long-Term Hypopituitarism

2011 ◽  
pp. OR28-4-OR28-4 ◽  
Author(s):  
Mark J Hannon ◽  
Rachel K Crowley ◽  
Lucy Ann Behan ◽  
Eoin P O'Sullivan ◽  
Bairbre Rogers ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Total Cortisol ◽  
Free Cortisol

scholarly journals P119 The association of hand and wrist injuries with other skeletal injuries in multiple trauma patients in a UK Major Trauma Centre

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Prodromos Tsinaslanidis ◽  
Toby O Smith ◽  
Oliver S Brown ◽  
George Tsinaslanidis ◽  
Shamim Umarji ◽  
...  
Keyword(s):  
Multiple Trauma ◽  
Lower Limb ◽  
Major Trauma ◽  
Trauma Centre ◽  
Research Network ◽  
Trauma Patients ◽  
Wrist Injuries ◽  
Lower Limb Injury ◽  
Limb Injuries ◽  
Multiple Trauma Patients

Abstract Background There are 20,000 major trauma cases in England annually yet the association with concomitant upper limb injuries is unknown. Injuries of the hand and wrist can cause serious functional impairment, decreased quality of life and confer a significant economic burden to healthcare systems. The aim of this study was to determine the incidence, injury pattern and association of hand/wrist injuries with other injuries and the ISS score in multiple trauma patients in the UK. Methods A single centre retrospective cohort study was performed at a level one trauma centre. Trauma Association & Research Network (TARN) eligible patients during a 5-year period were included. Results A total of 107 patients were included in this study. Seventy patients had an ISS&lt;15 and 37: had an ISS&gt;15. The majority were male (70.1%) and the mean age was 45 Years. Hand and wrist injuries were the second most common injury found in 26.2% of patients. There was a significant association between hand/wrist injuries and lower limb injuries (p = 0.04) and pelvic injuries (p = 0.02). The association between hand and wrist injuries with ISS score was found to be not significant (p = 0.82). Conclusion Hand and wrist injuries should be screened for in multiply injured patients with a pelvic or lower limb injury.

Plasma Levels of Procalcitonin and Neopterin in Multiple Trauma Patients with or without Brain Injury

2003 ◽  
Vol 20 (10) ◽  
pp. 953-960 ◽  
Author(s):  
Stefan Sauerland ◽  
Thorsten Hensler ◽  
Bertil Bouillon ◽  
Dieter Rixen ◽  
Marcus R. Raum ◽  
...  
Keyword(s):  
Brain Injury ◽  
Multiple Trauma ◽  
Plasma Levels ◽  
Trauma Patients ◽  
Multiple Trauma Patients
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