The association between diastolic blood pressure and massive transfusion in severe trauma: a retrospective single-center study

2020 ◽  
pp. 1-14
Author(s):  
Dong Hun Lee ◽  
Hong Sug Kim ◽  
Byung Kook Lee ◽  
Yong Soo Cho ◽  
Tag Heo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Injury Severity ◽  
Massive Transfusion ◽  
Characteristic Curve ◽  
Multivariate Logistic Regression Analysis ◽  
Severe Trauma ◽  
Trauma Patients ◽  
Single Center Study ◽  
Blood Pressure Data

Abstract Objective: To evaluate the association between diastolic blood pressure and massive transfusion in severe trauma. Methods: The retrospective study was conducted at a tertiary emergency medical centre in Gwangju , Republic of Korea, and comprised data of severe trauma patients with injury severity score >15 presenting between January 2016 and December 2017. Multivariate logistic regression analysis was performed to evaluate the association between diastolic blood pressure and massive transfusion. Receiver operating characteristic curve analysis was performed to estimate the prognostic performance of diastolic blood pressure. Data was analysed using SPSS 18. Results: Of the 827 patients, 64(7.7%) underwent massive transfusion. After adjusting the confounders, diastolic blood pressure was found to be an independent factor in predicting massive transfusion (odds ratio: 0.965; 95% confidence interval: 0.956–0.975). Conclusion: Initially low diastolic blood pressure was found to be an independent predictor for massive transfusion in severe trauma cases. Key Words: Trauma, Diastolic blood pressure, Massive transfusion.

scholarly journals Fibrinogen Level Deteriorates before Other Routine Coagulation Parameters and Massive Transfusion in the Early Phase of Severe Trauma: A Retrospective Observational Study

2015 ◽  
Vol 41 (01) ◽  
pp. 035-042 ◽  
Author(s):  
Mineji Hayakawa ◽  
Satoshi Gando ◽  
Yuichi Ono ◽  
Takeshi Wada ◽  
Yuichiro Yanagida ◽  
...  
Keyword(s):  
Platelet Count ◽  
Early Phase ◽  
Injury Severity ◽  
Massive Transfusion ◽  
Severe Trauma ◽  
Massive Bleeding ◽  
Trauma Patients ◽  
Critical Levels ◽  
Coagulation Parameters ◽  
Routine Coagulation

In trauma, hemostatic functions should be maintained appropriately to prevent massive bleeding. This study elucidated the time-dependent changes in platelet count and coagulation variables, and the effects of disseminated intravascular coagulation (DIC) on these changes during the early phase of trauma. Trauma patients with an injury severity score ≥16 were enrolled. The critical levels of platelet count and coagulation variables were defined according to recent trauma guidelines. Massive transfusion was defined as >10 units red cell concentrate. The time from arrival at the emergency department to reaching the critical levels and meeting the criteria for massive transfusion were evaluated. Eighty trauma patients were enrolled; 35 were diagnosed with DIC on arrival. Among all patients, fibrinogen levels reached the critical level earliest among routine coagulation parameters; other routine coagulation parameters deteriorated after the patients met the criteria for massive transfusion. Routine coagulation parameters reached their critical levels earlier in DIC patients than patients without DIC. Massive transfusion was performed more frequently in DIC patients, who met the criteria earlier. During the early phase of trauma, fibrinogen levels deteriorate earlier than other routine coagulation parameters, especially in DIC patients.

Vital Signs Strongly Predict Massive Transfusion Need in Geriatric Trauma Patients

2016 ◽  
Vol 82 (7) ◽  
pp. 632-636 ◽  
Author(s):  
Scott C. Fligor ◽  
Mark E. Hamill ◽  
Katie M. Love ◽  
Bryan R. Collier ◽  
Dan Lollar ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Massive Transfusion ◽  
Early Recognition ◽  
Characteristic Curve ◽  
Vital Signs ◽  
Trauma Team ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Geriatric Population

Early recognition of massive transfusion (MT) requirement in geriatric trauma patients presents a challenge, as older patients present with vital signs outside of traditional thresholds for hypotension and tachycardia. Although many systems exist to predict MT need in trauma patients, none have specifically evaluated the geriatric population. We sought to evaluate the predictive value of presenting vital signs in geriatric trauma patients for prediction of MT. We retrospectively reviewed geriatric trauma patients presenting to our Level I trauma center from 2010 to 2013 requiring full trauma team activation. The area under the receiver operating characteristic curve was calculated to assess discrimination of arrival vital signs for MT prediction. Ideal cutoffs with high sensitivity and specificity were identified. A total of 194 patients with complete data were analyzed. Of these, 16 patients received MT. There was no difference between the MT and non-MT groups in sex, age, or mechanism. Systolic blood pressure, pulse pressure, diastolic blood pressure, and shock index all were strongly predictive of MT need. Interestingly, we found that heart rate does not predict MT. MT in geriatric trauma patients can be reliably and simply predicted by arrival vital signs. Heart rate may not reflect serious hemorrhage in this population.

Splanchnic Hypoperfusion-Directed Therapies in Trauma: A Prospective, Randomized Trial

2005 ◽  
Vol 71 (3) ◽  
pp. 252-260 ◽  
Author(s):  
Stephen M. Cohn ◽  
Stephen M. Cohn ◽  
Orlando Kirton ◽  
Margaret Brown ◽  
S. Morad Hameed ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Injury Severity ◽  
Ischemia Reperfusion ◽  
Unit Group ◽  
Severe Trauma ◽  
Prospective Randomized Trial ◽  
Gastric Tonometry ◽  
Trauma Patients ◽  
Splanchnic Perfusion ◽  
Splanchnic Hypoperfusion

Splanchnic hypoperfusion as reflected by gastric intramucosal acidosis has been recognized as an important determinant of outcome in shock. A comprehensive splanchnic hypoperfusion-ischemia reperfusion (IRP) protocol was evaluated against conventional shock management protocols in critical trauma patients. The study was a prospective randomized trial comparing three therapeutic approaches to hypoperfusion after severe trauma in 151 trauma patients admitted to the intensive care unit. Group 1 patients received hemodynamic support based on conventional indicators of hypoperfusion. In group 2, resuscitation was further guided by gastric tonometry-derived estimates of splanchnic hypoperfusion and included more invasive hemodynamic monitoring and additional administration of colloid or crystalloid solutions, or inotropic support. Group 3 patients additionally received therapies specifically aimed at optimizing splanchnic perfusion and minimizing oxidant-mediated damage from reperfusion. The three groups were similar based on age, Injury Severity Score, and Acute Physiology and Chronic Health Evaluation II Scores. There were no statistically significant differences in mortality rates, organ dysfunction, ventilator days, or length of stay between any of the interventions. Techniques of optimization of splanchnic perfusion and minimization of oxidant-mediated reperfusion injury evaluated in this study were not advantageous relative to standard resuscitation measures guided by conventional or tonometric measures of hypoperfusion in the therapy of occult and clinical shock in trauma patients.

Evaluation of Microvascular Perfusion and Resuscitation after Severe Injury

2015 ◽  
Vol 81 (12) ◽  
pp. 1272-1278 ◽  
Author(s):  
Yann-Leei L. Lee ◽  
Jon D. Simmons ◽  
Mark N. Gillespie ◽  
Diego F. Alvarez ◽  
Richard P. Gonzalez ◽  
...  
Keyword(s):  
Injury Severity ◽  
Capillary Flow ◽  
Severe Trauma ◽  
Dark Field ◽  
Serum Lactate ◽  
Microvascular Perfusion ◽  
Trauma Patients ◽  
Sidestream Dark Field ◽  
Trauma Population ◽  
Severity Scores

Achieving adequate perfusion is a key goal of treatment in severe trauma; however, tissue perfusion has classically been measured by indirect means. Direct visualization of capillary flow has been applied in sepsis, but application of this technology to the trauma population has been limited. The purpose of this investigation was to compare the efficacy of standard indirect measures of perfusion to direct imaging of the sublingual microcirculatory flow during trauma resuscitation. Patients with injury severity scores >15 were serially examined using a handheld sidestream dark-field video microscope. In addition, measurements were also made from healthy volunteers. The De Backer score, a morphometric capillary density score, and total vessel density (TVD) as cumulative vessel area within the image, were calculated using Automated Vascular Analysis (AVA3.0) software. These indices were compared against clinical and laboratory parameters of organ function and systemic metabolic status as well as mortality. Twenty severely injured patients had lower TVD (X = 14.6 ± 0.22 vs 17.66 ± 0.51) and De Backer scores (X = 9.62 ± 0.16 vs 11.55 ± 0.37) compared with healthy controls. These scores best correlated with serum lactate (TVD R2 = 0.525, De Backer R2 = 0.576, P < 0.05). Mean arterial pressure, heart rate, oxygen saturation, pH, bicarbonate, base deficit, hematocrit, and coagulation parameters correlated poorly with both TVD and De Backer score. Direct measurement of sublingual microvascular perfusion is technically feasible in trauma patients, and seems to provide real-time assessment of micro-circulatory perfusion. This study suggests that in severe trauma, many indirect measurements of perfusion do not correlate with microvascular perfusion. However, visualized perfusion deficiencies do reflect a shift toward anaerobic metabolism.

scholarly journals A retrospective cohort study of 27,049 polytraumatized patients age 60 and above: identifying changes over 16 years

2021 ◽  
Author(s):  
Y. Kalbas ◽  
M. Lempert ◽  
F. Ziegenhain ◽  
J. Scherer ◽  
V. Neuhaus ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Injury Severity ◽  
Descriptive Analysis ◽  
Patient Characteristics ◽  
Severe Trauma ◽  
Diagnostic Tools ◽  
Trauma Patients ◽  
Treatment Algorithms ◽  
Injured Patients ◽  
Over Time

Abstract Purpose The number of severely injured patients exceeding the age of 60 has shown a steep increase within the last decades. These patients present with numerous co-morbidities, polypharmacy, and increased frailty requiring an adjusted treatment approach. In this study, we establish an overview of changes we observed in demographics of older severe trauma patients from 2002 to 2017. Methods A descriptive analysis of the data from the TraumaRegister DGU® (TR-DGU) was performed. Patients admitted to a level one trauma center in Germany, Austria and Switzerland between 2002 and 2017, aged 60 years or older and with an injury severity score (ISS) over 15 were included. Patients were stratified into subgroups based on the admission: 2002–2005 (1), 2006–2009 (2), 2010–2013 (3) and 2014–2017 (4). Trauma and patient characteristics, diagnostics, treatment and outcome were compared. Results In total 27,049 patients with an average age of 73.9 years met the inclusion criteria. The majority were males (64%), and the mean ISS was 27.4. The proportion of patients 60 years or older [(23% (1) to 40% (4)] rose considerably over time. Trauma mechanisms changed over time and more specifically low falls (< 3 m) rose from 17.6% (1) to 40.1% (4). Altered injury patterns were also identified. Length-of-stay decreased from 28.9 (1) to 19.5 days (4) and the length-of-stay on ICU decreased from 17.1 (1) to 12.7 days (4). Mortality decreased from 40.5% (1) to 31.8% (4). Conclusion Length of stay and mortality decreased despite an increase in patient age. We ascribe this observation mainly to increased use of diagnostic tools, improved treatment algorithms, and the implementation of specialized trauma centers for older patients allowing interdisciplinary care.

Abstract 287: Plasma PCSK9 Concentrations in Critically Ill Patients

2012 ◽  
Vol 32 (suppl_1) ◽  
Author(s):  
Bertrand Cariou ◽  
Maëlle Le Bras ◽  
Antoine Roquilly ◽  
Fanny Feuillet ◽  
Véronique Sebille ◽  
...  
Keyword(s):  
Multiple Trauma ◽  
Injury Severity ◽  
Ldl Receptor ◽  
Plasma Lipid ◽  
Severity Of Illness ◽  
Inverse Correlation ◽  
Severe Trauma ◽  
Trauma Patients ◽  
Intensive Care Patients ◽  
Pearson Coefficient

Objective. Pro-protein convertase subtilisin/kexin type 9 (PCSK9) is a circulating protein that impairs LDL clearance by promoting the LDL receptor (LDLR) degradation. Plasma lipid parameters (LDL-C and HDL-C) are related to severity of illness and survival in intensive care patients. Here, we aimed to determine whether circulating PCSK9 concentrations were correlated to the severity of illness in patients with multiple trauma. Methods/Results. Plasma PCSK9 were measured, at day 0 and 8 after admission, by ELISA in 111 patients hospitalized in ICU for severe trauma. Patients were included in the HIPOLYTE study and were randomly assigned to hydrocortisone therapy or placebo. Plasma PCSK9 levels were significantly increased by 161% at day 8 compared to day 0 (481 ± 227 vs 231 ± 117 ng/ml, P=0.0001). Hydrocortisone therapy did not alter PCSK9 concentrations at day 8 compared to placebo (451 ± 216 vs 511 ± 239ng/ml, P=0.33). In the whole population of the study, PCSK9 was positively associated with LDL-C (Pearson coefficient : 0.26, p=0.007) at day 0, but not with markers of severity illness. At day 8, an inverse correlation was found between PCSK9 and HDL-C (β =-653 ; P=0.004). Interestingly, PCSK9 concentrations at day 8 were related to markers of severity illness as injury severity score (β =6.17 ; P=0.0007), length of stay in ICU (β =6.14 ; P=0.0001), duration of both mechanical ventilation (β =8.26 ; P=0.0001) and cathecolamines infusion (β =18.57; P=0.015). Conclusion. PCSK9 appears as a late biomarker of severity illness in patients hospitalized for multiple trauma in ICU. These results open new perspectives for a role of PCSK9 in critical illness.

Early predictors for massive transfusion in older adult severe trauma patients

Injury ◽  
2017 ◽  
Vol 48 (5) ◽  
pp. 1006-1012 ◽  
Author(s):  
Takao Ohmori ◽  
Taisuke Kitamura ◽  
Junko Ishihara ◽  
Hirokazu Onishi ◽  
Tsuyoshi Nojima ◽  
...  
Keyword(s):  
Older Adult ◽  
Massive Transfusion ◽  
Severe Trauma ◽  
Trauma Patients ◽  
Early Predictors

Multiple Laparotomies are a Predictor of Fascial Dehiscence in the Setting of Severe Trauma

2005 ◽  
Vol 71 (5) ◽  
pp. 402-405 ◽  
Author(s):  
Mamta Swaroop ◽  
Michael Williams ◽  
Wendy Ricketts Greene ◽  
Jack Sava ◽  
Kenneth Park ◽  
...  
Keyword(s):  
Wound Infection ◽  
Injury Severity ◽  
Damage Control ◽  
Wound Dehiscence ◽  
Severe Trauma ◽  
Outcome Data ◽  
Fascial Closure ◽  
Trauma Patients ◽  
Abdominal Abscess ◽  
Increased Risk

The purpose of this study was to determine the incidence of wound dehiscence after repeat trauma laparotomy. We performed a retrospective analysis of adult trauma patients who underwent laparotomy at an urban level 1 trauma center during the past 5 years. Patients were divided into single (SL) and multiple laparotomy (ML) groups. Demographic, clinical, and outcome data were collected. Data were analyzed using χ2, t testing, and ANOVA. Overall dehiscence rate was 0.7 per cent. Multiple laparotomy patients had damage control, staged management of their injuries, or abdominal compartment syndrome as the reason for reexploration. SL and ML patients had similar age and sex. ML patients had a higher rate of intra-abdominal abscess than SL patients (13.7% vs 1.2% P < 0.0001), but intra-abdominal abscess did not predict wound dehiscence in the ML group ( P = 0.24). This was true in spite of the fact that ML patients had a significantly higher Injury Severity Score (ISS) than SL patients (21.68 vs 14.35, P < 0.0001). Interestingly, wound infection did not predict dehiscence. Patients undergoing repeat laparotomy after trauma are at increased risk for wound dehiscence. This risk appears to be associated with intraabdominal abscess and ISS, but not wound infection. Surgeons should leave the skin open in the setting of repeat trauma laparotomy, which will allow serial assessment of the integrity of the fascial closure.

Massive Transfusion Protocol and Subsequent Development of Venous Thromboembolism: Statewide Analysis

2020 ◽  
pp. 000313482094890
Author(s):  
Eric H. Bradburn ◽  
Kwok M. Ho ◽  
Madison E. Morgan ◽  
Lauren D’Andrea ◽  
Tawnya M. Vernon ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Injury Severity ◽  
Massive Transfusion ◽  
Subsequent Development ◽  
Multivariate Logistic Regression Model ◽  
Trauma Patients ◽  
Vte Prophylaxis ◽  
Vein Thrombosis ◽  
Hemorrhagic Event ◽  
High Index Of Suspicion

Background Massive transfusion protocols (MTP) are a routine component of any major trauma center’s armamentarium in the management of exsanguinating hemorrhages. Little is known about the potential complications of those that survive a MTP. We sought to determine the incidence of venous thromboembolism (VTE) following MTP. We hypothesized that MTP would be associated with a higher risk of VTE when compared with a risk-adjusted control population without MTP. Methods The Pennsylvania Trauma Outcome Study database was retrospectively queried from 2015 to 2018 for trauma patients who developed VTE and survived until discharge at accredited trauma centers in Pennsylvania. Patient demographics, injury severity, and clinical outcomes were compared to assess differences in VTE development between MTP and non-MTP patients. A multivariate logistic regression model assessed the adjusted impact of MTP on VTE development. Results 176 010 patients survived until discharge, meeting inclusion criteria. Of those, 1667 developed a VTE (pulmonary embolism [PE]: 662 [0.4%]; deep vein thrombosis [DVT]: 1142 [0.6%]; PE and DVT: 137 [0.1%]). 1268 patients (0.7%) received MTP and, of this subset of patients, 171 (13.5%) developed a VTE during admission. In adjusted analysis, patients who had a MTP and survived until discharge had a higher odds of developing a VTE (adjusted odds ratio: 2.62; 95% CI: 2.13-3.24; P < .001). Discussion MTP is a harbinger for higher risk of VTE in those patients who survive. This may, in part, be related to the overcorrection of coagulation deficits encountered in the hemorrhagic event. A high index of suspicion for the development of VTE as well as aggressive VTE prophylaxis is warranted in those patients who survive MTP.

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