Major trauma patients are not who you might think they are: a linked data study

IntroductionMajor trauma patients are often perceived as being young males injured by high energy transfer mechanisms. The aim of this study was to describe the demographics of major trauma patients who were transported to hospital by ambulance.MethodsThis is a retrospective cohort study of adult major trauma (injury severity score >15) patients transported to hospital by St John Western Australia emergency ambulance in metropolitan Perth, between 1 January 2013 and 31 December 2016. To describe the cohort, median and interquartile range (IQR) were used for continuous variables and counts and percentages for categorical variables. Differences between mechanism of injury groups were assessed using the Kruskal-Wallis test. Trauma deaths were defined as early (declared deceased within 24 hours) or late (declared deceased within 30 days). ResultsA total of 1625 patients were included. The median age was 51 years (IQR 30-75) and 1158 (71%) were male. Falls from standing were the most common mechanism of injury (n=460, 28%) followed by motor vehicle crashes (n=259, 16%). Falls from standing were responsible for the majority of early (n=45/175, 26%) and late deaths (n=69/158, 44%). A large number of early deaths also resulted from motorbike crashes (n=32/175, 18%) with a median age of 34 years (IQR 21-46, p<0.001). ConclusionMajor trauma is not only a disease of the young. More than half of the cohort was more than 51 years of age and the most common cause was a fall from standing. Pre-hospital care must evolve to address the needs of a changing trauma patient demographic.

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Renal trauma: the current best practice

Therapeutic Advances in Urology ◽

10.1177/1756287218785828 ◽

2018 ◽

Vol 10 (10) ◽

pp. 295-303 ◽

Cited By ~ 21

Author(s):

Tomer Erlich ◽

Noam D. Kitrey

Keyword(s):

Renal Injury ◽

Best Practice ◽

Motor Vehicle ◽

Penetrating Trauma ◽

High Energy ◽

Renal Trauma ◽

Common Mechanism ◽

Trauma Patients ◽

Vehicle Accidents ◽

Enhanced Computed Tomography

The kidneys are the most vulnerable genitourinary organ in trauma, as they are involved in up to 3.25% of trauma patients. The most common mechanism for renal injury is blunt trauma (predominantly by motor vehicle accidents and falls), while penetrating trauma (mainly caused by firearms and stab wound) comprise the rest. High-velocity weapons impose specifically problematic damage because of the high energy and collateral effect. The mainstay of renal trauma diagnosis is based on contrast-enhanced computed tomography (CT), which is indicated in all stable patients with gross hematuria and in patients presenting with microscopic hematuria and hypotension. Additionally, CT should be performed when the mechanism of injury or physical examination findings are suggestive of renal injury (e.g. rapid deceleration, rib fractures, flank ecchymosis, and every penetrating injury of the abdomen, flank or lower chest). Renal trauma management has evolved during the last decades, with a distinct evolution toward a nonoperative approach. The lion’s share of renal trauma patients are managed nonoperatively with careful monitoring, reimaging when there is any deterioration, and the use of minimally invasive procedures. These procedures include angioembolization in cases of active bleeding and endourological stenting in cases of urine extravasation.

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Outcomes of Traumatic Pancreatic Injuries in Pediatric and Adult Patients: A Retrospective Study Involving Four Trauma Centers

Journal of Child Science ◽

10.1055/s-0037-1607313 ◽

2017 ◽

Vol 07 (01) ◽

pp. e136-e141

Author(s):

Toni Iurcotta ◽

Poppy Addison ◽

Leo Amodu ◽

Meredith Akerman ◽

Horacio Rilo

Keyword(s):

Injury Severity ◽

Motor Vehicle ◽

Adult Patients ◽

Hospital Length Of Stay ◽

Categorical Variables ◽

Blunt Injury ◽

P Value ◽

Trauma Centers ◽

Continuous Variables ◽

Pancreatic Injuries

AbstractTraumatic injuries of the pancreas are rare and affect both children and adults. Very little has been done to investigate differences in outcome between these two age groups. We performed a retrospective review of cases in four trauma hospitals to determine the differences in outcomes between pediatric and adult patients with traumatic pancreatic injuries. A retrospective chart review was performed for 69 pediatric and adult patients seen at four trauma centers in our health system between 1990 and 2014. The Mann–Whitney's U-test was used to compare continuous variables, while the chi-square and Fisher's exact tests were used for categorical variables. Mortality was determined using the Social Security Death Master File. In this study, 26 pediatric and 43 adult patients were included. Median ages were 11.4 and 42.3 years, respectively. There were significant differences in mechanism of blunt injury between pediatric and adults (motor vehicle collisions = 17.4 vs. 64.9%, bicycle accidents = 43.5 vs. 0.0%; p-value for both comparisons < 0.0001), median injury severity score (6.5 vs. 12; p = 0.030), surgical management (30.8 vs. 67.4%; p = 0.003), and postinjury pancreatitis (57.7 vs. 20.9%; p = 0.002). Median hospital length of stay was 5 versus 11 days (p = 0.005), respectively. There were no differences in mortality or other complications. In spite of significant differences in blunt injury type, injury severity, and the need for surgery, there were no significant differences in mortality or most postinjury complications between pediatric and adult patients with traumatic pancreatic injuries.

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Factors affecting mortality in major trauma patients in Trinidad and Tobago – A view from the developing world

Trauma ◽

10.1177/1460408619885505 ◽

2019 ◽

Vol 22 (3) ◽

pp. 220-228

Author(s):

Saleem Varachhia ◽

Vidya Ramcharitar Maharaj ◽

Joanne F Paul ◽

Paula Robertson ◽

Paula Nunes ◽

...

Keyword(s):

Injury Severity Score ◽

Trinidad And Tobago ◽

Severity Score ◽

Major Trauma ◽

Injury Severity ◽

Developing World ◽

Motor Vehicle ◽

Motor Vehicle Accidents ◽

Trauma Patients ◽

Vehicle Accidents

Introduction There are few data on major trauma in the developing world. This study investigated the characteristics and outcomes of seriously injured patients in Trinidad and Tobago, using Trauma and Injury Severity Score (TRISS) methodology. We also aimed to assess the predictive accuracy of the TRISS model in patients in Trinidad and Tobago. Methods Retrospective data from major trauma patients attending the Emergency Department of a tertiary hospital in Trinidad between 2010 and 2014 were analysed. Patients ≥18 years having an Injury Severity Score >15 were included. The impact of age, gender, comorbidities, mechanisms and patterns of injury on mortality was investigated. Using TRISS methodology, predicted mortality was calculated and compared to actual mortality. Results Of 323 patients analysed, 284 were male and 24 were aged ≥65 years. The commonest injury mechanisms in younger people were motor vehicle accidents (34.1%) and stabbings (30.8%) compared to falls (66.7%) and motor vehicle accidents (20.8%) in people aged ≥65 years. The commonest areas injured were the chest in younger patients (81.9%) and the head and neck in patients aged ≥65 years (58.3%). Women’s mortality rates were similar to men (RR 1.8; 95% CI 0.7–4.9). Mortality was higher with age ≥65 years (RR 7.0; 95% CI 3.1–15.9), blunt trauma (RR 7.6; 95% CI 1.8–32.4) and Charlson Comorbidity Index of 1 or more (RR 3.2; 95% CI 1.3–8.0). The TRISS model performed well at lower ISS scores and was excellent at predicting survival (discrimination statistic 0.94). Conclusion Multiple factors influence mortality in major trauma patients in Trinidad and Tobago, including age, co-morbidities and injury mechanism. TRISS methodology accurately predicted survival in this population but was better at predicting mortality in patients with lower Injury Severity Score.

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The cost and compensability of trauma patients

Australian Health Review ◽

10.1071/ah090084 ◽

2009 ◽

Vol 33 (1) ◽

pp. 84 ◽

Cited By ~ 10

Author(s):

Kate Curtis ◽

Cara Dickson ◽

Deborah Black ◽

Thomas Nau

Keyword(s):

Health Insurance ◽

Injury Severity ◽

Motor Vehicle ◽

Direct Costs ◽

Trauma Centre ◽

Third Party ◽

Workers Compensation ◽

Trauma Patients ◽

Mechanism Of Injury ◽

Insurance Cover

Injury in Australia was responsible for 400 000 hospitalisations in 2002. This study aimed to examine the direct costs of trauma patients in a Level 1 trauma centre and determine the compensability of those patients. Data on all admitted patients (206) filling trauma criteria were collected prospectively over a 3-month period (November 2006 to January 2007). A 10-question survey was completed on each patient to record mechanism of injury, third party private health insurance or workers compensation, and direct costs were also obtained. 30% of trauma admissions had an injury severity score (ISS)> 15 (n = 62; median ISS =9; range, 1?56). Median length of stay was 3 days (range, 1?126). Almost half (47%) of the patients were involved in road trauma, and 29% in falls. More than half (53.4%) were eligible for compensation (21.8% of patients had full hospital health insurance cover, 21.4% third party insurance and 9.2% workers compensation). The mechanism of injury with the highest median cost per patient was assault, followed by pedal cyclists, pedestrians then motor vehicle collisions.

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Trauma Team Activation at a Level I Trauma Center in Southern California: Time of Day Matters

The American Surgeon ◽

10.1177/000313481908501014 ◽

2019 ◽

Vol 85 (10) ◽

pp. 1142-1145

Author(s):

Morgan Schellenberg ◽

Kenji Inaba ◽

Bryan E. Love ◽

Zachary Warriner ◽

Matthew J. Forestiere ◽

...

Keyword(s):

Injury Severity ◽

Motor Vehicle ◽

Penetrating Trauma ◽

Trauma Team ◽

Time Of Day ◽

Operative Intervention ◽

Trauma Patients ◽

Mechanism Of Injury ◽

Trauma Team Activation ◽

Level I

The ACS Committee on Trauma specifies prehospital criteria that trigger trauma team activation (TTA). The study aims to define the relationship between TTA and time of day, mechanism of injury, and need for operative intervention. All trauma patients presenting to LAC1USC (January 2008–July 2018) after triggering TTA were screened. Patients were excluded if time of ED arrival was undocumented. Demographics, injury data, and outcomes were analyzed. After exclusions (<1%), 54,826 patients were enrolled. The median age was 35 [IQR 23–53]. The median Injury Severity Score was 4 [1–10]. The most common mechanisms of injury were falls (n = 14,166; 31%), auto versus pedestrian collisions (n = 11,921; 26%), and motor vehicle collisions (n = 11,024; 24%). Penetrating trauma comprised 16 per cent (n = 8,686). The busiest hour for TTAs was 19:00 to 20:00, although penetrating trauma was most common between 23:00 and 01:00. Emergent surgical intervention in absolute numbers was most frequent between 20:00 and 01:00. As a proportion of the number of TTAs per hour, emergent operative intervention was most frequent between 23:00 and 06:00. In conclusion, the volume of TTAs and the triggering mechanism of injury vary significantly by time of day. The need for operative intervention is highest overnight. This information can be used to help increase hospital preparedness and allocate resources accordingly.

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Octogenarian Motor Vehicle Collisions: Injury Patterns Matter

Kansas Journal of Medicine ◽

10.17161/kjm.vol15.15710 ◽

2022 ◽

Vol 15 (1) ◽

pp. 336-340

Author(s):

Michael Lemon ◽

Stephen Helmer ◽

Kathryn Soba ◽

Jeanette Ward ◽

James M Haan

Keyword(s):

Injury Severity ◽

Motor Vehicle ◽

Oldest Old ◽

Rural Setting ◽

Common Mechanism ◽

Trauma Patients ◽

Injury Patterns ◽

Discharge Disposition ◽

Vehicle Collision ◽

Potential Factors

Introduction. Motor vehicle collision (MVC) is the second most common mechanism of injury among octogenarians and is on the rise. These “oldest old” trauma patients have much higher mortality rates than expected. This study examined potential factors influencing this increased mortality including comorbidities, medications, injury patterns, and hospital interventions. Methods. A 10-year retrospective review was conducted of patients aged 80 and over who were injured in a MVC. Data collected included patient demographics, comorbidities, medication use prior to injury, collision details, injury severity and patterns, hospitalization details, outcomes, and discharge disposition. Results. We identified 239 octogenarian patients involved in a MVC. Overall mortality was 18.8%. We recognized an increased mortality for specific injury patterns, patients injured in a rural setting, and those who were transfused, intubated, or admitted to the ICU. We found no correlation between mortality and medications or comorbidities. Conclusions. The high mortality rate for octogenarian patients involved in a MVC is related to injury severity, type of injury, and in-hospital complications, and not due to comorbidities and prior medications.

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Severe equestrian injuries: A seven-year review of admissions to a UK major trauma centre

Trauma ◽

10.1177/14604086211041271 ◽

2021 ◽

pp. 146040862110412

Author(s):

Aref-Ali Gharooni ◽

Fahim Anwar ◽

Romann Ramdeep ◽

Harry Mee

Keyword(s):

United Kingdom ◽

Major Trauma ◽

Injury Severity ◽

Trauma Centre ◽

Common Mechanism ◽

Mechanism Of Injury ◽

The United Kingdom ◽

Major Trauma Centre ◽

Limb Injuries ◽

Significant Difference

Background Equestrian sports are regaining popularity in the United Kingdom. Due to horses’ considerable weight and speed, serious injuries can occur. Riding style and equipment differ between North America and the United Kingdom with previous studies focusing on the former. Objective This study aims to assess the pattern of horse-related injury admissions to a major trauma centre in the United Kingdom. Methods A retrospective study of our hospital’s trauma registry between years 2012 and 2020 was performed. Cases included those admitted for severe horse-related injuries (irrespective of age/sex) with Injury Severity Score (ISS) of ≥ 4. Demographics, injury characteristics (ISS, Glasgow Coma Scale (GCS), injury region and operations), hospital stay and Glasgow Outcome Scale (GOS) on discharge were extracted. Four groups were formed based on mechanism of injury: fall from horse, fall and horse landing on top (FL group), kicked, and fall and kicked (FK group). Comparisons in injury and outcomes were analysed between these groups. Results 301 (2.8%) eligible cases were identified from 10,911 cases. 70.8% were female with mean (± SD) age of 42.7 (± 16.5) years. Most common mechanism of injury was fall (72.8%) then kicked (14.6%) with groups FL and FK forming < 10% each. No significant difference was found between the groups initial GCS, ISS, total or ICU length of stay and GOS ( p > 0.05). Most common regions of injury were orthopaedic (41.9%), spinal (26.2%), thoracic (20.1%) and head injuries (19.3%). 75% had good recovery on GOS though there were 3 fatalities relating to severe traumatic brain injury. Conclusion Orthopaedic limb injuries form the majority of horse-related injuries which contrasts the 1970s where head injury prevailed which is likely due to the widespread use of better head protection. Consideration should be given to enhanced limb safety equipment to prevent injury.

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National temporal variation in major trauma in England, Wales and Northern Ireland

Trauma ◽

10.1177/1460408620982264 ◽

2021 ◽

pp. 146040862098226

Author(s):

Will Kieffer ◽

Daniel Michalik ◽

Jason Bernard ◽

Omar Bouamra ◽

Benedict Rogers

Keyword(s):

Northern Ireland ◽

Temporal Variation ◽

Major Trauma ◽

Injury Severity ◽

Research Network ◽

Trauma Patients ◽

Trauma Outcomes ◽

Causes Of Mortality ◽

Injured Patients ◽

Time Of Admission

Introduction Trauma is one of the leading causes of mortality worldwide, but little is known of the temporal variation in major trauma across England, Wales and Northern Ireland. Proper workforce and infrastructure planning requires identification of the caseload burden and its temporal variation. Materials and Methods The Trauma Audit Research Network (TARN) database for admissions attending Major Trauma Centres (MTCs) between 1st April 2011 and 31st March 2018 was analysed. TARN records data on all trauma patients admitted to hospital who are alive at the time of admission to hospital. Major trauma was classified as an Injury Severity Score (ISS) >15. Results A total of 158,440 cases were analysed. Case ascertainment was over 95% for 2013 onwards. There was a statistically significant variation in caseload by year (p < 0.0001), times of admissions (p < 0.0001), caseload admitted during weekends vs weekdays, 53% vs 47% (p < 0.0001), caseload by season with most patients admitted during summer (p < 0.0001). The ISS varied by time of admission with most patients admitted between 1800 and 0559 (p < 0.0001), weekend vs weekday with more severely injured patients admitted during the weekend (p < 0.0001) and by season p < 0.0001). Discussion and Conclusion: There is a significant national temporal variation in major trauma workload. The reasons are complex and there are multiple theories and confounding factors to explain it. This is the largest dataset for hospitals submitting to TARN which can help guide workforce and resource allocation to further improve trauma outcomes.

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Outcomes of major trauma among patients with chronic kidney disease and receiving dialysis in Nova Scotia: a retrospective analysis

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2020-000672 ◽

2021 ◽

Vol 6 (1) ◽

pp. e000672

Author(s):

Ryan Pratt ◽

Mete Erdogan ◽

Robert Green ◽

David Clark ◽

Amanda Vinson ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Nova Scotia ◽

Kidney Disease ◽

Hospital Mortality ◽

Major Trauma ◽

Injury Severity ◽

Cox Regression ◽

Trauma Patients ◽

Risk Of Death ◽

Increased Risk

BackgroundThe risk of death and complications after major trauma in patients with chronic kidney disease (CKD) is higher than in the general population, but whether this association holds true among Canadian trauma patients is unknown.ObjectivesTo characterize patients with CKD/receiving dialysis within a regional major trauma cohort and compare their outcomes with patients without CKD.MethodsAll major traumas requiring hospitalization between 2006 and 2017 were identified from a provincial trauma registry in Nova Scotia, Canada. Trauma patients with stage ≥3 CKD (estimated glomerular filtration rate <60 mL/min/1.73 m2) or receiving dialysis were identified by cross-referencing two regional databases for nephrology clinics and dialysis treatments. The primary outcome was in-hospital mortality; secondary outcomes included hospital/intensive care unit (ICU) length of stay (LOS) and ventilator-days. Cox regression was used to adjust for the effects of patient characteristics on in-hospital mortality.ResultsIn total, 6237 trauma patients were identified, of whom 4997 lived within the regional nephrology catchment area. CKD/dialysis trauma patients (n=101; 28 on dialysis) were older than patients without CKD (n=4896), with higher rates of hypertension, diabetes, and cardiovascular disease, and had increased risk of in-hospital mortality (31% vs 11%, p<0.001). No differences were observed in injury severity, ICU LOS, or ventilator-days. After adjustment for age, sex, and injury severity, the HR for in-hospital mortality was 1.90 (95% CI 1.33 to 2.70) for CKD/dialysis compared with patients without CKD.ConclusionIndependent of injury severity, patients without CKD/dialysis have significantly increased risk of in-hospital mortality after major trauma.

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Traumatic Spinal Injuries in Saudi Arabia: A Retrospective Single-center Medical Record Review

Journal of Spine Practice (JSP) ◽

10.18502/jsp.v1i1.9801 ◽

2021 ◽

pp. 43

Author(s):

Mohammed Alsabieh

Keyword(s):

Saudi Arabia ◽

Medical Record ◽

Trauma Center ◽

Motor Vehicle ◽

Tertiary Care ◽

Spinal Injuries ◽

Medical Record Review ◽

Common Mechanism ◽

Mechanism Of Injury ◽

Record Review

Introduction: The aim of this retrospective medical record review was to describe the patterns and outcomes of traumatic spinal injuries (TSIs) in a tertiary care trauma center in Riyadh, Saudi Arabia. Methodology: Data of all patients who presented at a setting level-1 trauma center with any type of spinal trauma between February 1, 2016 and December 31, 2018 were review. The data obtained included age, gender, nationality (as Saudi and non-Saudi), date of presentation, site of fracture/injury, associated injuries, mechanism of injury, presence of neurological involvement, and hospital mortality. The main outcome of the review was frequencies of different types of TSI across various subgroups. Result: We identified 692 patients who presented with TSI during the study period. The mean age was 36.9 years. Males represented 83.2% (n = 576) of the sample size, and the most common mechanism of injury was motor vehicle collision (MVC), accounting for 66.8% of the cases (n = 462), while fall-related injuries were seen in 31.6% of the cases (n = 219). A total of 454 (65.6%) of all patients were Saudi, and 332 (73.1%) of the TSIs in Saudis were due to MVC. Non-Saudi cases accounted for 238 (34.4%) of all patients, and 89 (37.4%) of the non-Saudi injuries were due to falls from height, this association was statistically significant (p < 0.001). Conclusion: TSI was not thoroughly examined in Saudi Arabia; therefore, this study is considered the first to be done in the Kingdom using a representative sample. The fact that non-Saudi patients had a higher proportion of falls as a mechanism of injury should be taken into consideration in terms of raising awareness and taking more safety precautions, as most construction workers tend to be expatriates.

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