scholarly journals Splenic Embolization Decreases Infectious Complications and Resource Utilization Compared to Splenectomy in Severely Injured Patients

2014 ◽  
Vol 7 (2) ◽  
pp. 50-57
Author(s):  
James M Haan ◽  
Grant V Bochicchio ◽  
Anne Conway ◽  
Kelly M Bochicchio ◽  
Thomas M Scalea
Keyword(s):  
Intensive Care Unit ◽  
Resource Utilization ◽  
Splenic Injury ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Complication Rates ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Injury Grade ◽  
Injured Patients

Introduction. Increasing use of main coil angioembolization for splenic injury has raised concerns of increased complication rates and resource utilization compared to splenectomy. This study examined complication rates for severely injured patients undergoing splenectomy versus main coil angioembolization. Methods. Demographic data (age, sex, and race), Injury Severity Score (ISS), and splenic injury grade were collected prospectively on all patients admitted to the intensive care unit with blunt splenic injury treated with splenectomy or main coil angioembolization. Outcome measures (transfusion requirements, mechanical ventilation use and duration, mortality, intensive care unit and hospital length of stay, infection rate, and systemic inflammatory response syndrome or SIRS score) were reviewed daily. Results. Of 116 patients reviewed, 65 underwent splenectomy and 51 underwent main coil angioembolization. Groups were comparable for age, sex, race, and mechanism of injury. Splenectomized patients had a higher ISS (41 vs 31) and splenic injury grade (3.7 vs 3.2). The main coil angioembolization group had a lower transfusion requirement, hospital length of stay, incidence of mechanical ventilation, nosocomial infection rate, and SIRS score. Overall, mortality and ventilator days were lower but not statistically significant. Conclusions. Severely injured patients treated with splenectomy had significantly higher infection rates and resource utilization compared to those treated with main coil angioembolization.

The (Absence of a) Role of Venous Duplex Scan in the Diagnosis of Pulmonary Embolism after Severe Trauma

2006 ◽  
Vol 72 (1) ◽  
pp. 7-10
Author(s):  
George C. Velmahos ◽  
Carlos V. Brown ◽  
Demetrios Demetriades
Keyword(s):  
Intensive Care Unit ◽  
Pulmonary Embolism ◽  
Intensive Care ◽  
Sensitivity And Specificity ◽  
Clinical Suspicion ◽  
Severely Injured ◽  
Duplex Scan ◽  
Severely Injured Patients ◽  
High Level ◽  
Injured Patients

Venous duplex scan (VDS) has been used for interim bedside diagnosis of pulmonary embolism (PE) in severely injured patients deemed to be at risk if transported out of the intensive care unit. In combination with the level of clinical suspicion for PE, VDS helps select patients for temporary treatment until definitive diagnosis is made. We evaluate the sensitivity and specificity of VDS in critically injured patients with a high level of clinical suspicion for PE. We performed a prospective observational cohort study at the surgical intensive care unit of an academic level 1 trauma center. Patients were 59 critically injured patients suspected to have PE over a 30-month period. The level of clinical suspicion for PE was classified as low or high according to preset criteria. Interventions were VDS and a PE outcome test (conventional or computed tomographic pulmonary angiography). The sensitivity and specificity of VDS to detect PE in all patients and in patients with high level of clinical suspicion was calculated against the results of the outcome test. PE was diagnosed in 21 patients (35.5%). The sensitivity and specificity of VDS was 33 per cent and 89 per cent, respectively. Among the 28 patients who had a high level of clinical suspicion for PE, the sensitivity of VDS was 23 per cent and the specificity 93 per cent. In this latter population, 1 of the 4 (25%) positive VDS was of a patient without PE and 10 of the 24 (42%) negative VDS were of patients who had PE. VDS does not accurately predict PE in severely injured patients, even in the presence of a high level of clinical suspicion.

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.

Spinal Injury Without Neurological Symptoms in Severely Injured Patients: Impact on the Length of Stay?

2020 ◽  
Author(s):  
Ulrike Fochtmann ◽  
Pascal Jungbluth ◽  
Werner Zimmermann ◽  
Rolf Lefering ◽  
Sven Lendemans ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Risk Factor ◽  
Intensive Care ◽  
Length Of Stay ◽  
Independent Risk Factor ◽  
Spinal Injury ◽  
Neurological Symptoms ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Injured Patients

Abstract Background The impact of spinal injuries on clinical outcome in most severely injured patients is currently being controversially discussed. At the same time, most of the studies examine patients with post-traumatic neurological disorders. The aim of this study was therefore to analyse severely injured patients with spinal injuries but without neurological symptoms with regard to their clinical outcome. Here the focus was then on the question, whether spinal injury is an independent risk factor increasing length of stay in the intensive care unit and in the hospital in total. Material and Methods Data of the TraumaRegister DGU® were retrospectively analysed. Inclusion criteria were: Injury Severity Score ≥ 16, primary admission, age ≥ 16 years, time interval 2009 – 2016, and a full data set on length of stay in the hospital and the intensive care unit, respectively. Following a univariate analysis in the first step, independent risk factors for the length of stay in the intensive care unit and in the hospital in total were investigated using a multivariate regression analysis. Results 98,240 patients met the inclusion criteria. In this population, patients with Abbreviated Injury Scale (AIS) 2 and 3 spinal injuries were significantly younger (up to 60 years), and injuries were significantly more commonly caused by falls from a great height and traffic accidents (age ≤ 60 years: AISSpine 0: 58.4%, AISSpine 3: 65%; p < 0.001). Multivariate analysis showed that spinal injury without neurological symptoms is an independent risk factor for increased length of stay in the intensive care unit (odds ratio: + 1.1 d) and in the hospital in total (AIS 3 odds ratio: + 3.4 d). Conclusion It has been shown for the first time that spinal injury without initial neurological symptoms has a negative impact on the length of stay of most severely injured patients in the intensive care unit and in the hospital in total and thus represents an independent risk factor in this group of patients.

scholarly journals Operation Bali Assist—The Royal Darwin Hospital Intensive Care Unit

2003 ◽  
Vol 31 (3) ◽  
pp. 300-305 ◽  
Author(s):  
D.P. Stephens ◽  
B. L. De Keulenaer ◽  
S. Collins ◽  
P. W. Harbison ◽  
G. Weidmann ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Emergency Treatment ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Efficient Manner ◽  
Disaster Plan ◽  
Hospital Intensive Care Unit ◽  
Injured Patients

On October 12, 2002 the Bali bombing resulted in 62 severely injured patients being evacuated to Royal Darwin Hospital. This paper describes the planning and execution of the Intensive Care Unit disaster plan in the wake of the Bali bombing. There were a total of 20 patients from the Bali blast admitted to the Intensive Care Unit. The disaster operation was successful with all patients admitted, resuscitated, emergency treatment performed and then evacuated to interstate burns units in a timely and efficient manner.

scholarly journals Acute kidney injury in severely injured patients admitted to the intensive care unit

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Alberto F. García ◽  
Ramiro Manzano-Nunez ◽  
Juan G. Bayona ◽  
Maria P. Naranjo ◽  
Dary Neicce Villa ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Regression Analysis ◽  
Multivariate Regression ◽  
Kidney Injury ◽  
Multivariate Regression Analysis ◽  
Apache Ii Score ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
Injured Patients

Abstract Background Our objective was to identify possible associations between clinical and laboratory variables and the risk of developing acute kidney injury (AKI) in severely injured patients admitted to the intensive care unit (ICU) for whom creatine kinase (CK) levels were available. Methods For this retrospective observational study, we analyzed adult trauma patients admitted to the ICU from 2011 to 2015 at Fundación Valle del Lili (FVL) University Hospital. Our primary outcome was the incidence of AKI. Multivariate regression analysis was used to assess risk factors for this outcome. Results A total of 315 patients were included. The trauma mechanisms were blunt (n = 130), penetrating (n = 66) and blast (n = 44) trauma. The median (interquartile range, IQR) of injury severity score (ISS) was 21 (16–29). AKI developed in 75 patients (23.8%). Multivariate regression analysis revealed that the thoracic abbreviated injury scale (AIS) value (median (IQR) in the AKI group: 3 (0–4)), Acute Physiology and Chronic Health Evaluation (APACHE II) score (median (IQR) in the AKI group: 18 (10–27)), CK greater than 5000 U/L, lactic acid concentration at admission, and dobutamine administration were independently associated with AKI. Conclusion We found that age, APACHE II score, thoracic trauma, lactic acidosis, and dobutamine administration were independently associated with AKI. Trauma surgeons need to be aware of the increased odds of AKI if one of these factors is identified during the evaluation and treatment of injured patients.

scholarly journals The evolution of trauma care in the Netherlands over 20 years

2019 ◽  
Vol 46 (2) ◽  
pp. 329-335 ◽  
Author(s):  
Falco Hietbrink ◽  
Roderick M. Houwert ◽  
Karlijn J. P. van Wessem ◽  
Rogier K. J. Simmermacher ◽  
Geertje A. M. Govaert ◽  
...  
Keyword(s):  
The Netherlands ◽  
Trauma Care ◽  
Trauma System ◽  
Trauma Surgeon ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
The Past ◽  
Level 1 ◽  
Trauma Surgeons ◽  
Injured Patients

Abstract Introduction In 1999 an inclusive trauma system was initiated in the Netherlands and a nationwide trauma registry, including all admitted trauma patients to every hospital, was started. The Dutch trauma system is run by trauma surgeons who treat both the truncal (visceral) and extremity injuries (fractures). Materials and Methods In this comprehensive review based on previous published studies, data over the past 20 years from the central region of the Netherlands (Utrecht) was evaluated. Results It is demonstrated that the initiation of the trauma systems and the governance by the trauma surgeons led to a region-wide mortality reduction of 50% and a mortality reduction for the most severely injured of 75% in the level 1 trauma centre. Furthermore, major improvements were found in terms of efficiency, demonstrating the quality of the current system and its constructs such as the type of surgeon. Due to the major reduction in mortality over the past few years, the emphasis of trauma care evaluation shifts towards functional outcome of severely injured patients. For the upcoming years, centralisation of severely injured patients should also aim at the balance between skills in primary resuscitation and surgical stabilization versus longitudinal surgical involvement. Conclusion Further centralisation to a limited number of level 1 trauma centres in the Netherlands is necessary to consolidate experience and knowledge for the trauma surgeon. The future trauma surgeon, as specialist for injured patients, should be able to provide the vast majority of trauma care in this system. For the remaining part, intramural, regional and national collaboration is essential

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