scholarly journals Delayed Embolization Associated With Increased Mortality in Patients With Hemodynamically Stable Pelvic Fracture

2021 ◽  
Author(s):  
Makoto Aoki ◽  
Toshikazu Abe ◽  
Shokei Matsumoto ◽  
Shuichi Hagiwara ◽  
Daizoh Saitoh ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Pelvic Fracture ◽  
Early Identification ◽  
Retrospective Cohort ◽  
Injury Severity ◽  
Data Bank ◽  
Pelvic Embolization ◽  
Arterial Hemorrhage ◽  
Using Data ◽  
Japan Trauma Data Bank

Abstract Background: Embolization is widely used for controlling arterial hemorrhage associated with pelvic fracture. However, the effect of a delay in embolization among hemodynamically stable patients with pelvic fracture is unknown. Therefore, our aim was to investigate the association between the time to embolization and mortality in hemodynamically stable patients with a pelvic fracture.Methods: A multicenter, retrospective cohort study was undertaken using data from the Japan Trauma Data Bank from between 2004 and 2018. Hemodynamically stable patients with pelvic fracture who underwent an embolization within 3 h were divided into six groups of 30-min blocks of time until pelvic embolization (0–30, 30–60, 60–90, 90–120, 120–150, and 150–180 min). We compared the adjusted 30-day mortality rate according to time to embolization. Results: We studied 620 hemodynamically stable patients with a pelvic fracture who underwent pelvic embolization within 3 h of hemorrhage. The median age was 68 (48–79) years and 55% were male. The median injury severity score was 26 (18–38). Thirty-day mortality was 8.9% (55/620) and 24-hour mortality was 4.2% (26/619). A Cochran–Armitage test showed that a 30-min delay for embolization was associated with increased 30-day (p = 0.0186) and 24-hour (p = 0.033) mortality. Mortality within 0–30 min to embolization was 0%. The adjusted 30-day mortality rate increased with delayed embolization and was up to 17.0% (10.2–23.9) for the 150–180 min group. Conclusion: Delayed embolization was associated with increased mortality among hemodynamically stable patients with pelvic fracture. Early identification and embolization reduced mortality in such patients.

scholarly journals Delayed embolization associated with increased mortality in pelvic fracture with hemodynamic stability at hospital arrival

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Makoto Aoki ◽  
Toshikazu Abe ◽  
Shokei Matsumoto ◽  
Shuichi Hagiwara ◽  
Daizoh Saitoh ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Pelvic Fracture ◽  
Injury Severity ◽  
Data Bank ◽  
Hemodynamic Stability ◽  
Hospital Arrival ◽  
Pelvic Embolization ◽  
Arterial Hemorrhage ◽  
Using Data ◽  
Japan Trauma Data Bank

Abstract Background Embolization is widely used for controlling arterial hemorrhage associated with pelvic fracture. However, the effect of a delay in embolization among hemodynamically stable patients at hospital arrival with a pelvic fracture is unknown. Therefore, our aim was to investigate the association between the time to embolization and mortality in hemodynamically stable patients at hospital arrival with a pelvic fracture. Methods A multicenter, retrospective cohort study was undertaken using data from the Japan Trauma Data Bank between 2004 and 2018. Hemodynamically, stable patients with a pelvic fracture who underwent an embolization within 3 h were divided into six groups of 30-min blocks of time until pelvic embolization (0–30, 30–60, 60–90, 90–120, 120–150, and 150–180 min). We compared the adjusted 30-day mortality rate according to time to embolization. Results We studied 620 hemodynamically stable patients with a pelvic fracture who underwent pelvic embolization within 3 h of hemorrhage. The median age was 68 (48–79) years and 55% were male. The median injury severity score was 26 (18–38). Thirty-day mortality was 8.9% (55/620) and 24-h mortality was 4.2% (26/619). A Cochran–Armitage test showed that a 30-min delay for embolization was associated with increased 30-day (p = 0.0186) and 24-hour (p = 0.033) mortality. Mortality within 0–30 min to embolization was 0%. The adjusted 30-day mortality rate increased with delayed embolization and was up to 17.0% (10.2–23.9) for the 150–180 min group. Conclusion Delayed embolization was associated with increased mortality in pelvic fracture with hemodynamic stability at hospital arrival. When you decide to embolize pelvic fracture patients, the earlier embolization may be desirable to promote improved survival regardless of hemodynamics.

scholarly journals Clinical features and risk factors for mortality in patients with open pelvic fracture: A retrospective study of 46 cases

2020 ◽  
Vol 28 (2) ◽  
pp. 230949902093983
Author(s):  
Qingshan Guo ◽  
Letian Zhang ◽  
Siru Zhou ◽  
Zhiyang Zhang ◽  
Huayu Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Clinical Features ◽  
Pelvic Fracture ◽  
Injury Severity ◽  
Univariate Analysis ◽  
Pelvic Fractures ◽  
Average Hospital ◽  
Transfusion Requirements ◽  
Independent Risk Factors

Background: This study aimed to investigate the clinical features, current management strategies, and outcomes of open pelvic fracture patients. Methods: We performed a retrospective review of data on patients with blunt trauma and open pelvic fractures admitted to our trauma center over a 5-year period (January 2013 to December 2017). Demographic as well as clinical data including injury mechanism, injury severity score (ISS), fracture classifications, transfusion requirements, interventions, length of hospital and intensive care unit (ICU) stay, and prognosis were investigated. Univariate analysis and binary logistic regression were used to identify the risk variables of death. Finally, a brief literature review was performed to understand the current capacity of treatment and prognosis of this type of injury. Results: Forty-six patients (36 male and 10 female) were included in this study, mean age 43.2 ± 14.2 years. The overall mortality rate was 17.4%; 43.5% of the patients were hypotensive (systolic blood pressure (SBP) <90 mmHg) on arrival. The average ISS was 31.7 ± 6.7, and the average packed red blood cell (PRBC) transfusion during the first 24 h was 9.6 ± 7.4 units. Five patients (10.9%) underwent transcatheter arterial embolization in the early stage of management. The average hospital and ICU length of stay were 53.0 ± 37.6 days and 14.3 ± 15.3 days, respectively. Statistically significant differences were found in ISS, PRBC units received with the first 24 h, SBP, lactate and base excess on admission, and mechanism of injury when comparing between the death and the survival groups ( p < 0.05). ISS and lactate on admission were found to be the independent risk factors for mortality. Conclusion: The mortality rate of open pelvic fractures remains high. ISS and lactate on admission were the independent risk factors for mortality. Optimization of the trauma care algorithms for early identification and treatment of this injury could be the key to decreasing mortality.

Validation of the Pediatric Physiological and Anatomical Triage Score in Injured Pediatric Patients

2019 ◽  
Vol 34 (04) ◽  
pp. 363-369
Author(s):  
Takashi Muguruma ◽  
Chiaki Toida ◽  
Shintaro Furugori ◽  
Takeru Abe ◽  
Ichiro Takeuchi
Keyword(s):  
Pediatric Patients ◽  
Injury Severity ◽  
Vital Signs ◽  
Data Bank ◽  
Medical Treatments ◽  
Priority Ranking ◽  
Life Saving ◽  
Revised Trauma Score ◽  
Trauma Score ◽  
Japan Trauma Data Bank

AbstractIntroduction:Triaging plays an important role in providing suitable care to a large number of casualties in a disaster setting. A Pediatric Physiological and Anatomical Triage Score (PPATS) was developed as a new secondary triage method. This study aimed to validate the accuracy of the PPATS in identifying injured pediatric patients who are admitted at a high frequency and require immediate treatment in a disaster setting. The PPATS method was also compared with the current triage methods, such as the Triage Revised Trauma Score (TRTS).Methods:A retrospective review of pediatric patients aged ≤15 years, registered in the Japan Trauma Data Bank (JTDB) from 2012 through 2016, was conducted and PPATS was performed. The PPATS method graded patients from zero to 22, and was calculated based on vital signs, anatomical abnormalities, and the need for life-saving interventions. It categorized patients based on their priority, and the intensive care unit (ICU)-indicated patients were assigned a PPATS ≥six. The accuracy of PPATS and TRTS in predicting the outcome of ICU-indicated patients was compared.Results:Of 2,005 pediatric patients, 1,002 (50%) were admitted to the ICU. The median age of the patients was nine years (interquartile range [IQR]: 6-13 years). The sensitivity and specificity of PPATS were 78.6% and 43.7%, respectively. The area under the receiver-operating characteristic (ROC) curve (AUC) was larger for PPATS (0.61; 95% confidence interval [CI], 0.59-0.63) than for TRTS (0.57; 95% CI, 0.56-0.59; P &lt;.01). Regression analysis showed a significant correlation between PPATS and the Injury Severity Score (ISS; r2 = 0.353; P &lt;.001), predicted survival rate (r2 = 0.396; P &lt;.001), and duration of hospital stay (r2 = 0.252; P &lt;.001).Conclusion:The accuracy of PPATS for injured pediatric patients was superior to that of current secondary triage methods. The PPATS method is useful not only for identifying high-priority patients, but also for determining the priority ranking for medical treatments and evacuation.

Brain tissue oxygen monitoring in traumatic brain injury and major trauma: outcome analysis of a brain tissue oxygen–directed therapy

2009 ◽  
Vol 111 (4) ◽  
pp. 672-682 ◽  
Author(s):  
Pradeep K. Narotam ◽  
John F. Morrison ◽  
Narendra Nathoo
Keyword(s):  
Brain Injury ◽  
Mortality Rate ◽  
Brain Tissue ◽  
Major Trauma ◽  
Injury Severity ◽  
Data Bank ◽  
Tissue Oxygen ◽  
Diffuse Brain Injury ◽  
Brain Tissue Oxygen ◽  
And Control

Object Cerebral ischemia is the leading cause of preventable death in cases of major trauma with severe traumatic brain injury (TBI). Intracranial pressure (ICP) control and cerebral perfusion pressure (CPP) manipulation have significantly reduced the mortality but not the morbidity rate in these patients. In this study, the authors describe their 5-year experience with brain tissue oxygen (PbtO2) monitoring, and the effect of a brain tissue oxygen–directed critical care guide (PbtO2-CCG) on the 6-month clinical outcome (based on the 6-month Glasgow Outcome Scale score) in patients with TBIs. Methods One hundred thirty-nine patients admitted to Creighton University Medical Center with major traumatic injuries (Injury Severity Scale [ISS] scores ≥ 16) and TBI underwent prospective evaluation. All patients were treated with a PbtO2-CCG to maintain a brain oxygen level > 20 mm Hg, and control ICP < 20 mm Hg. The role of demographic, clinical, and imaging parameters in the identification of patients at risk for cerebral hypooxygenation and the influence of hypooxygenation on clinical outcome were recorded. Outcomes were compared with those in a historical ICP/CPP patient cohort. Subgroup analysis of severe TBI was performed and compared to data reported in the Traumatic Coma Data Bank. Results The majority of injuries were sustained in motor vehicle crashes (63%), and diffuse brain injury was the most common abnormality (58%). Mechanism of injury, severity of TBI, pathological entity, neuroimaging results, and trauma indices were not predictive of ischemia. Factors affecting death included gunshot injury, poor trauma indices, subarachnoid hemorrhage, and coma. After standard resuscitation, 65% of patients had an initially low PbtO2. Data are presented as means ± SDs. Treatment with the PbtO2-CCG resulted in a 44% improvement in mean PbtO2 (16.21 ± 12.30 vs 23.65 ± 14.40 mm Hg; p < 0.001), control of ICP (mean 12.76 ± 6.42 mm Hg), and the maintenance of CPP (mean 76.13 ± 15.37 mm Hg). Persistently low cerebral oxygenation was seen in 37% of patients at 2 hours, 31% at 24 hours, and 18% at 48 hours of treatment. Thus elevated ICP and a persistent low PbtO2 after 2 hours represented increasing odds of death (OR 14.3 at 48 hours). Survivors and patients with good outcomes generally had significantly higher mean daily PbtO2 and CPP values compared to nonsurvivors. Polytrauma, associated with higher ISS scores, presented an increased risk of vegetative outcome (OR 9.0). Compared to the ICP/CPP cohort, the mean Glasgow Outcome Scale score at 6 months in patients treated with PbtO2-CCG was higher (3.55 ± 1.75 vs 2.71 ± 1.65, p < 0.01; OR for good outcome 2.09, 95% CI 1.031–4.24) as was the reduction in mortality rate (25.9 vs 41.50%; relative risk reduction 37%), despite higher ISS scores in the PbtO2 group (31.6 ± 13.4 vs 27.1 ± 8.9; p < 0.05). Subgroup analysis of severe closed TBI revealed a significant relative risk reduction in mortality rate of 37–51% compared with the Traumatic Coma Data Bank data, and an increased OR for good outcome especially in patients with diffuse brain injury without mass lesions (OR 4.9, 95% CI 2.9–8.4). Conclusions The prevention and aggressive treatment of cerebral hypooxygenation and control of ICP with a PbtO2-directed protocol reduced the mortality rate after TBI in major trauma, but more importantly, resulted in improved 6-month clinical outcomes over the standard ICP/CPP-directed therapy at the authors' institution.

Elderly Patients with Pelvic Fracture: Interventions and Outcomes

2009 ◽  
Vol 75 (4) ◽  
pp. 291-295 ◽  
Author(s):  
Tracey A. Dechert ◽  
Therèse M. Duane ◽  
Brett P. Frykberg ◽  
Michel B. Aboutanos ◽  
Ajai K. Malhotra ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Elderly Patients ◽  
Pelvic Fracture ◽  
Injury Severity ◽  
The Elderly ◽  
Hospital Length ◽  
Pelvic Fractures ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Level I

We examined the outcome of elderly trauma patients with pelvic fractures. Patients 65 years of age and older (elderly) with pelvic fractures were retrospectively compared with patients younger than 65 years with pelvic fractures and also with elderly patients without fracture. Over the study period, 1223 patients sustained a pelvic fracture (younger than 65 years, n = 1066, 87.2%; elderly, n = 157,12.8%). These patients were also compared with 1770 elderly patients with blunt trauma without fracture. Although the pelvic fracture patients were equally matched for Injury Severity Score (21.2 ± 13.4 nonelderly vs 20.5 ± 13.6 elderly), hospital length of stay was increased in the elderly (12.5 ± 13.1 days vs 11.5 ± 14.1 days) and they had a higher mortality rate (20.4% [32 of 157] vs 8.3% 88 of 1066]). The elderly without fracture also had a higher mortality rate when compared with the younger patients (10.9% [191 of 1760]; P < 0.03). The elderly were more likely to die from multisystem organ failure (25.0% [eight of 32] vs 10.2% [nine of 88]), whereas the nonelderly group was more likely to die from exsanguination (45.5% [40 of 88] younger than 65 years vs 21.9% [seven of 32] 65 years or older; P < 0.05). Elderly patients with pelvic fracture have worse outcomes than their younger counterparts despite aggressive management at a Level I trauma center.

scholarly journals Validation of the BATT score for prehospital risk stratification of traumatic haemorrhagic death: usefulness for tranexamic acid treatment criteria

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Francois-Xavier Ageron ◽  
Timothy J. Coats ◽  
Vincent Darioli ◽  
Ian Roberts
Keyword(s):  
Tranexamic Acid ◽  
Acid Treatment ◽  
Injury Severity ◽  
External Validation ◽  
Research Network ◽  
Brier Score ◽  
Trauma Patients ◽  
Using Data ◽  
The Uk ◽  
The Impact

Abstract Background Tranexamic acid reduces surgical blood loss and reduces deaths from bleeding in trauma patients. Tranexamic acid must be given urgently, preferably by paramedics at the scene of the injury or in the ambulance. We developed a simple score (Bleeding Audit Triage Trauma score) to predict death from bleeding. Methods We conducted an external validation of the BATT score using data from the UK Trauma Audit Research Network (TARN) from 1st January 2017 to 31st December 2018. We evaluated the impact of tranexamic acid treatment thresholds in trauma patients. Results We included 104,862 trauma patients with an injury severity score of 9 or above. Tranexamic acid was administered to 9915 (9%) patients. Of these 5185 (52%) received prehospital tranexamic acid. The BATT score had good accuracy (Brier score = 6%) and good discrimination (C-statistic 0.90; 95% CI 0.89–0.91). Calibration in the large showed no substantial difference between predicted and observed death due to bleeding (1.15% versus 1.16%, P = 0.81). Pre-hospital tranexamic acid treatment of trauma patients with a BATT score of 2 or more would avoid 210 bleeding deaths by treating 61,598 patients instead of avoiding 55 deaths by treating 9915 as currently. Conclusion The BATT score identifies trauma patient at risk of significant haemorrhage. A score of 2 or more would be an appropriate threshold for pre-hospital tranexamic acid treatment.

scholarly journals Association between denture use, chewing ability, and all-cause mortality in middle-aged and older adults who exercised regularly in Korea

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jong-Hwa Jang ◽  
Ji-Liang Kim ◽  
Jae-Hyun Kim
Keyword(s):  
Oral Health ◽  
Mortality Rate ◽  
Significant Risk ◽  
Subjective Health ◽  
Middle Aged ◽  
Masticatory Ability ◽  
Chewing Ability ◽  
All Cause Mortality ◽  
Using Data ◽  
Middle Aged Adults

AbstractHerein, using data from the Korean Longitudinal Study of Aging (2006–2018), we evaluated denture use and chewing ability to determine the status of oral health in middle-aged adults who exercised regularly; further, we investigated the relationship of oral health with all-cause mortality. From the basic survey conducted in 2006, we interviewed 10,254 participants who were followed up until death. The participants were grouped based on regular exercise into REG (n = 3921) and non-REG (n = 6290) groups. The mortality rate was higher in the non-REG group than in the REG group (35.8% versus 26.9%; p < 0.001). The mortality rate was higher in denture users (versus non-denture users), non-drinkers (versus alcohol drinkers), and those on medical aid (versus national health insurance). The mortality rate was higher in participants with poor masticatory ability, lower education level, and poor subjective health perception (p < 0.001). Denture use and masticatory discomfort were not significant risk factors for mortality in the non-REG group (p > 0.05). In conclusion, masticatory discomfort was a risk factor for increased mortality in middle-aged Korean adults who exercised regularly, at least once a week. Thus, assessment of masticatory ability could be a useful indicator of life expectancy in middle-aged adults.

Investigating the Spread of Coronavirus Disease via Edge-AI and Air Pollution Correlation

2021 ◽  
Vol 21 (4) ◽  
pp. 1-10
Author(s):  
V. Gomathy ◽  
K. Janarthanan ◽  
Fadi Al-Turjman ◽  
R. Sitharthan ◽  
M. Rajesh ◽  
...  
Keyword(s):  
Machine Learning ◽  
Air Pollution ◽  
Mortality Rate ◽  
Respiratory Diseases ◽  
Past Research ◽  
Viral Disease ◽  
Machine Learning Method ◽  
Learning Method ◽  
Death Rates ◽  
Using Data

Coronavirus Disease 19 (COVID-19) is a highly infectious viral disease affecting millions of people worldwide in 2020. Several studies have shown that COVID-19 results in a severe acute respiratory syndrome and may lead to death. In past research, a greater number of respiratory diseases has been caused by exposure to air pollution for long periods of time. This article investigates the spread of COVID-19 as a result of air pollution by applying linear regression in machine learning method based edge computing. The analysis in this investigation have been based on the death rates caused by COVID-19 as well as the region of death rates based on hazardous air pollution using data retrieved from the Copernicus Sentinel-5P satellite. The results obtained in the investigation prove that the mortality rate due to the spread of COVID-19 is 77% higher in areas with polluted air. This investigation also proves that COVID-19 severely affected 68% of the individuals who had been exposed to polluted air.

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