Predictors of increasing injury severity across suspected recurrent episodes of non-accidental trauma: a retrospective cohort study

Blunt trauma is a potentially life-threatening injury that requires prompt diagnostic examination and therapeutic intervention. Nevertheless, how impactful a rapid response time is on mortality or functional outcomes has not been well-investigated. This study aimed to evaluate effects of earlier door-to-computed tomography time (D2CT) and door-to-bleeding control time (D2BC) on clinical outcomes in severe blunt trauma. This was a single-center, retrospective cohort study of patients with severe blunt trauma (Injury Severity Score > 16). To assess the effect of earlier D2CT and D2BC on clinical outcomes, we conducted multivariable regression analyses with a consideration for nonlinear associations. Among 671 patients with severe blunt trauma who underwent CT scanning, 163 patients received an emergency bleeding control procedure. The median D2CT and D2BC were 19 min and 57 min, respectively. In a Cox proportional hazard regression model, earlier D2CT was not associated with improved 28-day mortality (p = 0.30), but it was significantly associated with decreased mortality from exsanguination (p = 0.003). Earlier D2BC was significantly associated with improved 28-day mortality (p = 0.026). In conclusion, earlier time to a hemostatic procedure was independently associated with decreased mortality. Meanwhile, time benefits of earlier CT examination were not observed for overall survival but were observed for decreased mortality from exsanguination.

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Factors associated with survival in Adult Patients with Traumatic Arrest: A Retrospective Cohort Study from US Trauma Centers

10.21203/rs.3.rs-112660/v1 ◽

2020 ◽

Author(s):

Abdel-Badih Ariss ◽

Rana Bachir ◽

Mazen El Sayed

Keyword(s):

Cohort Study ◽

Hospital Discharge ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Injury Severity ◽

Motor Vehicle ◽

Age Group ◽

Trauma Centers ◽

Level Of Evidence ◽

Factors Associated

Abstract Background: Traumatic arrests (TA) increasingly affect young adults worldwide with low reported survival rates. This study examines factors associated with survival (to hospital discharge) in traumatic arrests transported to US trauma centers. Methods: This retrospective cohort study used the US National Trauma Databank 2015 dataset and included patients who presented to trauma centers with “no signs of life”. Univariate and bivariate analyses were done. Factors associated with survival were identified using multivariate regression analyses. Results: The study included 5,980 patients with traumatic arrests. Only 664 patients (11.1%) survived to hospital discharge. Patients were predominantly in age group 16-64 (84.6%), were mostly males (77.8%) and white (55.1%). Most were admitted to Level I (55.5%) or Level II trauma centers (31.6%). Injuries were mostly blunt (56.7%) or penetrating (39.3%). Mean ISS was 23.71 (± 20.79). Factors associated with decreased survival included: Age group ≥65 (Ref: 16-24), male gender, self-inflicted and other or undetermined types of injuries (Ref: assault), injuries to head & neck, injuries to torso and injury severity score (ISS) ≥ 16 (Ref: <16). While factors associated with increased survival included: All injury mechanisms (with the exception of Motor Vehicle Transportation (MVT)) (Ref: firearm), injuries to extremities or spine & back and all methods of coverage (Ref: self-pay).Conclusion: Patients with traumatic arrests have poor outcomes with only 11.1 % surviving to hospital discharge. Factors associated with survival in traumatic arrests were identified. These findings are important for devising injury prevention strategies and help guide trauma management protocols to improve outcomes in traumatic arrests. Level of evidence: Level III

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No Need for Sternal Fixation in Traumatic Sternovertebral Fractures: Outcomes of a 10-Year Retrospective Cohort Study

Global Spine Journal ◽

10.1177/2192568220902413 ◽

2020 ◽

pp. 219256822090241 ◽

Cited By ~ 1

Author(s):

Dorine S. Klei ◽

F. Cumhur Öner ◽

Luke P. H. Leenen ◽

Karlijn J. P. van Wessem

Keyword(s):

Cohort Study ◽

Treatment Failure ◽

Failure Rate ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Injury Severity ◽

Spinal Fractures ◽

Thoracic Wall ◽

Upper Cervical Spine ◽

Lower Lumbar Spine

Study Design: Retrospective cohort study. Objectives: Combined sternal and spinal fractures are rare traumatic injuries and present a high risk of spinal and thoracic wall instability. Limited research has addressed the treatment of sternovertebral injuries and biomechanical need for sternal fixation to achieve spinal healing. Methods: A 10-year retrospective cohort study was conducted, including patients with sternovertebral fractures admitted to our level-1 trauma centre between 2007 and 2016. Patients who died during hospital admission, military patients, patients with isolated upper cervical spine or lower lumbar spine fractures, and patients lost to follow-up were excluded. Results: In 10 years, 73 patients with sternovertebral fractures were included. Mean injury severity score was 24 (range 4-57). Most sternal fractures were located in the sternal body and manubrium. Spinal fractures were type A (52%), B (40%), or C (8%), and were located in the subaxial cervical (21%), upper thoracic (16%), thoracic (21%), thoracolumbar (47%) area; 7 patients had spinal fractures at multiple levels. Fourteen patients (19%) had a neurological deficit. A total of 42 patients received conservative and 31 patients received operative spinal treatment. Two patients (3%) underwent primary sternal fixation. Sternal failure rate was 1% and biomechanical spinal failure rate was 8%, there was no difference in treatment failure between surgical and conservative spinal treatment. Associated thoracic injuries did not influence sternal or spinal treatment outcomes. Conclusions: These findings indicate that conservative sternal treatment in presence of spinal fractures is safe and effective. The low spinal treatment failure rates imply that sternal fixation is not necessary to achieve spinal stability.

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Comparing trauma mortality of injured patients in India and the USA: a risk-adjusted analysis

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2021-000719 ◽

2021 ◽

Vol 6 (1) ◽

pp. e000719

Author(s):

Stas Amato ◽

Levi Bonnell ◽

Monali Mohan ◽

Nobhojit Roy ◽

Ajai Malhotra

Keyword(s):

Cohort Study ◽

Trauma Care ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Injury Severity ◽

Trauma Patients ◽

Specific Patient ◽

Severity Scores ◽

The Usa ◽

Trauma Mortality

ObjectivesComparisons of risk-adjusted trauma mortality between high-income countries and low and middle-income countries (LMICs) can be used to identify specific patient populations and injury patterns for targeted interventions. Due to a paucity of granular patient and injury data from LMICs, there is a lack of such comparisons. This study aims to identify independent predictors of trauma mortality and significant differences between India and the USA.MethodsA retrospective cohort study of two trauma databases was conducted. Demographic, injury, physiologic, anatomic and outcome data were analyzed from India’s Towards Improved Trauma Care Outcomes project database and the US National Trauma Data Bank from 2013 to 2015. Multivariate logistic regression analyses were performed to determine significant independent predictors of mortality.Results687 407 adult trauma patients were included (India 11 796; USA 675 611). Patients from India were significantly younger with greater male preponderance, a higher proportion presented with physiologic abnormalities and suffered higher mortality rates (23.2% vs. 2.8%). When controlling for age, sex, physiologic abnormalities, and injury severity, sustaining an injury in India was the strongest predictor of mortality (OR 13.85, 95% CI 13.05 to 14.69). On subgroup analyses, the greatest mortality difference was seen in patients with lower Injury Severity Scores.ConclusionAfter adjusting for demographic, physiologic abnormalities, and injury severity, trauma-related mortality was found to be significantly higher in India. When compared with trauma patients in the USA, the odds of mortality are most notably different among patients with lower Injury Severity Scores. While troubling, this suggests that relatively simple, low-cost interventions focused on standard timely trauma care, early imaging, and protocolized treatment pathways could result in substantial improvements for injury mortality in India, and potentially other LMICs.Level of evidenceLevel 3, retrospective cohort study.

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Infection Complications After Trauma Contribute to Increased in-Hospital Mortality in Mild Patients Compared With Severe Patients: A Retrospective Cohort Study Using a Nationwide Trauma Registry in Japan

10.21203/rs.3.rs-150962/v1 ◽

2021 ◽

Author(s):

Akira Komori ◽

Hiroki Iriyama ◽

Takako Kainoh ◽

Makoto Aoki ◽

Toshio Naito ◽

...

Keyword(s):

Cohort Study ◽

Hospital Mortality ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Injury Severity ◽

Penetrating Trauma ◽

Multivariable Logistic Regression Analysis ◽

Trauma Patients ◽

Trauma Severity ◽

The Impact

Abstract Background: Infection is a very common but poor prognostic complication affecting trauma patients. However, the impact of infection on the prognosis of trauma patients according to severity remains unclear. We aimed to assess the impact of infection complications on in-hospital mortality among patients with trauma according to severity. Methods: This retrospective cohort study used a nationwide registry of trauma patients (Japan Trauma Data Bank). Patients aged ≥ 18 years with blunt or penetrating trauma who were admitted to intensive care units or general wards between 2004 and 2017 were included. We compared the baseline characteristics and outcomes between patients with and without infection and conducted a multivariable logistic regression analysis to investigate the impact of infection on in-hospital mortality according to trauma severity, which was classified as mild [Injury Severity Score (ISS) < 15], moderate (ISS 15–29), or severe (ISS ≥ 30). Results: Among the 150,948 patients in this study, 10,172 (6.7%) developed infections. The severity of trauma was greater in patients with infection than those without [mild, 3,837 (37.7%) vs. 84,106 (59.7%); moderate, 4,518 (44.4%) vs. 47,809 (34.0%); severe, 1,817 (17.9%) vs. 8,861 (6.3%), p < 0.01]. Patients with infection had greater in-hospital mortality than patients without infection [1,079 (10.6%) vs. 2,904 (2.1%), p < 0.01]. After adjusting for clinical characteristics, in-hospital mortality differed significantly between trauma patients with and without infection according to trauma severity [16.7% (95% CI; 14.6%–18.8%) vs. 3.6% (95% CI; 3.3%–3.9%), p < 0.01, in patients with mild trauma; 12.3% (95% CI; 11.0%–13.6%) vs. 7.3% (95% CI; 6.9%–7.7%), p < 0.01, in patients with moderate trauma; and 12.0% (95% CI; 9.8%–14.2%) vs. 11.1% (95% CI; 9.8%–12.4%), p = 0.41, in patients with severe trauma].Conclusion: The effect of infection complications in patients with trauma on in-hospital mortality differs by trauma severity.

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Analysis of Clinical Outcome and Predictors of Mortality in Pediatric Trauma Population: Evidence from a 10 Year Analysis in a Single Center

Children ◽

10.3390/children8080688 ◽

2021 ◽

Vol 8 (8) ◽

pp. 688

Author(s):

Ya-Chih Yang ◽

Tsung-Han Hsieh ◽

Chi-Yuan Liu ◽

Chun-Yu Chang ◽

Yueh-Tseng Hou ◽

...

Keyword(s):

Cohort Study ◽

Injury Severity Score ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Injury Severity ◽

Pediatric Trauma ◽

Vital Signs ◽

Traumatic Injuries ◽

Icu Admission ◽

Trauma Population

The shock index (SI) is a useful tool for predicting the injury severity and mortality in patients with trauma. However, pediatric physiology differs from that of adults. In the pediatric trauma population, the shock status may be obscured within the normal range of vital signs. Pediatric age-adjusted SI (SIPA) is reported more accurately compared to SI. In our study, we conducted a 10 year retrospective cohort study of pediatric trauma population to evaluate the SI and SIPA in predicting mortality, intensive care unit (ICU) admission, and the need for surgery. This retrospective cohort study included 1265 pediatric trauma patients from January 2009 to June 2019 at the Taipei Tzu Chi Hospital, who had a history of hospitalization. The primary outcome of this investigation was in-hospital mortality, and the secondary outcomes were the length of hospital and ICU stay, operation times, and ICU admission times. The SIPA group can detect changes in vital signs early to reflect shock progression. In the elevated SIPA group, more severe traumatic injuries were identified, including high injury severity score (ISS), revised trauma score (RTS), and new injury severity score (NISS) scores than SI > 0.9. The odds ratio of elevated SIPA and SI (>0.9) to predict ISS ≥ 16 was 3.593 (95% Confidence interval [CI]: 2.175–5.935, p < 0.001) and 2.329 (95% CI: 1.454–3.730, p < 0.001). SI and SIPA are useful for identifying the compensatory phase of shock in prehospital and hospital settings, especially in corresponding normal to low-normal blood pressure. SIPA is effective in predicting the mortality and severity of traumatic injuries in the pediatric population. However, SI and SIPA were not significant predictors of ICU admission and the need for surgery analysis.

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Effect of earlier door-to-CT and door-to-bleeding control in severe blunt trauma: a retrospective cohort study

10.21203/rs.3.rs-23452/v1 ◽

2020 ◽

Author(s):

Shuhei Murao ◽

Kazuma Yamakawa ◽

Daijiro Kabata ◽

Takahiro Kinoshita ◽

Yutaka Umemura ◽

...

Keyword(s):

Cohort Study ◽

Blunt Trauma ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Injury Severity ◽

Ct Scanning ◽

Whole Body ◽

Control Procedure ◽

Bleeding Control ◽

Scanning Time

Abstract BackgroundBlunt trauma is a potentially life-threatening injury that requires prompt diagnostic examination and therapeutic intervention. Nevertheless, how impactful a rapid response time is on mortality or functional outcomes has not been well investigated. This study aimed to evaluate effects of earlier door-to-computed tomography time (D2CT) and door-to-bleeding control time (D2BC) on clinical outcomes in severe blunt trauma.MethodThis was a single-center, retrospective cohort study of patients with severe blunt trauma (Injury Severity Score > 16) treated between August 2007 and July 2015 in a tertiary trauma center in Japan. Patients who underwent whole-body CT scanning within 90 minutes of emergency room arrival were included. To assess the effect of earlier D2CT and D2BC on 28-day mortality, we conducted multivariable regression analyses with consideration of non-linear associations. The effects on 24-hour mortality and the Oxford Handicap Scale were also evaluated as secondary outcomes.ResultsAmong 671 patients with severe blunt trauma who underwent CT scanning, 163 patients received an emergency bleeding control procedure. The median D2CT and D2BC were 19 min (IQR 12–27) and 57 min (IQR 45–75), respectively. In a Cox proportional hazard regression model, earlier D2CT was not associated with improved 28-day mortality (p = 0.30), whereas earlier D2BC was significantly associated with improved 28-day mortality (p = 0.026). This beneficial trend of D2BC was consistently observed for the assessment of secondary outcomes.ConclusionAmong patients with severe blunt trauma undergoing CT scanning, time benefits were not observed for the CT examination itself but were for therapeutic bleeding control.

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Factors associated with survival in adult patients with traumatic arrest: a retrospective cohort study from US trauma centers

BMC Emergency Medicine ◽

10.1186/s12873-021-00473-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Abdel-Badih Ariss ◽

Rana Bachir ◽

Mazen El Sayed

Keyword(s):

Cohort Study ◽

Hospital Discharge ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Injury Severity ◽

Motor Vehicle ◽

Age Group ◽

Trauma Centers ◽

Level Of Evidence ◽

Factors Associated

Abstract Background Traumatic arrests increasingly affect young adults worldwide with low reported survival rates. This study examines factors associated with survival (to hospital discharge) in traumatic arrests transported to US trauma centers. Methods This retrospective cohort study used the US National Trauma Databank 2015 dataset and included patients who presented to trauma centers with “no signs of life”. Univariate and bivariate analyses were done. Factors associated with survival were identified using multivariate regression analyses. Results The study included 5980 patients with traumatic arrests. Only 664 patients (11.1%) survived to hospital discharge. Patients were predominantly in age group 16–64 (84.6%), were mostly males (77.8%) and white (55.1%). Most were admitted to Level I (55.5%) or Level II trauma centers (31.6%). Injuries were mostly blunt (56.7%) or penetrating (39.3%). The median of the injury severity score (ISS) was 19 (interquartile range [IQR]: 9–30). Factors associated with decreased survival included: Age group ≥ 65 (Ref: 16–24), male gender, self-inflicted and other or undetermined types of injuries (Ref: assault), injuries to head and neck, injuries to torso and ISS ≥ 16 (Ref: < 16) and ED thoracotomy. While factors associated with increased survival included: All injury mechanisms (with the exception of motor vehicle transportation) (Ref: firearm), injuries to extremities or spine and back and all methods of coverage (Ref: self-pay). Conclusion Patients with traumatic arrests have poor outcomes with only 11.1% surviving to hospital discharge. Factors associated with survival in traumatic arrests were identified. These findings are important for devising injury prevention strategies and help guide trauma management protocols to improve outcomes in traumatic arrests. Level of evidence Level III.

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