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

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.

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Alteration of Transthyretin Microheterogeneity in Serum of Multiple Trauma Patients

Biomarker Insights ◽

10.1177/117727190700200014 ◽

2007 ◽

Vol 2 ◽

pp. 117727190700200 ◽

Cited By ~ 11

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.

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

PeerJ ◽

10.7717/peerj.10242 ◽

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.

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

Critical Care Medicine ◽

10.1097/00003246-199712000-00019 ◽

1997 ◽

Vol 25 (12) ◽

pp. 2015-2024 ◽

Cited By ~ 91

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

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

Chinese Journal of Traumatology ◽

10.1016/s1008-1275(08)60074-7 ◽

2008 ◽

Vol 11 (6) ◽

pp. 368-371 ◽

Cited By ~ 7

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

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Costs of Multiple Trauma Patients Treatment During the Acute Phase

Swiss Surgery ◽

10.1024/1023-9332.9.6.268 ◽

2003 ◽

Vol 9 (6) ◽

pp. 268-274 ◽

Cited By ~ 5

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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The Structure of Trauma Patients, its Management and Health Care in the University Hospital of Alexandroupolis

Folia Medica ◽

10.2478/folmed-2014-0008 ◽

2014 ◽

Vol 56 (1) ◽

pp. 50-55 ◽

Cited By ~ 3

Author(s):

Georgios V. Tsatsanidis ◽

Georgios I. Minopoulos ◽

Nicolaos D. Liratzopoulos ◽

Jannis V. Papathanasiou ◽

Konstantinos E. Simopoulos

Keyword(s):

Multiple Trauma ◽

Injury Severity ◽

Admission Rate ◽

Occupational Accidents ◽

Anatomical Location ◽

Trauma Patients ◽

Mechanism Of Injury ◽

Body Regions ◽

The Mean ◽

Multiple Trauma Patients

ABSTRACT OBJECTIVE: The present study was designed to describe the patterns of trauma patients using a newly-introduced trauma registry, as well as retrospectively assess the management and outcome facts of these patients. MATERIALS AND METHODS: The study included 2346 patients (62.15% male) with a mean age of 34.06 ± 23.77 years. Of these patients, 355 were multiple trauma patients. Privately owned vehicles were used as a mode of transportation for most of the trauma patients (96.65%). Data regarding patient demographics, arrival at the Emergency Department, mechanism of injury, injury severity, anatomical location and type of injury were collected and analyzed. RESULTS: Falls were the most prevalent mechanism of injury, accounting for 62.19% of the total admitted cases, with other causes (that also included occupational accidents and machinery trauma) being the second most prevalent, and MVAs - the third with a rate of 11.46%. The most commonly injured body regions were the extremities (50.26%), the head (42.50%), and the torso (19.39%). Fractures represented 11.46% of the injuries, while open wounds were much more frequent (29.41%). The mean abbreviated injury severity (AIS) score was 1.78 ± 1.48 for all admitted patients and 3.56 ± 1.02 for multiple trauma patients. A multi-disciplinary approach was required for 23% of the multiple trauma patients. The clinic admission rate for the whole patient sample was 13.55% and 48.96% for multiple trauma patients. The mean duration of stay for all clinic admissions was 2.7 days and 2.9 days for multiple trauma patients. CONCLUSIONS: With the epidemiology of trauma in Greece being rather poorly investigated, the present study manages to identify the major epidemiological patterns of trauma cases presenting to a tertiary regional hospital and addresses the need for development and implementation of injury prevention activities and policies

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The modified injury severity scale in pediatric multiple trauma patients

Journal of Pediatric Surgery ◽

10.1016/s0022-3468(80)80271-5 ◽

1980 ◽

Vol 15 (6) ◽

pp. 719-726 ◽

Cited By ~ 95

Author(s):

Thom Mayer ◽

Michael E. Matlak ◽

Dale G. Johnson ◽

Marion L. Walker

Keyword(s):

Multiple Trauma ◽

Injury Severity ◽

Trauma Patients ◽

Severity Scale ◽

Multiple Trauma Patients

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

BMC Emergency Medicine ◽

10.1186/s12873-021-00525-0 ◽

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.

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Whole-Body CT in Multiple Trauma Patients: Clinically Adapted Usage of Differently Weighted CT Protocols

RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren ◽

10.1055/a-0643-4553 ◽

2018 ◽

Vol 190 (12) ◽

pp. 1141-1151 ◽

Cited By ~ 3

Author(s):

Stefan Reske ◽

Rainer Braunschweig ◽

Andreas Reske ◽

Reinhard Loose ◽

Michael Wucherer

Keyword(s):

Multiple Trauma ◽

Injury Severity ◽

The Body ◽

Whole Body ◽

Clinical Approach ◽

Trauma Patients ◽

Diagnostic Modality ◽

Whole Body Ct ◽

Multiple Trauma Patients ◽

Body Ct

Purpose Whole-body CT (wbCT) has been established as an internationally accepted diagnostic modality in multiple trauma. Until 2011, a uniform CT scanning protocol was used for all multiple trauma patients (pat.) at our hospital (OLD protocol = OP). In 2011, 2 new differently weighted protocols were introduced: TIME protocol (TP) for hemodynamically unstable pat. and DOSE protocol (DP) for pat. with stable vital parameters. The aim of this study was to compare the original “One-fits-all-concept” with the new, clinically oriented approach to wbCT. Materials and Methods This study retrospectively evaluated 3 distinct wbCT protocols, looking at automatic exposure control variation (AEC; OP/TP) and arm positioning close to the body/overhead (TP/DP). The analysis included waist circumference (WC, cm), injury severity score (ISS), examination time (ET, min), image noise (IN), and effective dose (E, mSv). Normality of distribution was assessed with the Kolmogorov-Smirnov test. Data are given as median and range. Test of significance with Kruskal-Wallis test or Mann-Whitney-U-test. Level of significance: 0.05. Results 308 pat. were included in the study (77 % m; age: 46 a, 18 – 90 a; WC: 93 cm, 66 – 145 cm). ISS was 14 (OP; n = 104; 0 – 75), 18 (TP; n = 102; 0 – 75) and 9 (DP; n = 102; 0 – 50). ET was 3.9 min (OP; 3.3 – 5.6 min), 4.1 min (TP; 2.8 – 7.2 min) and 7.7 min (DP; 6 – 10 min). IN showed no significant differences when comparing OP/TP but was significantly reduced in DP. For a wbCT (vertex to ischium), E could be reduced from 49.7 mSv to 35.4 mSv by optimizing AEC (OP/TP). Through the overhead repositioning of the arms in DP, a further reduction to 28.2 mSv was achieved. Conclusion AEC and arm repositioning have a crucial influence on image quality and dose. The presented clinical approach is superior to the original concept. Key Points: Citation Format

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