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Asim M, El-Menyar A, Abdelrahman H, Consunji R, Siddiqui T, Kanbar A, Taha I, Rizoli S, Al-Thani H. Time and Risk Factors of Trauma-Related Mortality: A 5-Year Retrospective Analysis From a National Level I Trauma Center. J Intensive Care Med 2024:8850666231225607. [PMID: 38193211 DOI: 10.1177/08850666231225607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
Background: We aimed to analyze in-hospital timing and risk factors for mortality in a level 1 trauma center. Methods: This is a retrospective analysis of all trauma-related mortality between 2013 and 2018. Patients were divided and analyzed based on the time of mortality (early (≤48 h) vs late (>48 h)), and within different age groups. Multivariate regression analysis was performed to predict in-hospital mortality. Results: 8624 trauma admissions and 677 trauma-related deaths occurred (47.7% at the scene and 52.3% in-hospital). Among in-hospital mortality, the majority were males, with a mean age of 35.8 ± 17.2 years. Most deaths occurred within 3-7 days (35%), followed by 33% after 1 week, 20% on the first day, and 12% on the second day of admission. Patients with early mortality were more likely to have a lower Glasgow coma scale, a higher shock index, a higher chest and abdominal abbreviated injury score, and frequently required exploratory laparotomy and massive blood transfusion (P < .005). The injury severity scores and proportions of head injuries were higher in the late mortality group than in the early group. The severity of injuries, blood transfusion, in-hospital complications, and length of intensive care unit stay were comparable among the age groups, whereas mortality was higher in the age group of 19 to 44. The higher proportions of early and late in-hospital deaths were evident in the age group of 24 to 29. In multivariate analysis, the shock index (OR 2.26; 95%CI 1.04-4.925; P = .04) was an independent predictor of early death, whereas head injury was a predictor of late death (OR 4.54; 95%CI 1.92-11.11; P = .001). Conclusion: One-third of trauma-related mortalities occur early after injury. The initial shock index appears to be a reliable hemodynamic indicator for predicting early mortality. Therefore, timely hemostatic resuscitation and appropriate interventions for bleeding control may prevent early mortality.
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Affiliation(s)
- Mohammad Asim
- Clinical Research, Trauma Surgery Section, Department of Surgery, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Ayman El-Menyar
- Clinical Research, Trauma Surgery Section, Department of Surgery, Hamad Medical Corporation (HMC), Doha, Qatar
- Clinical Medicine, Weill Cornell Medicine, Doha, Qatar
| | | | - Rafael Consunji
- Hamad Injury Prevention Program, Trauma Surgery Section, Department of Surgery, HMC, Doha, Qatar
| | - Tariq Siddiqui
- Trauma Surgery Section, Department of Surgery, HMC, Doha, Qatar
| | - Ahad Kanbar
- Trauma Surgery Section, Department of Surgery, HMC, Doha, Qatar
| | - Ibrahim Taha
- Trauma Surgery Section, Department of Surgery, HMC, Doha, Qatar
| | - Sandro Rizoli
- Trauma Surgery Section, Department of Surgery, HMC, Doha, Qatar
| | - Hassan Al-Thani
- Trauma Surgery Section, Department of Surgery, HMC, Doha, Qatar
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Stojek L, Bieler D, Neubert A, Ahnert T, Imach S. The potential of point-of-care diagnostics to optimise prehospital trauma triage: a systematic review of literature. Eur J Trauma Emerg Surg 2023; 49:1727-1739. [PMID: 36703080 PMCID: PMC10449679 DOI: 10.1007/s00068-023-02226-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 01/07/2023] [Indexed: 01/27/2023]
Abstract
PURPOSE In the prehospital care of potentially seriously injured patients resource allocation adapted to injury severity (triage) is a challenging. Insufficiently specified triage algorithms lead to the unnecessary activation of a trauma team (over-triage), resulting in ineffective consumption of economic and human resources. A prehospital trauma triage algorithm must reliably identify a patient bleeding or suffering from significant brain injuries. By supplementing the prehospital triage algorithm with in-hospital established point-of-care (POC) tools the sensitivity of the prehospital triage is potentially increased. Possible POC tools are lactate measurement and sonography of the thorax, the abdomen and the vena cava, the sonographic intracranial pressure measurement and the capnometry in the spontaneously breathing patient. The aim of this review was to assess the potential and to determine diagnostic cut-off values of selected instrument-based POC tools and the integration of these findings into a modified ABCDE based triage algorithm. METHODS A systemic search on MEDLINE via PubMed, LIVIVO and Embase was performed for patients in an acute setting on the topic of preclinical use of the selected POC tools to identify critical cranial and peripheral bleeding and the recognition of cerebral trauma sequelae. For the determination of the final cut-off values the selected papers were assessed with the Newcastle-Ottawa scale for determining the risk of bias and according to various quality criteria to subsequently be classified as suitable or unsuitable. PROSPERO Registration: CRD 42022339193. RESULTS 267 papers were identified as potentially relevant and processed in full text form. 61 papers were selected for the final evaluation, of which 13 papers were decisive for determining the cut-off values. Findings illustrate that a preclinical use of point-of-care diagnostic is possible. These adjuncts can provide additional information about the expected long-term clinical course of patients. Clinical outcomes like mortality, need of emergency surgery, intensive care unit stay etc. were taken into account and a hypothetic cut-off value for trauma team activation could be determined for each adjunct. The cut-off values are as follows: end-expiratory CO2: < 30 mm/hg; sonography thorax + abdomen: abnormality detected; lactate measurement: > 2 mmol/L; optic nerve diameter in sonography: > 4.7 mm. DISCUSSION A preliminary version of a modified triage algorithm with hypothetic cut-off values for a trauma team activation was created. However, further studies should be conducted to optimize the final cut-off values in the future. Furthermore, studies need to evaluate the practical application of the modified algorithm in terms of feasibility (e.g. duration of application, technique, etc.) and the effects of the new algorithm on over-triage. Limiting factors are the restriction with the search and the heterogeneity between the studies (e.g. varying measurement devices, techniques etc.).
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Affiliation(s)
- Leonard Stojek
- Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University Witten/Herdecke, Cologne, Germany
| | - Dan Bieler
- Department of Orthopedics and Trauma Surgery, Reconstructive Surgery, Hand Surgery, Plastic Surgery and Burn Medicine, German Armed Forces Central Hospital Koblenz, Koblenz, Germany
- Department of Orthopedics and Trauma Surgery, Medical Faculty University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Anne Neubert
- Department of Orthopedics and Trauma Surgery, Medical Faculty University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
- TraumaEvidence @ German Society of Traumatology, Berlin, Germany
| | - Tobias Ahnert
- Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University Witten/Herdecke, Cologne, Germany
- Helicopter Emergency Medical Service (HEMS) Christoph 3, Cologne, Germany
| | - Sebastian Imach
- Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University Witten/Herdecke, Cologne, Germany.
- Helicopter Emergency Medical Service (HEMS) Christoph 3, Cologne, Germany.
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Messelu MA, Tilahun AD, Beko ZW, Endris H, Belayneh AG, Tesema GA. Incidence and predictors of mortality among adult trauma patients admitted to the intensive care units of comprehensive specialized hospitals in Northwest Ethiopia. Eur J Med Res 2023; 28:113. [PMID: 36895008 PMCID: PMC9999519 DOI: 10.1186/s40001-023-01056-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/09/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Trauma is the leading cause of morbidity and mortality among adult population in the world. Despite many improvements in technology and care, mortality among trauma patients in the intensive care unit is still high particularly in Ethiopia. However, there is limited evidence on the incidence and predictors of mortality among trauma patients in Ethiopia. Therefore, this study aimed to assess the incidence and predictors of mortality among adult trauma patients admitted to intensive care units. METHODS Institutional-based retrospective follow-up study was conducted from January 9, 2019 to January 8, 2022. A total of 421 samples were chosen using simple random sampling. Data were collected with Kobo toolbox software and exported to STATA version 14.1 software for data analysis. Kaplan-Meier failure curve and log-rank test were fitted to explore the survival difference among groups. After the bivariable and multivariable Cox regression analysis, an Adjusted Hazard Ratio (AHR) with 95% Confidence Intervals (CI) was reported to declare the strength of association and statistical significance, respectively. RESULT The overall incidence rate of mortality was 5.47 per 100 person-day observation with a median survival time of 14 days. Did not get pre-hospital care (AHR = 2.00, 95%CI 1.13, 3.53), Glasgow Coma Scale (GCS) score < 9 (AHR = 3.89, 95%CI 1.67, 9.06), presence of complications (AHR = 3.71, 95%CI 1.29, 10.64), hypothermia at admission (AHR = 2.11, 95%CI 1.13, 3.93) and hypotension at admission (AHR = 1.93, 95%CI 1.01, 3.66) were found significant predictors of mortality among trauma patients. CONCLUSION The incidence rate of mortality among trauma patients in the ICU was high. Did not get pre-hospital care, GCS < 9, presence of complications, hypothermia, and hypotension at admission were significant predictors of mortality. Therefore, healthcare providers should give special attention to trauma patients with low GCS scores, complications, hypotension, and hypothermia and better to strengthen pre-hospital services to reduce the incidence of mortality.
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Affiliation(s)
- Mengistu Abebe Messelu
- Department of Nursing, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia.
| | - Ambaye Dejen Tilahun
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zerko Wako Beko
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Hussien Endris
- Department of Anesthesia, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Asnake Gashaw Belayneh
- Department of Emergency and Critical Care Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Cherkasov MF, Startsev YM, Cherkasov DM, Sitnikov VN, Melikova SG, Galashokyan KM. [Diagnosis and treatment of patients with abdominal trauma]. Khirurgiia (Mosk) 2022:75-82. [PMID: 35920226 DOI: 10.17116/hirurgia202208175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To improve the results of diagnosis and treatment of patients with abdominal injuries through a wider introduction of laparoscopic methods. MATERIAL AND METHODS We analyzed 3556 patients with concomitant abdominal injuries. All patients had damage to several organs and systems. Laparoscopy was performed in 1962 patients, laparotomy without previous laparoscopy - in 1594 patients. RESULTS Laparoscopy found no abdominal injuries in 25.7% of patients, other 13.7% of patients required no surgery and follow-up was indicated. In 60.7% of patients, injuries required surgical correction. Among these lesions, 26.6% of injuries were successfully eliminated using laparoscopic approach. In some cases, more than one injury was corrected. Indications for laparotomy were overestimated in 30.2% of patients who underwent open surgery without previous laparoscopy. CONCLUSION There is a tendency to decrease in the number of open and laparoscopic procedures for concomitant abdominal trauma over time that is associated with widespread introduction of modern diagnostic methods and accumulation of experience. Laparoscopy should be preferred for diagnosis of abdominal injuries in patients with concomitant trauma and no contraindications. This approach diagnoses no injuries or their mild nature in 39.3% of cases. Moreover, laparoscopy effectively eliminates certain lesions in 26.6% of cases.
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Affiliation(s)
- M F Cherkasov
- Rostov State Medical University, Rostov-on-Don, Russia
| | - Yu M Startsev
- Rostov State Medical University, Rostov-on-Don, Russia
| | - D M Cherkasov
- Rostov State Medical University, Rostov-on-Don, Russia
| | - V N Sitnikov
- Rostov State Medical University, Rostov-on-Don, Russia
| | - S G Melikova
- Rostov State Medical University, Rostov-on-Don, Russia
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Davoodabadi A, Abdorrahim Kashi E, Mohammadzadeh M, Mousavi N, Shafagh S, Ghafoor L, Sehat M, Ale Mohammad S, Hajian A. Predicting factors and incidence of preventable trauma induced mortality. Ann Med Surg (Lond) 2021; 68:102609. [PMID: 34381599 PMCID: PMC8340039 DOI: 10.1016/j.amsu.2021.102609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/23/2021] [Accepted: 07/25/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction Trauma is one of the most common causes of morbidity and mortality worldwide. Since the definition of preventable death has been described many studies like current one were conducted to evaluate this issue. Methods This cohort retrospective study investigated archived medical files of trauma victims from 2017 to 2020 in a referral single-center trauma hospital. Registered demographic data, vital signs, Glasgow coma scale (GCS), timing of trauma and death, executed interventions, type and mechanism of trauma in addition to time errors, clinical mismanagements, and missed injuries were extracted. Injury severity score, revised trauma score, and probability of survival based on TRISS method for each case were calculated. Eventually preventable and non-preventable death were defined and compared. Results Finally from the all 413 trauma deaths 246(54.9 %) files were enrolled. Dead persons were from 18 to 95 years. Of all 189(76.8 %) were males. Analysis manifested 135(54.9 %) of all deaths were potentially preventable and the rest 49.1 % was non-preventable for expiration(p = 0.001). Data showed that from all variables systolic blood pressure ≥80 mmHg, respiratory rate >19 per minute, GCS>8, higher RTS, road traffic accidents and control of external bleeding were contributed to prediction of preventable trauma related mortality. Conclusion This study implied on that frequency of trauma related preventable death was regionally high and associating factors that could influence the number of these mortalities included systolic blood pressure, respiratory rate, GCS, revised trauma score, mechanism of trauma, and external bleeding of trauma patients. Preventable trauma related mortality is achieved to 55 % in this study while World Health Organization considered 20 % averagely. Time errors, missing injuries, and clinical management errors were not generally attributed to preventable trauma death. SBP>80, RR>19, GCS>8, road-traffic accident, and adequate control of external bleeding could rescue patients from death.
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Affiliation(s)
| | | | | | - Noushin Mousavi
- Department of General Surgery, Kashan University of Medical Sciences, Kashan, Iran
| | - Shima Shafagh
- Department of General Surgery, Kashan University of Medical Sciences, Kashan, Iran
| | - Leila Ghafoor
- Department of General Surgery, Kashan University of Medical Sciences, Kashan, Iran
| | - Mojtaba Sehat
- Department of Biostatistics and Epidemiology, Kashan University of Medical Sciences, Kashan, Iran
| | | | - Abbas Hajian
- Department of General Surgery, Kashan University of Medical Sciences, Kashan, Iran
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Zitek T, Ataya R, Farino L, Mohammed S, Miller G. Is the use of greater than 1 L of intravenous crystalloids associated with worse outcomes in trauma patients? Am J Emerg Med 2020; 40:32-36. [PMID: 33340875 DOI: 10.1016/j.ajem.2020.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/05/2020] [Accepted: 12/05/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Advanced Trauma Life Support guidelines recommend only 1 L of intravenous (IV) crystalloid before transitioning to blood products. We sought to determine if receiving >1 L of IV crystalloid during the initial resuscitation is associated with worse outcomes. We also sought to determine if receiving no crystalloids is associated with better outcomes. METHODS We performed a single center retrospective study using trauma registry data, which was supplemented by manual chart review. We only included patients who had an initial heart rate ≥ 100 beats/min or a systolic blood pressure ≤ 90 mmHg. For each patient, we determined the total amount of IV crystalloid administered in the first 3 h after arrival to the hospital plus prehospital crystalloid. We performed multivariate regression analyses to determine if there is an association between the administration of >1 L of crystalloids or no crystalloids with in-hospital mortality, hospital length of stay (LOS), or packed red blood cells (PRBCs) transfused. RESULTS Between January 1, 2018 and September 30, 2019, there were 878 who met criteria for enrollment. Among those, 55.0% received ≤1 L of IV crystalloids, and 45.0% received >1 L. Multivariate analyses showed no significant association between receiving >1 L and mortality (p = 0.61) or PRBCs transfused (p = 0.29), but patients who received >1 L had longer hospital LOS (p = 0.04). We found no association between receiving no crystalloids and mortality, PRBCs transfused, or LOS. CONCLUSION On a multivariate analysis of trauma patients, we did not find an association between the administration of >1 L of IV crystalloid and in-hospital mortality or the volume of PRBCs transfused. However, receiving >1 L of crystalloids was associated with a longer hospital LOS. We found no benefit to completely withholding crystalloids.
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Affiliation(s)
- Tony Zitek
- Department of Emergency Medicine, Herbert Wertheim College of Medicine, Florida International University, 11200, SW Eight St Miami, FL 33199, United States of America; Department of Emergency Medicine, University Medical Center of Southern Nevada, 1800, W Charleston Blvd Las Vegas, NV 89102, United States of America.
| | - Ramsey Ataya
- Department of Emergency Medicine, Kendall Regional Medical Center, 11750, Bird Rd Miami, FL 33175, United States of America
| | - Lian Farino
- Department of Emergency Medicine, University of Nevada Las Vegas School of Medicine, 2040, W Charleston Blvd, 3rd Floor, Las Vegas, NV 89102, United States of America
| | - Salman Mohammed
- Department of Emergency Medicine, University Medical Center of Southern Nevada, 1800, W Charleston Blvd Las Vegas, NV 89102, United States of America
| | - Glenn Miller
- Department of Surgery, Kendall Regional Medical Center, 11750, Bird Rd Miami, FL 33175, United States of America
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Chiang YT, Lin TH, Hu RH, Lee PC, Shih HC. Predicting factors for major trauma patient mortality analyzed from trauma registry system. Asian J Surg 2020; 44:262-268. [PMID: 32859471 DOI: 10.1016/j.asjsur.2020.06.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/18/2020] [Accepted: 06/28/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE We investigated the predictors of mortality in major trauma patients using a trauma registry system database. METHODS Data were obtained from the trauma registry of a level I trauma center for all patients aged ≥18 years admitted to an intensive care unit (ICU) between January 1, 2006 and December 31, 2013. Models were adjusted for patient demographics, injury mechanism, preexisting comorbidity, Glasgow coma scale (GCS), injury severity score (ISS), emergency department (ED) and ICU procedures, surgical procedures, and complications. Multivariate logistic regression analysis was used to determine predictors of mortality and odds ratios of its associated factors. RESULTS In total, 1561 patients met the inclusion criteria. The overall mortality rate was 13.4%. After controlling for all variables in a logistic regression model, the factors associated with increased mortality risk (P < 0.05) were age ≥ 45 years; ISS > 24; GCS score < 8 and 8-12; fall accident; preexisting comorbidity of renal insufficiency; ED cardiopulmonary resuscitation (CPR) procedures; ICU blood transfusion; and cardiovascular, respiratory, digestive system and infection complications. CONCLUSION Our data showed some predictors of patient mortality after major trauma, most of which were determined during the trauma event. Only those treatment complications may be improved when performing the treatment procedures.
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Affiliation(s)
- Yueh-Tzu Chiang
- Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taiwan, ROC; Department of Orthopedics, KuangTien General Hospital, Taiwan, ROC.
| | - Tzu-Hsin Lin
- Department of Traumatology, National Taiwan University Hospital, And College of Medicine, National Taiwan University, Taiwan, ROC.
| | - Rey-Heng Hu
- Department of Traumatology, National Taiwan University Hospital, And College of Medicine, National Taiwan University, Taiwan, ROC
| | - Po-Chu Lee
- Department of Traumatology, National Taiwan University Hospital, And College of Medicine, National Taiwan University, Taiwan, ROC
| | - Hsin-Chin Shih
- Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taiwan, ROC
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8
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Lentsck MH, Oliveira RRD, Corona LP, Mathias TADF. Risk factors for death of trauma patients admitted to an Intensive Care Unit. Rev Lat Am Enfermagem 2020; 28:e3236. [PMID: 32074207 PMCID: PMC7021481 DOI: 10.1590/1518-8345.3482.3236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 09/23/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the risk factors for death of trauma patients admitted to the intensive care unit (ICU). METHOD Retrospective cohort study with data from medical records of adults hospitalized for trauma in a general intensive care unit. We included patients 18 years of age and older and admitted for injuries. The variables were grouped into levels in a hierarchical manner. The distal level included sociodemographic variables, hospitalization, cause of trauma and comorbidities; the intermediate, the characteristics of trauma and prehospital care; the proximal, the variables of prognostic indices, intensive admission, procedures and complications. Multiple logistic regression analysis was performed. RESULTS The risk factors associated with death at the distal level were age 60 years or older and comorbidities; at intermediate level, severity of trauma and proximal level, severe circulatory complications, vasoactive drug use, mechanical ventilation, renal dysfunction, failure to perform blood culture on admission and Acute Physiology and Chronic Health Evaluation II. CONCLUSION The identified factors are useful to compose a clinical profile and to plan intensive care to avoid complications and deaths of traumatized patients.
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Affiliation(s)
- Maicon Henrique Lentsck
- Universidade Estadual de Maringá, Departamento de Enfermagem, Maringá, PR, Brazil.,Universidade Estadual do Centro-Oeste, Departamento de Enfermagem, Guarapuava, PR, Brazil
| | - Rosana Rosseto de Oliveira
- Universidade Estadual de Maringá, Departamento de Enfermagem, Maringá, PR, Brazil.,Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | - Ligiana Pires Corona
- Universidade Estadual de Campinas, Faculdade de Ciências Aplicadas, Campinas, SP, Brazil
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Abstract
Introduction: Lactate devices offer the potential for paramedics to improve patient triage and escalation of care for specific presentations. There is also scope to improve existing prehospital tools by including lactate measurement. Method: A literature search was conducted using the Medline, CINAHL, Academic Search Premier, Sciencedirect and Scopus databases. Findings: Acquiring prehospital lactate measurement in trauma settings improved triage and recognition of the need for critical care. Within a medical setting, studies offered mixed results in relating prehospital lactate measurement to diagnosis, escalating treatments and mortality. The accuracy of prehospital lactate measurements acquired varies, which could impact decision making. Conclusion: Prehospital lactate thresholds could aid decision making, although the literature is limited and evidence varies. Lactate values of ≥4 mmol/litre in medical and ≥2.5 mmol/litre in trauma patients could signify that care should be escalated to an appropriate facility, and that resuscitative measures should be initiated, particularly with sepsis, as reflected by standardised lactate values that guide treatment in hospitals. Similarly, a lactate value of <2 mmol/litre could mean de-escalating care into the community, although further research is warranted on this.
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Dios-Barbeito S, Durán-Muñoz-Cruzado V, Martín-García C, Rubio-Manzanares-Dorado M, Padillo-Ruiz F, Pareja-Ciuró F. ¿Qué pacientes politraumatizados graves se benefician de la realización de un total-body CT ? Med Intensiva 2018; 42:129-131. [DOI: 10.1016/j.medin.2017.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 02/06/2017] [Accepted: 03/03/2017] [Indexed: 01/02/2023]
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Godoy DA, Moscote Zalazar LR, Rubiano A, Muñoz-Sánchez Á, Lubillo S, Murillo-Cabezas F. Secondary decompressive craniectomy for the management of refractory endocraneal hypertension in severe traumatic brain injury. Lights and shadows from recent studies. Med Intensiva 2017; 41:487-490. [PMID: 28365031 DOI: 10.1016/j.medin.2017.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 02/03/2017] [Accepted: 02/03/2017] [Indexed: 11/30/2022]
Affiliation(s)
- D A Godoy
- Unidad de Cuidados Neurointensivos, Sanatorio Pasteur, San Fernando del Valle de Catamarca, Argentina; Unidad de Terapia Intensiva, Hospital San Juan Bautista, San Fernando del Valle de Catamarca, Argentina
| | - L R Moscote Zalazar
- Unidad de Paciente Crítico, Clínica Universitaria de Puerto Montt, Puerto Montt, Chile
| | - A Rubiano
- Servicio de Neurocirugía, Universidad El Bosque, Bogotá, Colombia
| | - Á Muñoz-Sánchez
- Servicio de Urgencias, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - S Lubillo
- Unidad de Medicina Intensiva, Hospital Universitario Ntra. Sra. de Candelaria, Santa Cruz de Tenerife, España
| | - F Murillo-Cabezas
- Servicio de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, España.
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Method to assess the accuracy of scores in mortality prediction of trauma patients: Not only receiver operating characteristic curve. Injury 2016; 47:2382. [PMID: 27401030 DOI: 10.1016/j.injury.2016.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 06/25/2016] [Indexed: 02/02/2023]
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13
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Jia L, Wang H, Gao Y, Liu H, Yu K. High incidence of adverse events during intra-hospital transport of critically ill patients and new related risk factors: a prospective, multicenter study in China. Crit Care 2016; 20:12. [PMID: 26781179 PMCID: PMC4717618 DOI: 10.1186/s13054-016-1183-y] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 01/06/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The aim of the present study was to investigate the incidence of adverse events (AEs) during intra-hospital transport (IHT) of critically ill patients and evaluate the risk factors associated with these events. METHODS This prospective multicenter observational study was performed in 34 intensive care units in China during 20 consecutive days from 5 November to 25 November 2012. All consecutive patients who required IHT for diagnostic testing or therapeutic procedures during the study period were included. All AEs that occurred during IHT were recorded. The incidence of AEs was defined as the rate of transports with at least one AE. The statistical analysis included a description of demographic and clinical characteristics of the cohort as well as identification of risk factors for AEs during IHT by univariate and multivariate logistic regression analyses. RESULTS In total, 441 IHTs of 369 critically ill patients were analyzed. The overall incidence of AEs was 79.8% (352 IHTs). The proportion of equipment- and staff-related adverse events was 7.9% (35 IHTs). The rate of patient-related adverse events (P-AEs) was 79.4% (349 IHTs). The rates of vital sign-related P-AEs and arterial blood gas analysis-related P-AEs were 57.1% (252 IHTs) and 46.9% (207 IHTs), respectively. The incidence of critical P-AEs was 33.1% (146 IHTs). The rates of vital sign-related critical P-AEs and arterial blood gas analysis-related critical P-AEs were 22.9% (101 IHTs) and 15.0% (66 IHTs), respectively. All data collected in our study were considered potential risk factors. In the multivariate analysis, predictive factors for P-AEs were pH, partial pressure of carbon dioxide in arterial blood, lactate level, glucose level, and heart rate before IHT. Furthermore, the Acute Physiology and Chronic Health Evaluation II score, partial pressure of oxygen in arterial blood, lactate level, glucose level, heart rate, respiratory rate, pulse oximetry, and sedation before transport were independent influential factors for critical P-AEs during IHT. CONCLUSIONS The incidence of P-AEs during IHT of critically ill patients was high. Risk factors for P-AEs during IHT were identified. Strategies are needed to reduce their frequency. TRIAL REGISTRATION Chinese Clinical Trial Register identifier ChiCTR-OCS-12002661. Registered 5 November 2012.
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Affiliation(s)
- Liu Jia
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
| | - Hongliang Wang
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
| | - Yang Gao
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
| | - Haitao Liu
- Department of Critical Care Medicine, the Third Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
| | - Kaijiang Yu
- Department of Critical Care Medicine, the Third Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
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