Trauma in pregnancy: A review of the Pennsylvania Trauma Systems Foundation database

Trauma ◽  
2017 ◽  
Vol 20 (1) ◽  
pp. 30-37 ◽  
Author(s):  
Meike Schuster ◽  
Natasha Becker ◽  
Amanda Young ◽  
Michael J Paglia ◽  
A Dhanya Mackeen
Keyword(s):  
Blunt Trauma ◽  
Motor Vehicle ◽  
Penetrating Trauma ◽  
Blunt Injury ◽  
Trauma Patients ◽  
Severely Injured ◽  
Trauma Systems ◽  
Severely Injured Patients ◽  
Vaginal Deliveries ◽  
Injured Patients

Objective The goal of this study is to determine if injury severity score (ISS) of ≥9 and systolic blood pressure (SBP) predict poor maternal/pregnancy outcomes in blunt and penetrating trauma, respectively. Methods The Pennsylvania Trauma Systems Foundation database was used to identify pregnant trauma patients. Blunt trauma patients were analyzed with regard to ISS, while penetrating trauma patients were analyzed to determine whether SBP < 90 mmHg was predictive of poor maternal outcome. Results Patients with severe blunt injury (ISS ≥ 9) due to motor vehicle accident were less likely to wear seatbelts (51% vs. 63%, p = 0.005), and delivery was required in 17% of these patients as compared to 6% of the less severely injured, and only 6% of those were vaginal deliveries. Severely injured patients were discharged home 68% of the time and 6% died compared to less severely injured patients of which 83% were discharged home and <1% died; all other patients required discharge to a rehabilitation facility. Patients with penetrating trauma and SBP < 90 mmHg on arrival were more likely to require delivery (35% vs. 5%, p < 0.001) and were 14 times more likely to die (58% vs. 4%, p < 0.001) when compared to the normotensive group. Conclusion ISS ≥ 9 and SBP < 90 mmHg are predictors for poor outcomes after trauma during pregnancy. Severely injured blunt trauma patients often require surgery and delivery. Patients who present with SBP < 90 after penetrating trauma are more likely to deliver and are 14 times more likely to die.

Delays in Transfer of Elderly Less-injured Trauma Patients Can Have Deadly Consequences

2014 ◽  
Vol 80 (11) ◽  
pp. 1132-1135 ◽  
Author(s):  
Peter E. Fischer ◽  
Paul D. Colavita ◽  
Gregory P. Fleming ◽  
Toan T. Huynh ◽  
A. Britton Christmas ◽  
...  
Keyword(s):  
Trauma Center ◽  
Injury Severity ◽  
Trauma Patients ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Local Trauma ◽  
Level 1 ◽  
Poor Outcomes ◽  
Injured Patients ◽  
Level 1 Trauma Center

Transfer of severely injured patients to regional trauma centers is often expedited; however, transfer of less-injured, older patients may not evoke the same urgency. We examined referring hospitals’ length of stay (LOS) and compared the subsequent outcomes in less-injured transfer patients (TP) with patients presenting directly (DP) to the trauma center. We reviewed the medical records of less-injured (Injury Severity Score [ISS] 9 or less), older (age older than 60 years) patients transferred to a regional Level 1 trauma center to determine the referring facility LOS, demographics, and injury information. Outcomes of the TP were then compared with similarly injured DP using local trauma registry data. In 2011, there were 1657 transfers; the referring facility LOS averaged greater than 3 hours. In the less-injured patients (ISS 9 or less), the average referring facility LOS was 3 hours 20 minutes compared with 2 hours 24 minutes in more severely injured patients (ISS 25 or greater, P < 0.05). The mortality was significantly lower in the DP patients (5.8% TP vs 2.6% DP, P = 0.035). Delays in transfer of less-injured, older trauma patients can result in poor outcomes including increased mortality. Geographic challenges do not allow for every patient to be transported directly to a trauma center. As a result, we propose further outreach efforts to identify potential causes for delay and to promote compliance with regional referral guidelines.

scholarly journals Loss of GPVI and GPIbα contributes to trauma-induced platelet dysfunction in severely injured patients

2020 ◽  
Vol 4 (12) ◽  
pp. 2623-2630 ◽  
Author(s):  
Paul Vulliamy ◽  
Samantha J. Montague ◽  
Scarlett Gillespie ◽  
Melissa V. Chan ◽  
Lucy A. Coupland ◽  
...  
Keyword(s):  
Patient Characteristics ◽  
Surface Expression ◽  
Trauma Patients ◽  
Severely Injured ◽  
Platelet Dysfunction ◽  
Severely Injured Patients ◽  
Severe Injuries ◽  
Glycoprotein Vi ◽  
Active Hemorrhage ◽  
Injured Patients

Abstract Trauma-induced coagulopathy (TIC) is a complex, multifactorial failure of hemostasis that occurs in 25% of severely injured patients and results in a fourfold higher mortality. However, the role of platelets in this state remains poorly understood. We set out to identify molecular changes that may underpin platelet dysfunction after major injury and to determine how they relate to coagulopathy and outcome. We performed a range of hemostatic and platelet-specific studies in blood samples obtained from critically injured patients within 2 hours of injury and collected prospective data on patient characteristics and clinical outcomes. We observed that, although platelet counts were preserved above critical levels, circulating platelets sampled from trauma patients exhibited a profoundly reduced response to both collagen and the selective glycoprotein VI (GPVI) agonist collagen-related peptide, compared with those from healthy volunteers. These responses correlated closely with overall clot strength and mortality. Surface expression of the collagen receptors GPIbα and GPVI was reduced on circulating platelets in trauma patients, with increased levels of the shed ectodomain fragment of GPVI detectable in plasma. Levels of shed GPVI were highest in patients with more severe injuries and TIC. Collectively, these observations demonstrate that platelets experience a loss of GPVI and GPIbα after severe injury and translate into a reduction in the responsiveness of platelets during active hemorrhage. In turn, they are associated with reduced hemostatic competence and increased mortality. Targeting proteolytic shedding of platelet receptors is a potential therapeutic strategy for maintaining hemostatic competence in bleeding and improving the efficacy of platelet transfusions.

Influence of late fluid management on the outcomes of severe trauma patients: A retrospective analysis of 294 severely-injured patients

Injury ◽  
2017 ◽  
Vol 48 (9) ◽  
pp. 1964-1971 ◽  
Author(s):  
Mehdi Mezidi ◽  
Mehdi Ould-Chikh ◽  
Pauline Deras ◽  
Camille Maury ◽  
Orianne Martinez ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Fluid Management ◽  
Severe Trauma ◽  
Trauma Patients ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Injured Patients

scholarly journals Pretrauma Center Red Blood Cell Transfusion Is Associated With Reduced Mortality and Coagulopathy in Severely Injured Patients With Blunt Trauma

2015 ◽  
Vol 261 (5) ◽  
pp. 997-1005 ◽  
Author(s):  
Joshua B. Brown ◽  
Mitchell J. Cohen ◽  
Joseph P. Minei ◽  
Ronald V. Maier ◽  
Michaela A. West ◽  
...  
Keyword(s):  
Blood Cell ◽  
Blunt Trauma ◽  
Red Blood Cell ◽  
Red Blood Cell Transfusion ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Injured Patients

scholarly journals Malnutrition and its effects in severely injured trauma patients

2020 ◽  
Vol 46 (5) ◽  
pp. 993-1004 ◽  
Author(s):  
Suzan Dijkink ◽  
Karien Meier ◽  
Pieta Krijnen ◽  
D. Dante Yeh ◽  
George C. Velmahos ◽  
...  
Keyword(s):  
Nutritional Status ◽  
Adverse Outcomes ◽  
Hospital Length Of Stay ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Trauma Population ◽  
Injured Patients

Abstract Purpose In hospitalized patients, malnutrition is associated with adverse outcomes. However, the consequences of malnutrition in trauma patients are still poorly understood. This study aims to review the current knowledge about the pathophysiology, prevalence, and effects of malnutrition in severely injured patients. Methods A systematic literature review in PubMed and Embase was conducted according to PRISMA-guidelines. Results Nine review articles discussed the hypermetabolic state in severely injured patients in relation to malnutrition. In these patients, malnutrition negatively influenced the metabolic response, and vice versa, thereby rendering them susceptible to adverse outcomes and further deterioration of nutritional status. Thirteen cohort studies reported on prevalences of malnutrition in severely injured patients; ten reported clinical outcomes. In severely injured patients, the prevalence of malnutrition ranged from 7 to 76%, depending upon setting, population, and nutritional assessment tool used. In the geriatric trauma population, 7–62.5% were malnourished at admission and 35.6–60% were at risk for malnutrition. Malnutrition was an independent risk factor for complications, mortality, prolonged hospital length of stay, and declined quality of life. Conclusions Despite widespread belief about the importance of nutrition in severely injured patients, the quantity and quality of available evidence is surprisingly sparse, frequently of low-quality, and outdated. Based on the malnutrition-associated adverse outcomes, the nutritional status of trauma patients should be routinely and carefully monitored. Trials are required to better define the optimal nutritional treatment of trauma patients, but a standardized data dictionary and reasonable outcome measures are required for meaningful interpretation and application of results.

Analysis of Helicopter-Transported Trauma Patients at a Regional Trauma Center

2018 ◽  
Vol 84 (6) ◽  
pp. 952-959
Author(s):  
Christina Sebastian ◽  
Kevin Collopy ◽  
Thomas V. Clancy ◽  
Elizabeth Acquista
Keyword(s):  
Mortality Rate ◽  
Trauma Center ◽  
Motor Vehicle ◽  
Helicopter Emergency Medical Service ◽  
Blunt Injury ◽  
Trauma Patients ◽  
High Incidence ◽  
Timely Access ◽  
Hospital Resources ◽  
Injured Patients

Our medical center's regional helicopter emergency medical service (HEMS) serves southeastern North Carolina. Judicious HEMS use is vital to ensure that the resource is available for critically injured patients and to reduce morbidity and mortality by providing timely access to definitive care. We reviewed HEMS use, clinical outcomes, and overtriage rates. The data included airlifted trauma patients from January 2004 to December 2012. Of 1210 total patients, 733 were flown directly from the scene (FS) and 477 from referring hospitals (FH). The HEMS catchment area was a 100-mile radius of our trauma center. FS patients were younger and sustained more motor vehicle collisions. FH patients were older and sustained more falls. FS patients required more hospital resources including longer ventilator requirements, intensive care unit (ICU) stay, and hospital stay. For all HEMS patients, there was 92.2 per cent blunt injury, 47.5 per cent required Trauma I or II activation, 31 per cent required mechanical ventilation, and 50 per cent required ICU care. 59.5 per cent of HEMS trauma patients were critically injured (defined as requiring either immediate surgical intervention, immediate ICU admission, or immediate death). The overtriage rate was 1.8 per cent. The emergency department mortality rate was 2.3 per cent and the ultimate mortality rate was 7.5 per cent. Most of the airlifted trauma patients were critically injured, and therefore, HEMS transport was appropriate. However, overtriage was low, suggesting high incidence of undertriage. There should be a lower threshold for HEMS use for trauma patients in our region. More research is needed to determine ideal overtriage and undertriage rates.

scholarly journals Strategies for the treatment of femoral fractures in severely injured patients: trends in over two decades from the TraumaRegister DGU®

2021 ◽  
Author(s):  
Felix M. Bläsius ◽  
◽  
Markus Laubach ◽  
Hagen Andruszkow ◽  
Philipp Lichte ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Survival Rates ◽  
Treatment Strategies ◽  
Femoral Fractures ◽  
High Energy ◽  
Trauma Patients ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Femur Fractures ◽  
Injured Patients

Abstract Purpose Treatment strategies for femoral fracture stabilisation are well known to have a significant impact on the patient’s outcome. Therefore, the optimal choices for both the type of initial fracture stabilisation (external fixation/EF, early total care/ETC, conservative treatment/TC) and the best time point for conversion from temporary to definitive fixation are challenging factors. Patients Patients aged ≥ 16 years with moderate and severe trauma documented in the TraumaRegister DGU® between 2002 and 2018 were retrospectively analysed. Demographics, ISS, surgical treatment strategy (ETC vs. EF vs. TC), time for conversion to definitive care, complication (MOF, sepsis) and survival rates were analysed. Results In total, 13,091 trauma patients were included. EF patients more often sustained high-energy trauma (car: 43.1 vs. 29.5%, p < 0.001), were younger (40.6 vs. 48.1 years, p < 0.001), were more severely injured (ISS 25.4 vs. 19.1 pts., p < 0.001), and had higher sepsis (11.8 vs. 5.4%, p < 0.001) and MOF rates (33.1 vs. 16.0%, p < 0.001) compared to ETC patients. A shift from ETC to EF was observed. The time until conversion decreased for femoral fractures from 9 to 8 days within the observation period. Sepsis incidences decreased in EF (20.3 to 12.3%, p < 0.001) and ETC (9.1–4.8%, p < 0.001) patients. Conclusions Our results show the changes in the surgical treatment of severely injured patients with femur fractures over a period of almost two decades caused by the introduction of modern surgical strategies (e.g., Safe Definitive Surgery). It remains unclear which subgroups of trauma patients benefit most from these strategies.

scholarly journals Severely Injured Patients Presenting to the Singapore General Hospital: a one Year Study

2003 ◽  
Vol 10 (1) ◽  
pp. 19-23
Author(s):  
YH Lim ◽  
A Yeo ◽  
MP Koh ◽  
CY Wong
Keyword(s):  
General Hospital ◽  
Motor Vehicle ◽  
Length Of Hospital Stay ◽  
Working Hours ◽  
Resource Utilisation ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Resuscitation Room ◽  
Singapore General Hospital ◽  
Injured Patients

Study objectives To determine the quantity and resource utilisation in management of the severely injured patients presenting at the Singapore General Hospital (SGH). Method All patients who were initially triaged to the hospital Emergency Department's (ED) resuscitation room and all trauma related mortality in the year 1998 were studied. All records were traced and the cases were followed up. Important outcomes studied were mortality and length of hospital stay. Results Three hundred and forty-seven (0.2%) severely injured patients who were initially treated at the ED's resuscitation room were studied. The median age of the patients was 32 years old. Male patients formed 82.1% of the total. The three main causes of trauma in such patients were fall from height, motor vehicle related accidents and penetrating injuries caused by sharp instruments and firearms. Of all the patients, 62.8% were admitted to the ED between 1601 hours to 0759 hours and 30.5% of all severely injured patients were treated at the ED on weekends. One hundred and twenty three (35.4%) patients had emergency surgery within 24 hours of admission to the ED and 42.4% of the patients had an ISS score of 16 or more; 22.8% of patients had ISS score of 25 or more. The mortality of patients with ISS score of 25 or more was 39.2%. Conclusion One percent of all new ED patients with trauma were classified as ‘severely’ injured and these occurred mostly outside “normal working hours”. There was significant mortality in patients with ISS score of 25 or more.

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