scholarly journals Blossoming contusions: identifying factors contributing to the expansion of traumatic intracerebral hemorrhage

2018 ◽  
Vol 129 (5) ◽  
pp. 1305-1316 ◽  
Author(s):  
Joseph A. Carnevale ◽  
David J. Segar ◽  
Andrew Y. Powers ◽  
Meghal Shah ◽  
Cody Doberstein ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Glasgow Coma Scale ◽  
Injury Severity Score ◽  
Injury Severity ◽  
Expansion Rate ◽  
Blood Alcohol ◽  
Patient Disposition ◽  
Ordinal Response ◽  
Admission Glasgow Coma Scale

OBJECTIVETraumatic brain injury (TBI) remains a significant cause of neurological morbidity and mortality. Each year, more than 1.7 million patients present to the emergency department with TBI. The goal of this study was to evaluate the prognosis of traumatic cerebral intraparenchymal hemorrhage (tIPH), to develop subclassifications of these injuries that relate to prognosis, and to provide a more comprehensive assessment of hemorrhagic progression contusion (HPC) by analyzing the rate at which tIPH “blossom” (i.e., expansion), depending on a variety of intrinsic and modifiable factors.METHODSIn this retrospective study, 726 patients (age range 0–100 years) were admitted to a level 1 trauma center with tIPH during an 8-year period (2005–2013). Of these patients, 491 underwent both admission and follow-up head CT (HCT) within 72 hours. The change in tIPH volume over time, the expansion rate, was recorded for all 491 patients. Effects of prehospital and in-hospital variables were examined using ordinal response logistic regression analyses. These variables were further examined using multivariate linear regression analysis to accurately predict the extent to which a hemorrhage will progress.RESULTSOf the 491 (67.6%) patients who underwent both admission and follow-up HCT, 368 (74.9%) patients experienced HPC. These hemorrhages expanded on average by 61.6% (4.76 ml) with an average expansion rate of 0.71 ml per hour. On univariate analysis, certain patient characteristics were significantly (p < 0.05) related to HPC, including age (> 60 years), admission Glasgow Coma Scale score, blood alcohol level, international normalized ratio, absolute platelet count, transfusion of platelets, concomitant anticoagulation and antiplatelet medication, the initial tIPH volume on admission HCT, and ventriculostomy. Increased expansion rate was significantly associated with patient disposition to hospice or death (p < 0.001). To determine which factors most accurately predict overall patient disposition, an ordinal-response logistic regression identified systolic blood pressure, Injury Severity Score, admission Glasgow Coma Scale score, follow-up scan volume, transfusion of platelets, and ventriculostomy as predictors of patient discharge disposition following tIPH. A multivariate logistic regression identified several prehospital and in-hospital variables (age, Injury Severity Score, blood alcohol level, initial scan volume, concomitant epidural hematoma, presence of subarachnoid hemorrhage, transfusion of platelets, and ventriculostomy) that predicted the volumetric expansion of tIPH. Among these variables, the admission tIPH volume by HCT proved to be the factor most predictive of HPC.CONCLUSIONSSeveral factors contribute to the rate at which traumatic cerebral contusions blossom in the acute posttraumatic period. Identifying the intrinsic and modifiable aspects of cerebral contusions can help predict the rate of expansion and highlight potential therapeutic interventions to improve TBI-associated morbidity and mortality.

scholarly journals Applicability of Anatomic and Physiologic Scoring Systems for the Prediction of Outcome in Polytraumatized Patients with Blunt Aortic Injuries

Diagnostics ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 2156
Author(s):  
Alexander Omar ◽  
Marcel Winkelmann ◽  
Emmanouil Liodakis ◽  
Jan-Dierk Clausen ◽  
Tilman Graulich ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Injury Severity Score ◽  
Sensitivity And Specificity ◽  
Severity Score ◽  
Injury Severity ◽  
Scoring Systems ◽  
Apache Ii ◽  
Operating Characteristics ◽  
Aortic Injuries ◽  
Receiver Operating

Background: Most patients with blunt aortic injuries, who arrive alive in a clinic, suffer from traumatic pseudoaneurysms. Due to modern treatments, the perioperative mortality has significantly decreased. Therefore, it is unclear how exact the prediction of commonly used scoring systems of the outcome is. Methods: We analyzed data on 65 polytraumatized patients with blunt aortic injuries. The following scores were calculated: injury severity score (ISS), new injury severity score (NISS), trauma and injury severity score (TRISS), revised trauma score coded (RTSc) and acute physiology and chronic health evaluation II (APACHE II). Subsequently, their predictive value was evaluated using Spearman´s and Kendall´s correlation analysis, logistic regression and receiver operating characteristics (ROC) curves. Results: A proportion of 83% of the patients suffered from a thoracic aortic rupture or rupture with concomitant aortic wall dissection (54/65). The overall mortality was 24.6% (16/65). The sensitivity and specificity were calculated as the area under the receiver operating curves (AUC): NISS 0.812, ISS 0.791, APACHE II 0.884, RTSc 0.679 and TRISS 0.761. Logistic regression showed a slightly higher specificity to anatomical scoring systems (ISS 0.959, NISS 0.980, TRISS 0.957, APACHE II 0.938). The sensitivity was highest in the APACHE II with 0.545. Sensitivity and specificity for the RTSc were not significant. Conclusion: The predictive abilities of all scoring systems were very limited. All scoring systems, except the RTSc, had a high specificity but a low sensitivity. In our study population, the RTSc was not applicable. The APACHE II was the most sensitive score for mortality. Anatomical scoring systems showed a positive correlation with the amount of transfused blood products.

Follow-Up Abdominal CT is not Necessary in Low-Grade Splenic Injury

2007 ◽  
Vol 73 (1) ◽  
pp. 13-18 ◽  
Author(s):  
James M. Haan ◽  
Sharon Boswell ◽  
Deborah Stein ◽  
Thomas M. Scalea
Keyword(s):  
Injury Severity Score ◽  
Vascular Injury ◽  
Severity Score ◽  
Injury Severity ◽  
Splenic Injury ◽  
Nonoperative Management ◽  
Low Grade ◽  
Abdominal Ct ◽  
Simple Observation

Nonoperative management of splenic injury has become the standard of care in the hemodynamically stable patient. The time period of observation and the utility of follow-up scanning remain an area of debate. This study examined the utility of follow-up abdominal CT for detection of delayed vascular injury in patients with low-grade splenic injury. A retrospective review of all patients with low-grade splenic injuries undergoing nonoperative management from June 2000 to June 2004 was performed. Patients underwent follow-up abdominal CT 48 to 72 hours after admission to rule out delayed vascular injury and were discharged if the results were negative. Charts were reviewed for demographic data, abdominal CT results, and splenic salvage. A total of 472 patients underwent nonoperative management for splenic injury, with 140 patients treated with simple observation during this protocol. All patients were successfully managed with simple observation with no nonoperative failures; there were two instances of delayed vascular injury on follow-up CT. Both patients with progression of injury had decreasing hematocrit levels during admission prior to follow-up abdominal CT scan. Overall, the injury severity score was 22 points and the American Association for the Surgery of Trauma (AAST) splenic injury severity score was 1.8 points. Length of hospital stay was 2.8 days for patients with predominately splenic injury and 10 days for the overall cohort. Follow-up abdominal CT confers no benefit in patients with low-grade splenic injury, and a stable hematocrit level and abdominal exam.

Long-Term Functional Outcomes after Blunt Cerebrovascular Injury: A 20-Year Experience

2018 ◽  
Vol 84 (4) ◽  
pp. 551-556 ◽  
Author(s):  
Charles P. Shahan ◽  
Taylor C. Stavely ◽  
Martin A. Croce ◽  
Timothy C. Fabian ◽  
Louis J. Magnotti
Keyword(s):  
Cognitive Function ◽  
Injury Severity Score ◽  
Acute Care ◽  
Functional Outcomes ◽  
Injury Severity ◽  
Blunt Cerebrovascular Injury ◽  
Cerebrovascular Injury ◽  
Activity Measure

Since blunt cerebrovascular injury (BCVI) became increasingly recognized more than 20 years ago, significant improvements have been made in both diagnosis and treatment. Little is known regarding long-term functional outcomes in BCVI. The purpose of this study was to evaluate the impact of BCVI on those long-term outcomes. All patients with BCVI from 1996 to 2014 were identified from the trauma registry. Functional outcome was measured using the Boston University Activity Measure for Post-Acute Care. Multiple regression analysis was performed to identify potential predictors of outcomes. A total of 509 patients were identified. Overall mortality was 18 per cent (BCVI-related = 1%). Of the 415 survivors, follow-up was obtained in 77 (19%). Mean follow-up was five years, with a maximum of 19 years. Mean age and injury severity score were 47 and 25, respectively. Six (8%) patients suffered strokes. Mean Activity Measure for Post-Acute Care scores were 59 (mobility), 58 (activity), and 44 (cognitive function), each indicating significant impairment compared with normal. Multiple regression models identified 1) age as a predictor of decreased mobility, 2) injury severity score as a predictor of decreased mobility, activity, and cognitive function, and 3) stroke as a predictor of decreased activity, cognitive function, and likely mobility. Development of stroke and increased injury severity resulted in worse long-term functional outcomes after BCVI. Thus, stroke prevention with optimal diagnostic and treatment algorithms remains critical in the successful treatment of BCVI because it has significant impact on long-term functional outcomes and is the only modifiable predictor of outcomes in patients after BCVI.

Damage Control Resuscitation Protocol and the Management of Open Abdomens in Trauma Patients

2014 ◽  
Vol 80 (8) ◽  
pp. 768-775 ◽  
Author(s):  
Matthew Bradley ◽  
Samuel Galvagno ◽  
Amit Dhanda ◽  
Carlos Rodriguez ◽  
Margaret Lauerman ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Injury Severity ◽  
Damage Control ◽  
Fascial Closure ◽  
Trauma Patients ◽  
Damage Control Resuscitation ◽  
Total Blood ◽  
Independent Risk Factors ◽  
Student’S T ◽  
Admission Glasgow Coma Scale

Although the use of damage control laparotomy (DCL) is well established, the effect of damage control resuscitation (DCR) on the management of open abdomens is relatively poorly studied. The aim of the present study was to determine the predictors for failure to achieve primary fascial closure (PFC) after DCL in the setting of a massive transfusion (MT) and DCR. This is a retrospective review over a 12-year period of all patients that underwent MT and DCL. Patients who achieved PFC were compared with those who did not (NPFC). Student's t tests were used to compare the two groups. A multiple logistic regression model was performed to identify independent risk factors for failure to attain PFC. Of 174 patients, 101 achieved PFC. Mean (6 standard deviation) age was 35.6 ± 14.9 years for PFC and 36.3 ± 14.0 years for NPFC ( P = 0.75). Admission Glasgow Coma Scale score was 11.4 ± 4.6 for PFC and 10.6 ± 5.0 for NPFC ( P = 0.25). Initial lactate (7.3 ± 3.8 vs 7.7 ± 4.1, P = 0.50), hemoglobin (11.3 ± 1.9 vs 11.0 ± 2.2, P = 0.43), systolic blood pressure (108 ± 44 vs 107 ± 35, P = 0.82), Injury Severity Score (34 ± 14 vs 36 ± 15, P = 0.32), and abdominal Abbreviated Injury Score (3.6 ± 1.1 vs 3.9 ± 1.0, P = 0.13) were similar between the two groups. There was no difference in total blood products administered at 24 hours (46 ± 26 vs 49 ± 29 units, P = 0.45). Logistic regression identified increasing volume of crystalloid at 24 hours (odds ratio, 0.86; 95% confidence interval, 0.74 to 0.99; P = 0.047), earlier operative year (2.1; 1.52 to 2.91; P < 0.001), and increased number of procedures (0.32, 0.18 to 0.58; P < 0.001) as independent predictors for failure to obtain PFC. Injury severity is not associated with failure to achieve PFC, whereas administration of large-volume crystalloid resuscitation, increasing number procedures, and earlier year of DCL are independent predictors for failure to achieve PFC. Application of DCR to DCL techniques results in an improvement in ability to achieve PFC.

Penetrating brain injury: a case of survival following blast fragmentation injuries to the head

2013 ◽  
Vol 99 (2) ◽  
pp. 55-56
Author(s):  
J McKinlay ◽  
JE Smith
Keyword(s):  
Brain Injury ◽  
Glasgow Coma Scale ◽  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Head Injuries ◽  
Good Recovery ◽  
Coma Scale ◽  
Blast Fragmentation ◽  
Serious Injuries

AbstractWe present a case of penetrating head injuries caused by blast fragmentation, along with other serious injuries (including to the arms, face and neck), where a good recovery was made despite an Injury Severity Score (ISS) of 75. We suggest that survival and outcome are reliant on several factors and cannot be predicted from ISS, velocity of penetrating injury or presenting Glasgow Coma Scale (GCS) alone.

Lactate in Trauma: A Poor Predictor of Mortality in the Setting of Alcohol Ingestion

2011 ◽  
Vol 77 (12) ◽  
pp. 1576-1579 ◽  
Author(s):  
Hadley K. Herbert ◽  
Tracey A. Dechert ◽  
Luke Wolfe ◽  
Michel B. Aboutanos ◽  
Ajai K. Malhotra ◽  
...  
Keyword(s):  
Injury Severity Score ◽  
Blunt Trauma ◽  
Severity Score ◽  
Injury Severity ◽  
Alcohol Ingestion ◽  
Trauma Patients ◽  
Blood Alcohol ◽  
End Point ◽  
Blood Alcohol Levels ◽  
Level I

Resuscitation end point markers such as lactate and base deficit (BD) are used in trauma to identify and treat a state of compensated shock. Lactate and BD levels are also elevated by alcohol. In blunt trauma patients with positive blood alcohol levels, lactate may be a poor indicator of injury. Retrospective data were collected on 1083 blunt trauma patients with positive blood alcohol levels admitted a Level I trauma center between 2003 and 2006. Patients were stratified by Injury Severity Score, age, gender, and Glasgow Coma Score. Logistic regression analyses were used to assess lactate and BD as independent risk factors for mortality. Seventy-four per cent of patients had an abnormal lactate level compared with 28 per cent with abnormal BD levels. In patients with mild injury, lactate levels were abnormal in more than 70 per cent of patients compared with less than 20 per cent of patients with abnormal BD levels. Linear regression showed lactate is not a significant predictor of mortality. Regardless of Injury Severity Score, lactate appeared to be more often abnormal than BD in the setting of alcohol ingestion. Additionally, because BD, and not lactate, was shown to be an independent predictor of mortality, lactate may not be a reliable marker of end point resuscitation in this patient population.

scholarly journals Ten-year inhospital mortality trends for patients with trauma in Japan: a multicentre observational study

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e018635 ◽  
Author(s):  
Isao Nagata ◽  
Toshikazu Abe ◽  
Masatoshi Uchida ◽  
Daizoh Saitoh ◽  
Nanako Tamiya
Keyword(s):  
Logistic Regression ◽  
Observational Study ◽  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Whole Body ◽  
Inhospital Mortality ◽  
Regression Analyses ◽  
Mortality Trends ◽  
Multivariable Logistic Regression

ObjectivesTrauma is one of the main causes of death in Japan, and treatments and prognoses of these injuries are constantly changing. We therefore aimed to investigate a 10-year trend (2004–2013) in inhospital mortality among patients with trauma in Japan.DesignMulticentre observational study.SettingJapanese nationwide trauma registry (the Japan Trauma Data Bank) data.ParticipantsAll patients with trauma whose Injury Severity Score (ISS) were 3 and above, who were aged 15 years or older, and whose mechanisms of injury (MOI) were blunt and penetrating between 2004 and 2013 (n=90 833).Outcome measuresA 10-year trend in inhospital mortality.ResultsInhospital mortality for all patients with trauma significantly decreased over the study decade in our Cochran-Armitage test (P<0.001). Similarly, inhospital mortality for patients with ISS 16 or more and patients who scored 50% or better on the Trauma and Injury Severity Score (TRISS) probability of survival scale significantly decreased (P<0.001). In addition, the OR for inhospital mortality of these three patient groups decreased yearly after adjusting for age, gender, MOI, ISS, Glasgow Coma Scale, systolic blood pressure and respiratory rate on hospital arrival in multivariable logistic regression analyses. Furthermore, inhospital mortality for patient with blunt trauma significantly decreased in injury mechanism-stratified Mantel-extension testing (P<0.001). Finally, multivariable logistic regression analyses showed that the OR for inhospital mortality of patients with ISS 16 and over decreased each year after adding and adjusting for means of transportation and usage of whole-body CT.ConclusionInhospitalmortality for patients with trauma in Japan significantly decreased during the study decade after adjusting for patient characteristics, injury severity and the response environment after injury.

Comparison of the Prognostic Significance of Initial Blood Lactate and Base Deficit in Trauma Patients

2017 ◽  
Vol 126 (3) ◽  
pp. 522-533 ◽  
Author(s):  
Keyword(s):  
Logistic Regression ◽  
Injury Severity Score ◽  
Blood Lactate ◽  
Severity Score ◽  
Injury Severity ◽  
Prognostic Significance ◽  
Base Deficit ◽  
Trauma Patients ◽  
Operating Characteristics ◽  
Initial Blood

Abstract Background Initial blood lactate and base deficit have been shown to be prognostic biomarkers in trauma, but their respective performances have not been compared. Methods Blood lactate levels and base deficit were measured at admission in trauma patients in three level 1 trauma centers. This was a retrospective analysis of prospectively acquired data. The association of initial blood lactate and base deficit with mortality was tested using receiver operating characteristics curve, logistic regression using triage scores (Revised Trauma Score and Mechanism Glasgow scale and Arterial Pressure score), and Trauma Related Injury Severity Score as a reference standard. The authors also used a reclassification method. Results The authors evaluated 1,075 trauma patients (mean age, 39 ± 18 yr, with 90% blunt and 10% penetrating injuries and a mortality of 13%). At admission, blood lactate was elevated in 425 (39%) patients and base deficit was elevated in 725 (67%) patients. Blood lactate was correlated with base deficit (R2 = 0.54; P &lt; 0.001). Using logistic regression, blood lactate was a better predictor of death than base deficit when considering its additional predictive value to triage scores and Trauma Related Injury Severity Score. This result was confirmed using a reclassification method but only in the subgroup of normotensive patients (n = 745). Conclusions Initial blood lactate should be preferred to base deficit as a biologic variable in scoring systems built to assess the initial severity of trauma patients.

Higher Blood Alcohol Levels are Associated with a Lower Injury Severity Score among Intoxicated Trauma Patients

2018 ◽  
Vol 227 (4) ◽  
pp. e233-e234
Author(s):  
Nikathan S. Kumar ◽  
Matthew K. McIntyre ◽  
Elizabeth H. Tilley ◽  
David J. Samson ◽  
Rifat Latifi
Keyword(s):  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Trauma Patients ◽  
Blood Alcohol ◽  
Blood Alcohol Levels
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