scholarly journals Emergency angiography for trauma patients and potential association with acute kidney injury

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ryo Yamamoto ◽  
Ramon F. Cestero ◽  
Jo Yoshizawa ◽  
Katsuya Maeshima ◽  
Junichi Sasaki
Keyword(s):  
Acute Kidney Injury ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Injury Severity ◽  
Vital Signs ◽  
Kidney Injury ◽  
Trauma Patients ◽  
Potential Association ◽  
Trauma Surgeons ◽  
Injured Patients

Abstract Background Angiography has been conducted as a hemostatic procedure for trauma patients. While several complications, such as tissue necrosis after embolization, have been reported, little is known regarding subsequent acute kidney injury (AKI) due to contrast media. To elucidate whether emergency angiography would introduce kidney dysfunction in trauma victims, we compared the incidence of AKI between patients who underwent emergency angiography and those who did not. Methods A retrospective cohort study was conducted using a nationwide trauma database (2004–2019), and adult trauma patients were included. The indication of emergency angiography was determined by both trauma surgeons and radiologists, and AKI was diagnosed by treating physicians based on a rise in serum creatinine and/or fall in urine output according to any published standard criteria. Incidence of AKI was compared between patients who underwent emergency angiography and those who did not. Propensity score matching was conducted to adjust baseline characteristics including age, comorbidities, mechanism of injury, vital signs on admission, Injury Severity Scale (ISS), degree of traumatic kidney injury, surgical procedures, and surgery on the kidney, such as nephrectomy and nephrorrhaphy. Results Among 230,776 patients eligible for the study, 14,180 underwent emergency angiography. The abdomen/pelvis was major site for angiography (10,624 [83.5%]). Embolization was performed in 5,541 (43.5%). Propensity score matching selected 12,724 pairs of severely injured patients (median age, 59; median ISS, 25). While the incidence of AKI was rare, it was higher among patients who underwent emergency angiography than in those who did not (140 [1.1%] vs. 67 [0.5%]; odds ratio = 2.10 [1.57–2.82]; p < 0.01). The association between emergency angiography and subsequent AKI was observed regardless of vasopressor usage or injury severity in subgroup analyses. Conclusions Emergency angiography in trauma patients was probably associated with increased incidence of AKI. The results should be validated in future studies.

scholarly journals Impact of Trauma Center Care on Mortality in Gangwon Province in Korea 

2020 ◽  
Author(s):  
GYOJIN AN ◽  
Yoon-Seop Kim ◽  
Hye Sim Kim ◽  
Chan Young Kang ◽  
Sung Oh Hwang ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Trauma Center ◽  
Injury Severity ◽  
Trauma Patients ◽  
Severely Injured ◽  
Trauma Centers ◽  
Severely Injured Patients ◽  
Risk Of Mortality ◽  
Injured Patients

Abstract Background: Al though controversial, there has been a consensus that compared with non-regional trauma centers, regional trauma centers have survival benefits. In a predominantly rural province with a single regional trauma center, we compared the in-hospital mortality of all trauma patients and severely injured patients between regional and non-regional trauma centers.Methods: Using data extracted from the National Emergency Department Information System in Korea, we examined all trauma patients who visited emergency departments in Gangwon province between January 2015 and December 2017. The International Classification of Disease-Based Injury Severity Score (ICISS) was used to categorize the severity of the patients. Propensity score matching was used for balancing the severity between the two groups.Results: Of 23,510 trauma patients, 2,857 and 20,653 were treated in regional and non-regional trauma centers, respectively. After propensity score matching, all patients in the non-regional trauma center group had a 6.27-fold higher risk of mortality than those in the regional trauma center group; severely injured patients—defined as those with ICISS < 0.9—in the non-regional trauma center group had a 4.90-fold higher risk of mortality than those in the regional trauma center group. ICISS cutoff values for mortality were 0.9015 and 0.8737 for the non-regional and regional trauma center groups, respectively.Conclusion: Conventional paradigms of trauma systems can be used in predominantly rural Korean provinces, because trauma care in regional trauma centers conferred better survival benefits than that in non-regional trauma centers. Additionally, severely injured patients should be transported to regional trauma centers from the trauma scene.

scholarly journals 186 Acute Kidney Injury in Skeletal Trauma Admissions to Intensive Care: An Under-Estimated Complication

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
O Brown ◽  
T Crisp ◽  
M Flatman ◽  
C Hing
Keyword(s):  
Acute Kidney Injury ◽  
Intensive Care ◽  
Injury Severity ◽  
Penetrating Trauma ◽  
Kidney Injury ◽  
Long Bone ◽  
Trauma Patients ◽  
Skeletal Trauma ◽  
Body Regions ◽  
Intensive Care Stay

Abstract Introduction Acute kidney injury (AKI) is associated with prolonged admission and 3.5 times increased mortality for trauma patients requiring intensive care (ICU) treatment. Blunt trauma confers greater risk of AKI than penetrating trauma, potentially related to long bone fracture. The relationship between skeletal trauma and AKI in ICU has not previously been investigated. Method Retrospective data was analysed from 202 consecutive adult patients admitted to ICU with skeletal trauma from 01/06/2018 to 01/06/2019. AKI was defined by creatinine rise &gt;1.5 times baseline. Results AKI was found in 70/202 (34.65%) patients aged 16-99 years, 138 males and 64 females. Mean limb Abbreviated Injury Scale (AIS) was significantly higher in AKI (AIS= 2.57 (SD 0.53) versus non-AKI AIS=2.38 (SD 0.61), p = 0.027). Other body regions and total Injury Severity Score (ISS) were non-significant. AKI was associated with a significantly worse Glasgow Outcome Score (AKI 3.28 (SD 1.52) versus 4.02 (SD 1.08) p &lt; 0.001), increased intensive care stay (AKI 7.03 (SD 8.30) days versus non-AKI 3.8 (SD 4.1) days p &lt; 0.001) and increased 30-day mortality (AKI 18/70 (25.71%) versus non-AKI 10/132 (7.58%) p &lt; 0.001) Conclusions Skeletal trauma patients have a high incidence of AKI, which was significantly correlated with severity of skeletal limb trauma but not overall ISS.

scholarly journals Effect of Diabetes Mellitus on Acute Kidney Injury after Minimally Invasive Partial Nephrectomy: A Case-Matched Retrospective Analysis

2019 ◽  
Vol 8 (4) ◽  
pp. 468 ◽  
Author(s):  
Na Young Kim ◽  
Jung Hwa Hong ◽  
Dong Hoon Koh ◽  
Jongsoo Lee ◽  
Hoon Jae Nam ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Acute Kidney Injury ◽  
Propensity Score ◽  
Minimally Invasive ◽  
Propensity Score Matching ◽  
Partial Nephrectomy ◽  
Kidney Injury ◽  
Invasive Technique ◽  
Male Sex ◽  
Postoperative Aki

Postoperative acute kidney injury (AKI) is still a concern in partial nephrectomy (PN), even with the development of minimally invasive technique. We aimed to compare AKI incidence between patients with and without diabetes mellitus (DM) and to determine the predictive factors for postoperative AKI. This case-matched retrospective study included 884 patients with preoperative creatinine levels ≤1.4 mg/dL who underwent laparoscopic or robot-assisted laparoscopic PN between December 2005 and May 2018. Propensity score matching was employed to match patients with and without DM in a 1:3 ratio (101 and 303 patients, respectively). Of 884 patients, 20.4% had postoperative AKI. After propensity score matching, the incidence of postoperative AKI in DM and non-DM patients was 30.7% and 14.9%, respectively (P < 0.001). In multivariate analysis, male sex and warm ischemia time (WIT) >25 min were significantly associated with postoperative AKI in patients with and without DM. In patients with DM, hemoglobin A1c (HbA1c) >7% was a predictive factor for AKI, odds ratio (OR) = 4.59 (95% CI, 1.47–14.36). In conclusion, DM increased the risk of AKI after minimally invasive PN; male sex, longer WIT, and elevated HbA1c were independent risk factors for AKI in patients with DM.

scholarly journals Computed Tomography with Intravenous Contrast is Not Associated with Development of Acute Kidney Injury in Severely Injured Pediatric Patients

2019 ◽  
Vol 85 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Paul K. McGaha ◽  
Jeremy Johnson ◽  
Tabitha Garwe ◽  
Zoona Sarwar ◽  
Prasenjeet Motghare ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Ct Scan ◽  
Injury Severity ◽  
Pediatric Trauma ◽  
Kidney Injury ◽  
Trauma Patients ◽  
Severely Injured ◽  
Intravenous Contrast ◽  
Trauma Population ◽  
Significant Difference

Data for the incidence of acute kidney injury (AKI) related to intravenous contrast administration in the pediatric trauma population are limited. Obtaining a creatinine value before elective CT scans is a relatively accepted standard of care. We sought to determine whether there was any significant difference in the incidence of AKI between severely injured patients who received IV contrast and those who did not. We reviewed data from the trauma registry at our Level I pediatric trauma center. We limited the patients to severely injured pediatric traumas (<15 years old) directly transported from the scene of injury with a creatinine level measured on arrival. Two hundred and eleven patients were included in the study. AKI was defined by the criteria of the AKI Network. We then compared incidence of AKI in those who received a CT scan with IV contrast with those who did not receive IV contrast. The two groups were comparable in age, gender, Glasgow Coma Scale, Injury Severity Score, mean creatinine on arrival, and mean creatinine post–CT scan/arrival. There was no significant difference in AKI between the two. In a subgroup analysis of patients presenting in shock, there was no significant difference in AKI. Our study suggests that IV contrast is not associated with the development of AKI in severely injured pediatric trauma patients. Although obtaining a creatinine value before exposure is ideal, a CT scan with IV contrast in severely injured children should not be delayed to obtain a creatinine value.

Ketorolac Use for Pain Management in Trauma Patients With Rib Fractures Does not Increase of Acute Kidney Injury or Incidence of Bleeding

2020 ◽  
pp. 000313482095483
Author(s):  
Julia Torabi ◽  
Jody M. Kaban ◽  
Erin Lewis ◽  
Dana Laikhram ◽  
Rachel Simon ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Pain Management ◽  
Injury Severity ◽  
Kidney Injury ◽  
Rib Fractures ◽  
Rib Fracture ◽  
Trauma Patients ◽  
Bleeding Events ◽  
Transfusion Requirements ◽  
Intravenous Ketorolac

Introduction Ketorolac is useful in acute pain management to avoid opiate-related complications; however, some surgeons fear associated acute kidney injury (AKI) and bleeding despite a paucity of literature on ketorolac use in trauma patients. We hypothesized that our institution's use of intravenous ketorolac for rib fracture pain management did not increase the incidence of bleeding or AKI. Methods Rib fracture patients aged 15 years and above admitted between January 2016-June 2018 were identified in our trauma registry along with frequency of bleeding events. AKI was defined as ≥ 1.5x increase in serum creatinine from baseline measured on the second day of admission (after 24 hours of resuscitation) or an increase of ≥ .3 mg/dL over a 48-hour period. Patients receiving ketorolac were compared to patients with no ketorolac use. Results Two cohorts of 199 control and 205 ketorolac patients were found to be similar in age, gender, admission systolic blood pressure (SBP), injury severity score, intravenous radiocontrast received, and transfusion requirements. Analysis revealed no difference in frequency of AKI using both definitions (8% vs. 7.3%, P = .79) and (19.6% vs. 15.1%, P = .24), respectively, or bleeding events (2.5% vs. 0%, P = .03). Logistic regression demonstrated that ketorolac use was not an independent predictor for AKI but age and admission SBP < 90 were. Conclusion Use of ketorolac in this cohort of trauma patients with rib fractures did not increase the incidence of AKI or bleeding events.

Longer Prehospital Time Decreases Reliability of Vital Signs in the Field: A Dual Center Study

2020 ◽  
pp. 000313482095694
Author(s):  
Morgan Schellenberg ◽  
Subarna Biswas ◽  
James M. Bardes ◽  
Marc D. Trust ◽  
Daniel Grabo ◽  
...  
Keyword(s):  
Linear Regression ◽  
Propensity Score ◽  
Injury Severity ◽  
Propensity Score Analysis ◽  
Vital Signs ◽  
Trauma Team ◽  
Trauma Patients ◽  
Study Objective ◽  
Score Analysis ◽  
Prehospital Time

Background Field vital signs are integral in the American College of Surgeons (ASA) Committee on Trauma (COT) triage criteria for trauma team activation (TTA). Reliability of field vital signs in predicting first emergency department (ED) vital signs, however, may depend upon prehospital time. The study objective was to define the effect of prehospital time on correlation between field and first ED vital signs. Methods All highest level TTAs at two Level I trauma centers (2008-2018) were screened. Exclusions were unrecorded prehospital vital signs and those dead on arrival. Demographics, prehospital time (scene time + transport time), injury data, and vital signs were collected. Differences between field and first ED vitals were determined using the paired Student’s t test. Propensity score analysis, adjusting for age, sex, injury severity score (ISS), and mechanism of injury compared outcomes among patients with ISS ≥16. Multivariate linear regression determined impact of prehospital time on vital sign differences between field and ED among propensity-matched patients. Results After exclusions, 21 499 patients remained. Mean prehospital time was 32 vs. 41 minutes ( P < .001). On propensity score analysis, longer prehospital time was associated with significantly greater differences in systolic blood pressure (SBP) ( P < .001), pulse pressure (PP) ( P = .003), and Glasgow Coma Scale (GCS) ( P < .001). On multivariate analysis, linear regression that demonstrated longer prehospital time was associated with greater differences in SBP, heart rate (HR), and PP ( P < .001). Conclusions Field vital signs are less likely to reflect initial ED vital signs when prehospital times are longer. Given the reliance of trauma triage criteria on prehospital vital signs, medical providers must be cognizant of this pitfall during the prehospital assessment of trauma patients.

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