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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Abdessater M, Michel P, Bardet F, Kanbar A, Legeais D, Cabarrot P, May-Michelangeli L, Avrillon V, Fournier G, Cornu JN, Pogu B, Bart S. [Practice of French urologists concerning the checklist of the operating room]. Prog Urol 2023; 33:12-20. [PMID: 36207247 DOI: 10.1016/j.purol.2022.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/04/2022] [Accepted: 09/09/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION In 2018, the French High Authority of Health (HAS) included a "time-out" phase in the latest version of the checklist for the operating room in order to improve the safety of operated patients. The aim of this study is to evaluate the practice of French urologists concerning the check list (CL) of the operating room. MATERIAL AND METHODS A survey of 30 items was developed by the committee of accreditation of the French Association of Urology (AFU) and other contributors. It was centered on the characteristics of the urologists, the details of application of the CL, and the evaluation of the current version. After validation, the questionnaire was emailed as an online form in July 2021 for all the members of the AFU and AFUF. RESULTS Overall, 369 form the 1700 contacted urologists responded to the survey. The majority were more than 40 years old (70.11%) and less than 20 year of experience (54.49%). The engagement in individual or team accreditation was observed in 222 (60.7%) and 145 (39.84%) urologists, respectively. Almost half of them were present at the beginning of the CL (47.18%), and prescribed postoperative medication with the anesthesiologist (55.56%). The CL has modified the practice in 47.54%, however, with greater administrative burden, and 80% preferred that the AFU adapts the CL to the urology field. CONCLUSION The practice of CL between urologists is variable. On multivariate analysis, the engagement in team accreditation was the only variable to influence the practice of time out. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- M Abdessater
- Association française des urologues en Formation (AFUF), Paris, France; Service d'urologie, centre hospitalier René-Dubos, Pontoise, France.
| | - P Michel
- Department de recherche clinique, centre hospitalier René-Dubos, Pontoise, France
| | - F Bardet
- Association française des urologues en Formation (AFUF), Paris, France; Service d'urologie, CHU de Dijon, Bourgogne, France
| | - A Kanbar
- Association française des urologues en Formation (AFUF), Paris, France; Service d'urologie, hôpital Henri-Mondor, AP-HP, Créteil, France
| | - D Legeais
- Service d'urologie, groupe hospitalier mutualiste de Grenoble, Grenoble, France
| | - P Cabarrot
- Haute Autorité de la santé (HAS), La Plaine Saint-Denis, France
| | | | - V Avrillon
- Association française d'urologie (AFU), Paris, France
| | - G Fournier
- Association française d'urologie (AFU), Paris, France; Service d'urologie, CHUR de Brest, Brest, France
| | - J-N Cornu
- Service d'urologie, CHU de Rouen, Normandie, France
| | - B Pogu
- Association française d'urologie (AFU), Paris, France; Service d'urologie, hôpital de chalons en champagne, France
| | - S Bart
- Service d'urologie, centre hospitalier René-Dubos, Pontoise, France; Association française d'urologie (AFU), Paris, France
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Ramzee AF, El-Menyar A, Asim M, Kanbar A, Ahmed K, Daoud B, Mathradikkal S, Kloub A, Al-Thani H, Rizoli S. The impact of emergency department length of stay on the outcomes of trauma patients requiring hospitalization: a retrospective observational study. World J Emerg Med 2023; 14:96-105. [PMID: 36911054 PMCID: PMC9999135 DOI: 10.5847/wjem.j.1920-8642.2023.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 09/20/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND We aimed to explore the impact of the emergency department length of stay (EDLOS) on the outcome of trauma patients. METHODS A retrospective study was conducted on all trauma patients requiring hospitalization between 2015 and 2019. Patients were categorized into 4 groups based on the EDLOS (<4 h, 4-12 h,12-24 h, and >24 h). Data were analyzed using Chi-square test (categorical variables), Student's t-test (continuous variables), correlation coefficient, analysis of variance and multivariate logistic regression analysis for identifying predictors of short EDLOS and hospital mortality. RESULTS The study involved 7,026 patients with a mean age of 32.1±15.6 years. One-fifth of patients had a short EDLOS (<4 h) and had higher level trauma team T1 activation (TTA-1), higher Injury Severity Score (ISS), higher shock index (SI), and more head injuries than the other groups (P=0.001). Patients with an EDLOS >24 h were older (P=0.001) and had more comorbidities (P=0.001) and fewer deaths (P=0.001). Multivariate regression analysis showed that the predictors of short EDLOS were female gender, GCS, SI, hemoglobin level, ISS, and blood transfusion. The predictors of mortality were TTA-1 (odds ratio [OR]=4.081, 95%CI: 2.364-7.045), head injury (OR=3.920, 95%CI: 2.413-6.368), blood transfusion (OR=2.773, 95%CI: 1.668-4.609), SI (OR=2.132, 95%CI: 1.364-3.332), ISS (OR=1.077, 95%CI: 1.057-1.096), and age (OR=1.040, 95%CI: 1.026-1.054). CONCLUSIONS Patients with shorter EDLOS had different baseline characteristics and hospital outcomes compared with patients with longer EDLOS. Patients with prolonged EDLOS had better outcomes; however, the burden of prolonged boarding in the ED needs further elaboration.
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Affiliation(s)
- Ahmed Faidh Ramzee
- Trauma Surgery Section, Hamad General Hospital (HGH), Doha P.O Box 3050, Qatar
| | - Ayman El-Menyar
- Clinical Research, Trauma & Vascular Surgery Section, HGH, Doha P.O Box 3050, Qatar.,Clinical Medicine, Weill Cornell Medical College, Doha P.O Box 3050, Qatar
| | - Mohammad Asim
- Clinical Research, Trauma & Vascular Surgery Section, HGH, Doha P.O Box 3050, Qatar
| | - Ahad Kanbar
- Trauma Surgery Section, Hamad General Hospital (HGH), Doha P.O Box 3050, Qatar
| | - Khalid Ahmed
- Trauma Surgery Section, Hamad General Hospital (HGH), Doha P.O Box 3050, Qatar
| | - Bahaa Daoud
- Trauma Surgery Section, Hamad General Hospital (HGH), Doha P.O Box 3050, Qatar
| | - Saji Mathradikkal
- Trauma Surgery Section, Hamad General Hospital (HGH), Doha P.O Box 3050, Qatar
| | - Ahmad Kloub
- Trauma Surgery Section, Hamad General Hospital (HGH), Doha P.O Box 3050, Qatar
| | - Hassan Al-Thani
- Trauma Surgery Section, Hamad General Hospital (HGH), Doha P.O Box 3050, Qatar
| | - Sandro Rizoli
- Trauma Surgery Section, Hamad General Hospital (HGH), Doha P.O Box 3050, Qatar
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El-Menyar A, Ahmed K, Hakim S, Kanbar A, Mathradikkal S, Siddiqui T, Jogol H, Younis B, Taha I, Mahmood I, Ajaj A, Atique S, Alaieb A, Bahey AAA, Asim M, Alinier G, Castle NR, Mekkodathil A, Rizoli S, Al-Thani H. Efficacy and safety of the second in-hospital dose of tranexamic acid after receiving the prehospital dose: double-blind randomized controlled clinical trial in a level 1 trauma center. Eur J Trauma Emerg Surg 2021; 48:3089-3099. [PMID: 34910219 PMCID: PMC9360064 DOI: 10.1007/s00068-021-01848-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/23/2021] [Indexed: 11/29/2022]
Abstract
Background Prehospital administration of tranexamic acid (TXA) to injured patients is increasing worldwide. However, optimal TXA dose and need of a second infusion on hospital arrival remain undetermined. We investigated the efficacy and safety of the second in-hospital dose of TXA in injured patients receiving 1 g of TXA in the prehospital setting. We hypothesized that a second in-hospital dose of TXA improves survival of trauma patients. Methods A prospective, double-blind, placebo-controlled randomized, clinical trial included adult trauma patients receiving 1 g of TXA in the prehospital settings. Patients were then blindly randomized to Group I (second 1-g TXA) and Group II (placebo) on hospital arrival. The primary outcome was 24-h (early) and 28-day (late) mortality. Secondary outcomes were thromboembolic events, blood transfusions, hospital length of stay (HLOS) and organs failure (MOF). Results A total of 220 patients were enrolled, 110 in each group. The TXA and placebo groups had a similar early [OR 1.000 (0.062–16.192); p = 0.47] and late mortality [OR 0.476 (95% CI 0.157–1.442), p = 0.18].The cause of death (n = 15) was traumatic brain injury (TBI) in 12 patients and MOF in 3 patients. The need for blood transfusions in the first 24 h, number of transfused blood units, HLOS, thromboembolic events and multiorgan failure were comparable in the TXA and placebo groups. In seriously injured patients (injury severity score > 24), the MTP activation was higher in the placebo group (31.3% vs 11.10%, p = 0.13), whereas pulmonary embolism (6.9% vs 2.9%, p = 0.44) and late mortality (27.6% vs 14.3%, p = 0.17) were higher in the TXA group but did not reach statistical significance. Conclusion The second TXA dose did not change the mortality rate, need for blood transfusion, thromboembolic complications, organ failure and HLOS compared to a single prehospital dose and thus its routine administration should be revisited in larger and multicenter studies. Trial registration ClinicalTrials.gov Identifier: NCT03846973.
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Affiliation(s)
- Ayman El-Menyar
- Trauma & Vascular Surgery, Clinical Research, Hamad General Hospital, Hamad Medical Corporation (HMC), P.O Box 3050, Doha, Qatar. .,Clinical Medicine, Weill Cornell Medical College, Doha, Qatar.
| | - Khalid Ahmed
- Department of Surgery, Trauma Surgery, Hamad General Hospital, HMC, Doha, Qatar
| | - Suhail Hakim
- Department of Surgery, Trauma Surgery, Hamad General Hospital, HMC, Doha, Qatar
| | - Ahad Kanbar
- Department of Surgery, Trauma Surgery, Hamad General Hospital, HMC, Doha, Qatar
| | - Saji Mathradikkal
- Department of Surgery, Trauma Surgery, Hamad General Hospital, HMC, Doha, Qatar
| | - Tariq Siddiqui
- Department of Surgery, Trauma Surgery, Hamad General Hospital, HMC, Doha, Qatar
| | - Hisham Jogol
- Department of Surgery, Trauma Surgery, Hamad General Hospital, HMC, Doha, Qatar
| | - Basil Younis
- Department of Surgery, Trauma Surgery, Hamad General Hospital, HMC, Doha, Qatar
| | - Ibrahim Taha
- Department of Surgery, Trauma Surgery, Hamad General Hospital, HMC, Doha, Qatar
| | - Ismail Mahmood
- Department of Surgery, Trauma Surgery, Hamad General Hospital, HMC, Doha, Qatar
| | - Ahmed Ajaj
- Department of Surgery, Trauma Surgery, Hamad General Hospital, HMC, Doha, Qatar
| | - Sajid Atique
- Department of Surgery, Trauma Surgery, Hamad General Hospital, HMC, Doha, Qatar
| | - Abubaker Alaieb
- Department of Surgery, Trauma Surgery, Hamad General Hospital, HMC, Doha, Qatar
| | | | - Mohammad Asim
- Trauma & Vascular Surgery, Clinical Research, Hamad General Hospital, Hamad Medical Corporation (HMC), P.O Box 3050, Doha, Qatar
| | - Guillaume Alinier
- Hamad Medical Corporation Ambulance Service, Medical City, HMC, Doha, Qatar.,Weill Cornell Medicine-Qatar, Doha, Qatar.,School of Health and Social Work, Paramedic Division, University of Hertfordshire, Hatfield, UK.,Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Nicholas R Castle
- Hamad Medical Corporation Ambulance Service, Medical City, HMC, Doha, Qatar
| | - Ahammed Mekkodathil
- Trauma & Vascular Surgery, Clinical Research, Hamad General Hospital, Hamad Medical Corporation (HMC), P.O Box 3050, Doha, Qatar
| | - Sandro Rizoli
- Department of Surgery, Trauma Surgery, Hamad General Hospital, HMC, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery, Hamad General Hospital, HMC, Doha, Qatar
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El-Menyar A, Asim M, Mir F, Hakim S, Kanbar A, Siddiqui T, Younis B, Ahmed K, Mahmood I, Atique S, Al Jogol H, Taha I, Mustafa F, Alabdallat M, Abdelrahman H, Peralta R, Al-Thani H. Patterns and Effects of Admission Hyperglycemia and Inflammatory Response in Trauma Patients: A Prospective Clinical Study. World J Surg 2021; 45:2670-2681. [PMID: 34117510 PMCID: PMC8321976 DOI: 10.1007/s00268-021-06190-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The constellation of the initial hyperglycemia, proinflammatory cytokines and severity of injury among trauma patients is understudied. We aimed to evaluate the patterns and effects of on-admission hyperglycemia and inflammatory response in a level 1 trauma center. We hypothesized that higher initial readings of blood glucose and cytokines are associated with severe injuries and worse in-hospital outcomes in trauma patients. METHODS A prospective, observational study was conducted for adult trauma patients who were admitted and tested for on-admission blood glucose, hemoglobin A1c, interleukin (IL)-6, IL-18 and hs-CRP. Patients were categorized into four groups [non-diabetic normoglycemic, diabetic normoglycemic, diabetic hyperglycemic (DH) and stress-induced hyperglycemic (SIH)]. The inflammatory markers were measured on three time points (admission, 24 h and 48 h). Generalized estimating equations (GEE) were used to account for the correlation for the inflammatory markers. Pearson's correlation test and logistic regression analysis were also performed. RESULTS During the study period, 250 adult trauma patients were enrolled. Almost 13% of patients presented with hyperglycemia (50% had SIH and 50% had DH). Patients with SIH were younger, had significantly higher Injury Severity Score (ISS), higher IL-6 readings, prolonged hospital length of stay and higher mortality. The SIH group had lower Revised Trauma Score (p = 0.005), lower Trauma Injury Severity Score (p = 0.01) and lower GCS (p = 0.001). Patients with hyperglycemia had higher in-hospital mortality than the normoglycemia group (12.5% vs 3.7%; p = 0.02). A significant correlation was identified between the initial blood glucose level and serum lactate, IL-6, ISS and hospital length of stay. Overall rate of change in slope 88.54 (95% CI:-143.39-33.68) points was found more in hyperglycemia than normoglycemia group (p = 0.002) for IL-6 values, whereas there was no statistical significant change in slopes of age, gender and their interaction. The initial IL-6 levels correlated with ISS (r = 0.40, p = 0.001). On-admission hyperglycemia had an adjusted odds ratio 2.42 (95% CI: 1.076-5.447, p = 0.03) for severe injury (ISS > 12) after adjusting for age, shock index and blood transfusion. CONCLUSIONS In trauma patients, on-admission hyperglycemia correlates well with the initial serum IL-6 level and is associated with more severe injuries. Therefore, it could be a simple marker of injury severity and useful tool for patient triage and risk assessment. TRIAL REGISTRATION This study was registered at the ClinicalTrials.gov (Identifier: NCT02999386), retrospectively Registered on December 21, 2016. https://clinicaltrials.gov/ct2/show/NCT02999386 .
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Affiliation(s)
- Ayman El-Menyar
- Clinical Medicine, Weill Cornell Medical College, Doha, Qatar.
- Trauma & Vascular Surgery, Clinical Research, Hamad General Hospital, Doha, Qatar.
| | - Mohammad Asim
- Trauma & Vascular Surgery, Clinical Research, Hamad General Hospital, Doha, Qatar
| | - Fayaz Mir
- Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar
| | - Suhail Hakim
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ahad Kanbar
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Tariq Siddiqui
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Basil Younis
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Khalid Ahmed
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ismail Mahmood
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Sajid Atique
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Hisham Al Jogol
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ibrahim Taha
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Fuad Mustafa
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | | | - Husham Abdelrahman
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ruben Peralta
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
- Department of Surgery, Universidad Nacional Pedro Henriquez Urena, Santo Domingo, Dominican Republic
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
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Abdessater M, Kanbar A, El Khoury J, Akl H, Halabi R, Assaf S, Hanna E, Boustany J, El Khoury R. Role of urinary cotinine level in the recurrence of non-muscle invasive bladder cancer. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01102-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ghouri SI, Asim M, Mustafa F, Kanbar A, Ellabib M, Al Jogol H, Muneer M, Abdurraheim N, Goel AP, Abdelrahman H, Al-Thani H, El-Menyar A. Patterns, Management, and Outcome of Traumatic Femur Fracture: Exploring the Experience of the Only Level 1 Trauma Center in Qatar. Int J Environ Res Public Health 2021; 18:ijerph18115916. [PMID: 34072990 PMCID: PMC8198965 DOI: 10.3390/ijerph18115916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/24/2021] [Accepted: 05/27/2021] [Indexed: 11/16/2022]
Abstract
Background: Femur is the most fractured long bone in the body that often necessitates surgical fixation; however, data on the impact of the mechanism of injury (MOI), age, and timing of intervention are lacking in our region of the Arab Middle East. We aimed to describe the patterns, management, and outcome of traumatic femoral shaft fractures. Methods: A retrospective descriptive observational study was conducted for all trauma patients admitted with femoral shaft fractures between January 2012 and December 2015 at the only level 1 trauma center and tertiary hospital in the country. Data were analyzed and compared according to the time to intervention (intramedullary nailing; IMN), MOI, and age groups. Main outcomes included in-hospital complications and mortality. Results: A total of 605 hospitalized cases with femur fractures were reviewed. The mean age was 30.7 ± 16.2 years. The majority of fractures were unilateral (96.7%) and 91% were closed fractures. Three-fourths of fractures were treated by reamed intramedullary nailing (rIMN), antegrade in 80%. The pyriform fossa nails were used in 71.6% while trochanteric entry nails were used in 28.4%. Forty-five (8.9%) fractures were treated with an external fixator, 37 (6.1%) had conservative management. Traffic-related injuries occurred more in patients aged 14–30 years, whereas fall-related injuries were significantly higher in patients aged 31–59. Thirty-one patients (7.8%) had rIMN in less than 6 h post-injury, 106 (25.5%) had rIMN after 6–12 h and 267 (66.8%) had rIMN after more than 12 h. The implant type, duration of surgery, DVT prophylaxis, in-hospital complications, and mortality were comparable among the three treatment groups. Conclusions: In our center, the frequency of femoral fracture was 11%, and it mainly affected severely injured young males due to traffic-related collisions or falls. Further multicenter studies are needed to set a consensus for an appropriate management of femur fracture based on the MOI, location, and timing of injury.
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Affiliation(s)
- Syed Imran Ghouri
- Department of Surgery, Orthopedic Surgery, Hamad General Hospital, Doha, Qatar;
| | - Mohammad Asim
- Clinical Research, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar;
| | - Fuad Mustafa
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar; (F.M.); (A.K.); (M.E.); (H.A.J.); (N.A.); (A.P.G.); (H.A.)
| | - Ahad Kanbar
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar; (F.M.); (A.K.); (M.E.); (H.A.J.); (N.A.); (A.P.G.); (H.A.)
| | - Mohamed Ellabib
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar; (F.M.); (A.K.); (M.E.); (H.A.J.); (N.A.); (A.P.G.); (H.A.)
| | - Hisham Al Jogol
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar; (F.M.); (A.K.); (M.E.); (H.A.J.); (N.A.); (A.P.G.); (H.A.)
| | - Mohammed Muneer
- Department of Surgery, Plastic Surgery, Hamad General Hospital, Doha, Qatar;
| | - Nuri Abdurraheim
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar; (F.M.); (A.K.); (M.E.); (H.A.J.); (N.A.); (A.P.G.); (H.A.)
| | - Atirek Pratap Goel
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar; (F.M.); (A.K.); (M.E.); (H.A.J.); (N.A.); (A.P.G.); (H.A.)
| | - Husham Abdelrahman
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar; (F.M.); (A.K.); (M.E.); (H.A.J.); (N.A.); (A.P.G.); (H.A.)
| | - Hassan Al-Thani
- Department of Surgery, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar;
| | - Ayman El-Menyar
- Clinical Research, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar;
- Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
- Correspondence: ; Tel.: +974-44396130
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Clerget A, Kanbar A, Abdessater M. [Corrigendum to "Urinary tract symptoms and erectile dysfunction in obstructive sleep apnea: Systematic review"]. Prog Urol 2021; 31:240. [PMID: 33487549 DOI: 10.1016/j.purol.2020.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- A Clerget
- Sorbonne Université, 21, rue de l'École-de-médecine, 75006 Paris, France
| | - A Kanbar
- Service d'urologie, centre hospitalier René-Dubos, 6, avenue de l'Île-de-France, 95300 Pontoise, France
| | - M Abdessater
- Service d'urologie, centre hospitalier René-Dubos, 6, avenue de l'Île-de-France, 95300 Pontoise, France.
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Abdessater M, Akakpo W, Kanbar A, Parra J, Chartier-Kastler E, Roupret M. Traitement de la maladie de Lapeyronie par les ondes de choc de faible intensité : expérience monocentrique. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abdessater M, Boustany J, Khoury JE, Akl H, Hachem CE, Halabi R, Kanbar A, El Khoury R. La cotinine urinaire : un marqueur prometteur de récurrence des tumeurs vésicales non infiltrant le muscle (TVNIM). Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Al-Thani H, Mekkodathil A, Consunji R, Mollazehi M, Ammar AA, Parchani A, Jogol H, Hakim SY, Kanbar A, El-Menyar A. Traumatic injuries associated with suicide attempts: A retrospective study from single national level 1 trauma center. Int J Crit Illn Inj Sci 2020; 10:92-98. [PMID: 32904460 PMCID: PMC7456287 DOI: 10.4103/ijciis.ijciis_64_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 01/20/2020] [Accepted: 02/21/2020] [Indexed: 11/04/2022] Open
Abstract
Background: Suicide is a complex phenomenon involving several risk factors. We aimed to describe the frequency, pattern, and outcomes of patients with traumatic injuries following suicide attempts admitted to a level 1 trauma center. Methods: We conducted a retrospective analysis of data obtained from Qatar National Trauma Registry and mortuary database. The study included all patients with traumatic injuries following suicide attempts, admitted to the Hamad Trauma Center (HTC) from April 2008 to March 2018. Results: During this 10–year period, 206 patients were admitted to the HTC for injuries associated with suicide attempts. The majority were males (76%), young age (mean age 31 years), and expatriates specifically from South Asia (55%). The most common injury was due to self-inflicted cutting and piercing (51%) followed by jumping from height (30%). Females chose jumping from high place more often as a method of suicide attempt (59% vs. 20%), while males chose self-stabbing or cutting their throat (59% vs. 25%) (P = 0.001). Most of the patients had head injuries (30%) that was severe in terms of abbreviated injury scale score (3.6 ± 0.9). More than half (54%) of the patients required psychiatric consultations. The in-hospital mortality was 8% which was comparable in both genders. Conclusions: The present study revealed that 1.8% of trauma admissions at HTC were related to suicidal attempts. Better understanding of risk factors is important in devising preventive strategies.
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Affiliation(s)
- Hassan Al-Thani
- Department of Surgery, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Ahammed Mekkodathil
- Department of Surgery, Clinical Research, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Rafael Consunji
- Department of Surgery, Trauma Surgery, Hamad Injury Prevention Program, Hamad General Hospital, Doha, Qatar
| | - Monira Mollazehi
- Department of Surgery, Trauma Surgery, National Trauma Registry, Hamad General Hospital, Doha, Qatar
| | - Adham A Ammar
- Laboratory Department, Clinical Services Unit, Hamad General Hospital, Doha, Qatar
| | - Ashok Parchani
- Department of Surgery, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Hisham Jogol
- Department of Surgery, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Suhail Y Hakim
- Department of Surgery, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Ahad Kanbar
- Department of Surgery, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Department of Surgery, Clinical Research, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar.,Department of Clinical Medicine, Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
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Clerget A, Kanbar A, Abdessater M. [Urinary tract symptoms and erectile dysfunction in obstructive sleep apnea: Systematic review]. Prog Urol 2020; 30:1069-1077. [PMID: 32830023 DOI: 10.1016/j.purol.2020.07.244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 07/05/2020] [Accepted: 07/16/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The objective of this work was to make a review of urinary tract symptoms and erectile dysfunction involved in obstructive sleep apnea (OSA) but also to study their physiopathology and potential treatments. METHODS We conducted a literature review in the Pubmed database using PRISMA guidelines and the MeSH terms: sleep apnea, urinary incontinence, erectile dysfunction, sexuality. All French and English articles published up to 2020 were evaluated. RESULTS The initial evaluation identified 240 articles from which 30 were included. References lists review allowed the inclusion of 26 additional articles. Nocturia, overactive bladder (OAB) and erectile dysfunction (ED) were associated with OSA. Increased levels of natriuretic peptides are behind nocturia. Nocturia is associated with higher Apnea/Hypopnea Index (AHI) (49±11 vs 24±8 episodes/hour with P=0.0001). The severity of nocturia is proportional to the severity of OSA with a positive predictive value of 71%. Intermittent nocturnal hypoxemia causes peripheral axonal damage with subsequent urgency incontinence. There is correlation between severity of OAB and the severity of OSA especially when the latter is moderate or severe. An odds ratio of 0.45 (CI95%: 0.18-0.71) is found for ED in patients who don't have OSA, associating the latter to an increased risk of ED. Intermittent nocturnal hypoxemia, the decrease in the levels of nitric oxide, and the increase in blood pressure and levels of endothelin 1 contribute to the development of ED. An early treatment of OSA with continuous positive airway pressure (CPAP) may allow a partial but significant control of urinary symptoms and erectile dysfunction associated with OSA. CONCLUSION OSA is associated with urinary tract symptoms (nocturia and OAB) and erectile dysfunction. The severity of associated symptoms is related to the severity of OSA. Urinary and sexual troubles are reversible after treatment of OSA by CPAP. OSA research is reasonable in case of pathologic nocturia or ED with loss of morning erections.
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Affiliation(s)
- A Clerget
- Sorbonne Université, 21, rue de l'École-de-Médecine, 75006 Paris, France
| | - A Kanbar
- Service d'urologie, centre hospitalier René-Dubos, 6, avenue de l'Île-de-France, 95300 Pontoise, France
| | - M Abdessater
- Service d'urologie, centre hospitalier René-Dubos, 6, avenue de l'Île-de-France, 95300 Pontoise, France.
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Mekkodathil A, El-Menyar A, Kanbar A, Hakim S, Ahmed K, Siddiqui T, Al-Thani H. Epidemiological and clinical characteristics of fall-related injuries: a retrospective study. BMC Public Health 2020; 20:1186. [PMID: 32727594 PMCID: PMC7388431 DOI: 10.1186/s12889-020-09268-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 07/15/2020] [Indexed: 11/30/2022] Open
Abstract
Background Fall-related injuries are important public health problem worldwide. We aimed to describe the epidemiological and clinical characteristics of fall-related injuries in a level 1 trauma center. Method A retrospective analysis of Qatar Trauma Registry data was conducted on patients admitted for fall-related injuries between 2010 and 2017. Comparative analyses of data by gender, age-groups and height of falls were performed to describe the epidemiological and clinical characteristics of patients, and in-hospital outcomes. Results A total of 4040 patients with fall-related injuries were identified in the study duration which corresponds to the rate of 2.34 per 10,000 population. Although the rate of fall-related injuries decreased over the years, the average number of patients per year remained high accounting for 32% of the hospitalized patients with moderate to severe injuries. Most of the injuries affected the head (36%) followed by spines (29%) and chest (23%). Males were predominant (89%), more likely to fall at workplace, fall from a greater height and have polytrauma than females. The working age-group (20–59 years) constituted the majority of injured (73%) and were more likely to fall at workplace, and to fall from higher heights compared to the older adults who sustained more fall at home. Overall in-hospital mortality was 3%. Outcomes including longer hospital length of stay and mortality were generally correlated with the height of fall except for the fall at home. Conclusion Fall-related injuries remain as significant burden even in a level 1 trauma center. Variations in the pattern of injuries by age, gender and height of fall provide important information for targeted preventive measures.
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Affiliation(s)
- Ahammed Mekkodathil
- Clinical Research, Trauma & Vascular Surgery Section, Hamad General Hospital , PO Box 3050, Doha, Qatar
| | - Ayman El-Menyar
- Clinical Research, Trauma & Vascular Surgery Section, Hamad General Hospital , PO Box 3050, Doha, Qatar. .,Clinical Medicine, Weill Cornell Medical College, Doha, Qatar.
| | - Ahad Kanbar
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar
| | - Suhail Hakim
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar
| | - Khalid Ahmed
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar
| | - Tariq Siddiqui
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma &Vascular Surgery Section, HGH, Doha, Qatar
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Abdessater M, Kanbar A, Gas J, Bart S, Coloby P, Beley S, Sleiman W. [Non-surgical management of Peyronie's disease: State of current knowledge]. Prog Urol 2020; 30:353-364. [PMID: 32279954 DOI: 10.1016/j.purol.2020.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 02/01/2020] [Accepted: 03/05/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Peyronie's disease is an inflammatory disorder of the penis, where scar tissue creates a plaque at the level of the albuginea, limits its extension, and leads to a bent and shorter penis during erections. There are no international standards for the evaluation and the treatment of the disease. The aim of this article is to review the current knowledge about the management of Peyronie's disease and to suggest an algorithm to help physicians evaluate and manage this condition. MATERIAL AND METHODS A literature review was conducted through PubMed database following PRISMA guidelines using the Mesh terms: Peyronie, disease, treatment and diagnosis. Results are presented in a descriptive manner. RESULTS Multiple treatment strategies have been proposed, but no conclusive randomized clinical trial is done to assess their efficacies. The oral treatment was shown to be more beneficial in the setting of a multi-modal approach to treat the acute phase. The non-steroidal anti-inflammatories and the potassium para-aminobenzoate are superior to the other molecules of oral therapy for pain management. Local treatment with topical verapamil, iontophoresis and intra-lesional injection of verapamil, interferon alfa-2b and collagenase clostridium histolyticum (CCH) revolutionized the management of the disease by the modification of the plaque size and angulation. Alternative treatments using extra-corporeal shock wave or traction devices are promising. Intra-lesional injection of CCH is the only therapy approved by the Food and Drug Administration for this condition after the stabilization of the disease. The channeling of the plaque before CCH injections is making better results than the initial protocol, concerning angulation improvement. CONCLUSION Multiple therapeutic strategies exist for the management of the Peyronie's disease, but they lack evidence based data. Further randomized clinical trials are needed to evaluate the current practices and to study more efficient treatments.
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Affiliation(s)
- M Abdessater
- Service d'urologie et de transplantation rénale, hôpital universitaire Pitié-Salpêtrière, AP-HP, Paris, France.
| | - A Kanbar
- Service d'urologie, groupe hospitalier diaconesses, Croix-Saint-Simon, Paris, France
| | - J Gas
- Département d'urologie, andrologie et transplantation rénale, centre hospitalier universitaire de Toulouse, Toulouse, France
| | - S Bart
- Service d'urologie, centre hospitalier René-Dubos, Pontoise, France
| | - P Coloby
- Service d'urologie, centre hospitalier René-Dubos, Pontoise, France
| | - S Beley
- Service d'urologie, groupe hospitalier diaconesses, Croix-Saint-Simon, Paris, France
| | - W Sleiman
- Service d'urologie, centre hospitalier René-Dubos, Pontoise, France
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Al-Hassani A, Jabbour G, ElLabib M, Kanbar A, El-Menyar A, Al-Thani H. Delayed bile leak in a patient with grade IV blunt liver trauma: A case report and review of the literature. Int J Surg Case Rep 2015; 14:156-9. [PMID: 26279258 PMCID: PMC4573864 DOI: 10.1016/j.ijscr.2015.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 07/29/2015] [Accepted: 08/04/2015] [Indexed: 11/20/2022] Open
Abstract
A case with delayed bile leak in a young male patient who presented with grade IV blunt liver injury following a motor vehicle collision. In addition to a high grade injury; centrally located liver injury is a significant risk factor for major bile duct injury. For such patients, early MRCP and ERCP may be warranted to rule out a significant bile leak. Patients with high grade liver injury are at risk of serious complications. There is a need for prompt diagnosis and treatment of delayed bile leak in blunt liver injuries.
Introduction Delayed bile leak following blunt liver trauma is not common. Presentation of case We presented a case report and literature review of delayed bile leak in a young male patient who presented with grade IV blunt liver injury following a motor vehicle collision; he was a restrained driver who hit a fixed object. Physical examination was unremarkable except for revelaed tachycardia, right upper quadrant abdominal tenderness, and open left knee fracture. A diagnosis of grade IV multiple liver lacerations with large hemo-peritoneum was made and urgent exploratory laparotomy was performed. The patient developed a biloma collection post- operatively. He underwent endoscopic retrograde cholangiopancreatography (ERCP) and common bile duct stenting. His recovery was uneventful, and he was discharged home after 1 month. Discussion This is a rare case with no intra or extra hepatic biliary radicle injury seen on magnetic resonance cholangiopancreatography (MRCP) and no evidence of leak by ERCP. A review of the literature to highlight the incidence of delayed bile leak revealed only few reported cases. Conclusion Our findings demonstrate the need for prompt diagnosis and treatment of delayed bile leak in blunt liver injuries. When these principles are followed, a successful outcome is possible.
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Affiliation(s)
- Ammar Al-Hassani
- Department of surgery, Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar; Clinical Medicine, Weill Cornell Medical College, Doha, Qatar.
| | - Gaby Jabbour
- Department of Surgery, HGH, Doha, Qatar; Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Mohammad ElLabib
- Department of surgery, Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar; Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Ahad Kanbar
- Department of surgery, Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar; Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Ayman El-Menyar
- Department of Surgery, HGH, Doha, Qatar; Clinical Research, Trauma Surgery, HGH, Doha, Qatar; Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Hassan Al-Thani
- Department of surgery, Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar; Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
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Consunji R, Peralta R, Abdelrahman H, Mostafa Z, Al-Hamzawi H, Jogol HA, Alani M, Kanbar A, El-Menyar A, Al-Thani H. Critique of “Identifying the bleeding trauma patient: predictive factors for massive transfusion in an Australasian trauma population”. Journal of Emergency Medicine, Trauma and Acute Care 2014. [DOI: 10.5339/jemtac.2014.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background: Military and civilian data would suggest that hemostatic resuscitation results in improved outcomes for exsanguinating patients. However, identification of those patients who are at risk of significant hemorrhage is not clearly defined. We attempted to identify factors that would predict the need for massive transfusion (MT) in an Australasian trauma population, by comparing those trauma patients who did receive massive transfusion with those who did not. Methods: Between 1985 and 2010, 1,686 trauma patients receiving at least 1 U of packed red blood cells were identified from our prospectively maintained trauma registry. Demographic, physiologic, laboratory, injury, and outcome variables were reviewed. Univariate analysis determined significant factors between those who received MT and those who did not. A predictive multivariate logistic regression model with backward conditional stepwise elimination was used for MT risk. Statistical analysis was performed using SPSS PASW. Results: MT patients had a higher pulse rate, lower Glasgow Coma Scale (GCS) score, lower systolic blood pressure, lower hemoglobin level, higher Injury Severity Score (ISS), higher international normalized ratio (INR), and longer stay. Initial logistic regression identified base deficit (BD), INR, and hemoperitoneum at laparotomy as independent predictive variables. After assigning cutoff points of BD being greater than 5 and an INR of 1.5 or greater, a further model was created. A BD greater than 5 and either INR of 1.5 or greater or hemoperitoneum was associated with 51 times increase in MT risk (odds ratio, 51.6; 95% confidence interval, 24.9Y95.8). The area under the receiver operating characteristic curve for the model was 0.859. Conclusion: From this study, a combination of BD, INR, and hemoperitoneum has demonstrated good predictability for MT. This tool may assist in the determination of those patients who might benefit from hemostatic resuscitation.
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Affiliation(s)
- Rafael Consunji
- 1Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar
| | - Ruben Peralta
- 1Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar
| | - Husham Abdelrahman
- 1Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar
| | - Zeinab Mostafa
- 1Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar
| | - Hazim Al-Hamzawi
- 1Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar
| | - Hisham Al Jogol
- 1Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar
| | - Mushrek Alani
- 1Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar
| | - Ahad Kanbar
- 1Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar
| | - Ayman El-Menyar
- 2Clinical Research, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar
| | - Hassan Al-Thani
- 1Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar
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