scholarly journals Does the time of the day affect multiple trauma care in hospitals? A retrospective analysis of data from the TraumaRegister DGU®

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Stefanie Fitschen-Oestern ◽  
Sebastian Lippross ◽  
Rolf Lefering ◽  
Tim Klüter ◽  
Matthias Weuster ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Ct Scan ◽  
Multiple Trauma ◽  
Trauma Care ◽  
Trauma Center ◽  
Injury Severity ◽  
Emergency Operation ◽  
Trauma Patients ◽  
X Ray ◽  
Multiple Trauma Patients

Abstract Background Optimal multiple trauma care should be continuously provided during the day and night. Several studies have demonstrated worse outcomes and higher mortality in patients admitted at night. This study involved the analysis of a population of multiple trauma patients admitted at night and a comparison of various indicators of the quality of care at different admission times. Methods Data from 58,939 multiple trauma patients from 2007 to 2017 were analyzed retrospectively. All data were obtained from TraumaRegister DGU®. Patients were grouped by the time of their admission to the trauma center (6.00 am–11.59 am (morning), 12.00 pm–5.59 pm (afternoon), 6.00 pm–11.59 pm (evening), 0.00 am–5.59 am (night)). Incidences, patient demographics, injury patterns, trauma center levels and trauma care times and outcomes were evaluated. Results Fewer patients were admitted during the night (6.00 pm–11.59 pm: 18.8% of the patients, 0.00–5.59 am: 4.6% of the patients) than during the day. Patients who arrived between 0.00 am–5.59 am were younger (49.4 ± 22.8 years) and had a higher injury severity score (ISS) (21.4 ± 11.5) and lower Glasgow Coma Scale (GCS) score (11.6 ± 4.4) than those admitted during the day (12.00 pm–05.59 pm; age: 55.3 ± 21.6 years, ISS: 20.6 ± 11.4, GCS: 12.6 ± 4.0). Time in the trauma department and time to an emergency operation were only marginally different. Time to imaging was slightly prolonged during the night (0.00 am–5.59 am: X-ray 16.2 ± 19.8 min; CT scan 24.3 ± 18.1 min versus 12.00 pm- 5.59 pm: X-ray 15.4 ± 19.7 min; CT scan 22.5 ± 17.8 min), but the delay did not affect the outcome. The outcome was also not affected by level of the trauma center. There was no relevant difference in the Revised Injury Severity Classification II (RISC II) score or mortality rate between patients admitted during the day and at night. There were no differences in RISC II scores or mortality rates according to time period. Admission at night was not a predictor of a higher mortality rate. Conclusion The patient population and injury severity vary between the day and night with regard to age, injury pattern and trauma mechanism. Despite the differences in these factors, arrival at night did not have a negative effect on the outcome.

scholarly journals Alteration of Transthyretin Microheterogeneity in Serum of Multiple Trauma Patients

2007 ◽  
Vol 2 ◽  
pp. 117727190700200 ◽  
Author(s):  
Beate Gericke ◽  
Jens Raila ◽  
Maria Deja ◽  
Sascha Rohn ◽  
Bernd Donaubauer ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Multiple Trauma ◽  
Acute Phase ◽  
Acute Phase Response ◽  
Injury Severity ◽  
Phase Response ◽  
Linear Matrix ◽  
Trauma Patients ◽  
Flight Mass Spectrometry ◽  
Multiple Trauma Patients

Transthyretin (TTR) which exists in various isoforms, is a valid marker for acute phase response and subclinical malnutrition. The aim of the study was to investigate the relationship between inflammation, oxidative stress and the occurrence of changes in microheterogeneity of TTR. A prospective, observational study at a level-I trauma center of a large urban medical university was performed. Patients were severely injured (n = 18; injury severity score (ISS): 34–66), and were observed within the first 24 hours of admittance and over the following days until day 20 after injury. 20 healthy subjects, matched by age and sex, were used as controls. TTR was enriched by immunoprecipitation. Microheterogeneity of TTR was determined by linear matrix assisted laser desorption/ionization-time of flight-mass spectrometry (MALDI-TOF-MS). Four major mass signals were observed for TTR representing native, S-cysteinylated, S-cysteinglycinylated and S-glutathionylated TTR. In the course of their ICU stay, 14 of the 18 patients showed a transient change in microheterogeneity in favour of the S-cysteinglycinylated form of TTR (p < 0.05 vs. controls). The occurrence of this variant was not associated with the severity of trauma or the intensity of the acute-phase response, but was associated with oxidative stress as evidenced by Trolox. Our results demonstrate that changes in microheterogeneity of TTR occur in a substantial number of ICU trauma patients. The diagnostic values of these changes remains to be elucidated. It is speculated that TTR modification may well be the mechanism underlying the morphological manifestation of amyloidose or Alzheimer's diseases in patients surviving multiple trauma.

scholarly journals An improved modified early warning score that incorporates the abdomen score for identifying multiple traumatic injury severity

PeerJ ◽  
2020 ◽  
Vol 8 ◽  
pp. e10242
Author(s):  
Xiaobin Jiang
Keyword(s):  
Multiple Trauma ◽  
Early Warning ◽  
Injury Severity ◽  
Severe Trauma ◽  
Early Warning Score ◽  
Trauma Patients ◽  
Site Specific ◽  
Injury Site ◽  
Trauma Severity ◽  
Multiple Trauma Patients

Background Rapid identification of trauma severity is essential for the timely triage of multiple trauma patients. Tools such as the modified early warning score (MEWS) are used for determining injury severity. Although the conventional MEWS is a good predictor of mortality, its performance assessing injury severity is moderate. This study hypothesized that adding an injury site severity-related score (e.g., abdomen score) may enhance the capability of the MEWS for identifying severe trauma. Method To validate the hypothesis, we propose an improved modified early warning score called MEWS-A, which incorporates an injury site-specific severity-related abdomen score to MEWS. The utility of MEWS and MEWS-A were retrospectively evaluated and compared for identifying trauma severity in adult multiple trauma patients admitted to the emergency department. Results We included 1,230 eligible multiple trauma patients and divided them into minor and severe trauma groups based on the injury severity score. Results of logistic regression and receiver operating characteristic (ROC) curve analyses showed that the MEWS-A had a higher area under the ROC curve (AUC: 0.81 95% CI [0.78–0.83]) than did the MEWS (AUC: 0.77 95% CI [0.74–0.79]), indicating that the MEWS-A is superior to the MEWS in identifying severe trauma. The optimal MEWS-A cut-off score is 4, with a specificity of 0.93 and a sensitivity of 0.54. MEWS-A ≥ 4 can be used as a protocol for decision-making in the emergency department. Conclusions Our study suggests that while the conventional MEWS is sufficient for predicting mortality risk, adding an injury site-specific score (e.g., abdomen score) can enhance its performance in determining injury severity in multiple trauma patients.

Circulating complement proteins in multiple trauma patients-Correlation with injury severity, development of sepsis, and outcome

1997 ◽  
Vol 25 (12) ◽  
pp. 2015-2024 ◽  
Author(s):  
Friederike Hecke ◽  
Ulf Schmidt ◽  
Axel Kola ◽  
Wilfried Bautsch ◽  
Andreas Klos ◽  
...  
Keyword(s):  
Multiple Trauma ◽  
Injury Severity ◽  
Trauma Patients ◽  
Complement Proteins ◽  
Multiple Trauma Patients

scholarly journals Assessment of mechanism, type and severity of injury in multiple trauma patients: A cross sectional study of a trauma center in Iran

2017 ◽  
Vol 20 (2) ◽  
pp. 75-80 ◽  
Author(s):  
Hamidreza Reihani ◽  
Hossein Pirazghandi ◽  
Ehsan Bolvardi ◽  
Mohsen Ebrahimi ◽  
Elham Pishbin ◽  
...  
Keyword(s):  
Multiple Trauma ◽  
Trauma Center ◽  
Cross Sectional Study ◽  
Trauma Patients ◽  
Sectional Study ◽  
Cross Sectional ◽  
Severity Of Injury ◽  
Multiple Trauma Patients

scholarly journals Comparison of the new injury severity score and the injury severity score in multiple trauma patients

2008 ◽  
Vol 11 (6) ◽  
pp. 368-371 ◽  
Author(s):  
Xiao-gang ZHAO ◽  
Yue-feng MA ◽  
Mao ZHANG ◽  
Jian-xin GAN ◽  
Shao-wen XU ◽  
...  
Keyword(s):  
Injury Severity Score ◽  
Multiple Trauma ◽  
Severity Score ◽  
Injury Severity ◽  
Trauma Patients ◽  
New Injury Severity Score ◽  
Multiple Trauma Patients

scholarly journals Assessing the Pelvic X-ray Findings of High-energy Multiple Trauma Patients in Emergency Department of Rajaee Trauma Hospital, Shiraz-October 2013 to May 2014

2017 ◽  
Vol 4 (6) ◽  
Author(s):  
Mahsa Akhavan ◽  
Amir Reza Mesbahi ◽  
Mahsa Mohammadian ◽  
Alireza Shakibafard ◽  
Mahnaz Yadollahi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Multiple Trauma ◽  
High Energy ◽  
Trauma Patients ◽  
X Ray ◽  
Multiple Trauma Patients

scholarly journals Relationship between initial fibrinogen level with coagulopathy and mortality in multiple trauma patients

2017 ◽  
Vol 4 (2) ◽  
pp. 571
Author(s):  
Reno Rudiman ◽  
Lyana Sulistyanti ◽  
Nurhayat Usman
Keyword(s):  
Multiple Trauma ◽  
Injury Severity ◽  
Fibrinogen Level ◽  
Coagulation Factors ◽  
Bleeding Complications ◽  
Trauma Patients ◽  
Strongly Correlated ◽  
Chi Square ◽  
Multiple Trauma Patients ◽  
Chi Square Analysis

Background: In trauma induced coagulopathy (TIC), low fibrinogen value is often found and plasma fibrinogen reached low value earlier than other parameters of coagulation factors. Initial fibrinogen value is strongly correlated to the injury severity score (ISS) and be an independent predictor of mortality. This study was expected to see the relationship between initial fibrinogen level with coagulopathy and mortality, so it can predict early coagulopathy and can prevent bleeding complications that lead to mortality. Methods: The study was conducted prospectively. The entire examination obtained from patients with multiple trauma. Fibrinogen levels and coagulopathy were taken from the blood laboratory tests in conjunction with other routine examination when patients were admitted to the ER of Hasan Sadikin General Hospital. Outcome parameters were the incidence of coagulopathy and mortality. Statistical analyses were performed to look at the significance of relationships.Results: Of the 25 patients with multiple trauma obtained a majority of 80% were male patients and with the highest incidence mechanism was head trauma as many as 16 people (64%). There were 8 patients (32%) experienced coagulopathy and mortality occurred in 7 patients (28%). Chi square analysis found a significant association between fibrinogen and coagulopathy (p = 0.043), while the association between initial fibrinogen with mortality was not significant (p = 0.341).Conclusions: Initial fibrinogen level is significantly associated with coagulopathy but it cannot predict mortality in patients with multiple trauma. Further study is needed in order to assess the benefit of these results on the management of multiple trauma patients.

Costs of Multiple Trauma Patients Treatment During the Acute Phase

Swiss Surgery ◽  
2003 ◽  
Vol 9 (6) ◽  
pp. 268-274 ◽  
Author(s):  
Ganzoni ◽  
Zellweger ◽  
Trentz
Keyword(s):  
Injury Severity Score ◽  
Multiple Trauma ◽  
Acute Phase ◽  
Severity Score ◽  
Injury Severity ◽  
Trauma Patients ◽  
Multiple Trauma Patients

Alljährlich steigende Kosten im schweizerischen Gesundheitswesen geben immer wieder Anlass zu Diskussionen. Klarheit und Fakten über die differenzierten Behandlungskosten liegen keine vor. Ziel dieser Arbeit ist es, die Akuttherapiekosten von Polytraumatisierten am Universitätsspital Zürich zu untersuchen. Basierend auf den Schlussabrechnungen von gemäss Spitalleistungskatalog (SLK) abgerechneten Patientinnen und Patienten untersuchten wir in 16 Fällen mit einem mittleren Injury Severity Score (ISS) von 33.9 die Behandlungskosten der Akuttherapie. Wir entwarfen ein Konzept zur Bewertung des mittleren Verlustes pro Grund- und Unfallversicherten, welche über Tagespauschalen abgerechnet werden und den überwiegenden Teil der hospitalisierten Patienten stellen. Die mittleren in Rechnung gestellten Behandlungskosten beliefen sich auf 128'135 Franken (31'266-310'358 CHF). Es zeigte sich, dass nach Verwendung des Gewinns von Zusatzversicherten zur Subvention der Grund-, Unfallversicherten und Sozialfällen, eine Differenz je nach Verletzungskombination und Versicherungsstatus zwischen 42% und 65%, in absoluten Zahlen 33'703 bis 138'829 Franken, bestand. Verlangt man von Spitälern kostendeckend zu arbeiten, so ist ein solcher Verlust, welcher durch das Grundversicherungssystem bedingt ist, nicht zu vernachlässigen. Bei der Einführung von neuen Abrechnungsformen müssen die hohen Kosten, die diese Patientengruppe verursacht, berücksichtigt werden.

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