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Serviá L, Llompart-Pou JA, Chico-Fernández M, Montserrat N, Badia M, Barea-Mendoza JA, Ballesteros-Sanz MÁ, Trujillano J. Development of a new score for early mortality prediction in trauma ICU patients: RETRASCORE. Crit Care 2021; 25:420. [PMID: 34876199 PMCID: PMC8650319 DOI: 10.1186/s13054-021-03845-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/26/2021] [Indexed: 11/20/2022] Open
Abstract
Background Severity scores are commonly used for outcome adjustment and benchmarking of trauma care provided. No specific models performed only with critically ill patients are available. Our objective was to develop a new score for early mortality prediction in trauma ICU patients. Methods This is a retrospective study using the Spanish Trauma ICU registry (RETRAUCI) 2015–2019. Patients were divided and analysed into the derivation (2015–2017) and validation sets (2018–2019). We used as candidate variables to be associated with mortality those available in RETRAUCI that could be collected in the first 24 h after ICU admission. Using logistic regression methodology, a simple score (RETRASCORE) was created with points assigned to each selected variable. The performance of the model was carried out according to global measures, discrimination and calibration. Results The analysis included 9465 patients: derivation set 5976 and validation set 3489. Thirty-day mortality was 12.2%. The predicted probability of 30-day mortality was determined by the following equation: 1/(1 + exp (− y)), where y = 0.598 (Age 50–65) + 1.239 (Age 66–75) + 2.198 (Age > 75) + 0.349 (PRECOAG) + 0.336 (Pre-hospital intubation) + 0.662 (High-risk mechanism) + 0.950 (unilateral mydriasis) + 3.217 (bilateral mydriasis) + 0.841 (Glasgow ≤ 8) + 0.495 (MAIS-Head) − 0.271 (MAIS-Thorax) + 1.148 (Haemodynamic failure) + 0.708 (Respiratory failure) + 0.567 (Coagulopathy) + 0.580 (Mechanical ventilation) + 0.452 (Massive haemorrhage) − 5.432. The AUROC was 0.913 (0.903–0.923) in the derivation set and 0.929 (0.918–0.940) in the validation set. Conclusions The newly developed RETRASCORE is an early, easy-to-calculate and specific score to predict in-hospital mortality in trauma ICU patients. Although it has achieved adequate internal validation, it must be externally validated. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03845-6.
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Affiliation(s)
- Luis Serviá
- Servei de Medicina Intensiva, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, IRBLleida, Lleida, Spain
| | - Juan Antonio Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Mario Chico-Fernández
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Neus Montserrat
- Servei de Medicina Intensiva, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, IRBLleida, Lleida, Spain
| | - Mariona Badia
- Servei de Medicina Intensiva, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, IRBLleida, Lleida, Spain
| | - Jesús Abelardo Barea-Mendoza
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Javier Trujillano
- Servei de Medicina Intensiva, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, IRBLleida, Lleida, Spain. .,Intensive Care Unit, Hospital Universitario Arnau de Vilanova, Avda Rovira Roure 80, 25198, Lleida, Spain.
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Constantino CS, Carvalho AM, Vinga S. Coupling sparse Cox models with clustering of longitudinal transcriptomics data for trauma prognosis. BioData Min 2021; 14:25. [PMID: 33853663 PMCID: PMC8048345 DOI: 10.1186/s13040-021-00257-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/29/2021] [Indexed: 11/18/2022] Open
Abstract
Background Longitudinal gene expression analysis and survival modeling have been proved to add valuable biological and clinical knowledge. This study proposes a novel framework to discover gene signatures and patterns in a high-dimensional time series transcriptomics data and to assess their association with hospital length of stay. Methods We investigated a longitudinal and high-dimensional gene expression dataset from 168 blunt-force trauma patients followed during the first 28 days after injury. To model the length of stay, an initial dimensionality reduction step was performed by applying Cox regression with elastic net regularization using gene expression data from the first hospitalization days. Also, a novel methodology to impute missing values to the genes selected previously was proposed. We then applied multivariate time series (MTS) clustering to analyse gene expression over time and to stratify patients with similar trajectories. The validation of the patients’ partitions obtained by MTS clustering was performed using Kaplan-Meier curves and log-rank tests. Results We were able to unravel 22 genes strongly associated with hospital’s discharge. Their expression values in the first days after trauma showed to be good predictors of the length of stay. The proposed mixed imputation method allowed to achieve a complete dataset of short time series with a minimum loss of information for the 28 days of follow-up. MTS clustering enabled to group patients with similar genes trajectories and, notably, with similar discharge days from the hospital. Patients within each cluster have comparable genes’ trajectories and may have an analogous response to injury. Conclusion The proposed framework was able to tackle the joint analysis of time-to-event information with longitudinal multivariate high-dimensional data. The application to length of stay and transcriptomics data revealed a strong relationship between gene expression trajectory and patients’ recovery, which may improve trauma patient’s management by healthcare systems. The proposed methodology can be easily adapted to other medical data, towards more effective clinical decision support systems for health applications.
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Affiliation(s)
- Cláudia S Constantino
- INESC-ID, Instituto Superior Técnico, ULisboa, R. Alves Redol 9, Lisbon, 1000-029, Portugal
| | - Alexandra M Carvalho
- Instituto de Telecomunicações, Instituto Superior Técnico, ULisboa, Av. Rovisco Pais 1, Lisbon, 1049-001, Portugal
| | - Susana Vinga
- INESC-ID, Instituto Superior Técnico, ULisboa, R. Alves Redol 9, Lisbon, 1000-029, Portugal. .,IDMEC, Instituto Superior Técnico, ULisboa, Av. Rovisco Pais 1, Lisbon, 1049-001, Portugal.
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Visser E, Den Oudsten BL, Traa MJ, Gosens T, De Vries J. Patients' experiences and wellbeing after injury: A focus group study. PLoS One 2021; 16:e0245198. [PMID: 33411828 PMCID: PMC7790403 DOI: 10.1371/journal.pone.0245198] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 12/27/2020] [Indexed: 01/07/2023] Open
Abstract
Background Injury can have physical, psychological and social consequences. It is unclear which factors have an impact on patients’ wellbeing after injury. This study aimed to explore, using focus groups, patients’ experiences and wellbeing after injury and which factors, impede or facilitate patients’ wellbeing. Methods Trauma patients, treated in the shock room of the Elisabeth-TweeSteden Hospital, the Netherlands, participated in focus groups. Purposive sampling was used. Exclusion criteria were younger than 18 years old, severe traumatic brain injury, dementia, and insufficient knowledge of the Dutch language. The interviews were recorded, transcribed verbatim, and analyzed using coding technique open, axial, and selective coding, based on phenomenological approach. Results Six focus groups (3 to 7 participants) were held before data saturation was reached. In total, 134 patients were invited, 28 (21%) agreed to participate (Median age: 59.5; min. 18 –max. 84). Main reasons to decline were fear that the discussion would be too confronting or patients experienced no problems regarding the trauma or treatment. Participants experienced difficulties on physical (no recovery to pre-trauma level), psychological (fear of dying or for permanent limitations, symptoms of posttraumatic stress disorder, cognitive dysfunction), social (impact on relatives and social support) wellbeing. These are impeding factors for recovery. However, good communication, especially clarity about the injury and expectations concerning recovery and future perspectives could help patients in surrendering to care. Patients felt less helpless when they knew what to expect. Conclusions This is the first study that explored patients’ experiences and wellbeing after injury. Patients reported that their injury had an impact on their physical, psychological, and social wellbeing up to 12 months after injury. Professionals with the knowledge of consequences after injury could improve their anticipation on patients’ need.
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Affiliation(s)
- Eva Visser
- Trauma TopCare, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Tilburg, The Netherlands
- * E-mail:
| | - Brenda Leontine Den Oudsten
- Center of Research on Psychological and Somatic Disorders, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Marjan Johanna Traa
- Department of Medical Psychology; ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Tilburg, The Netherlands
| | - Taco Gosens
- Department of Orthopaedics, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Tilburg, The Netherlands
| | - Jolanda De Vries
- Center of Research on Psychological and Somatic Disorders, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
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Sainz Cabrejas J, García Fuentes C, García Juarranz C, González López A, Maure Blesa L, Montejo González J, Chico Fernández M. Valoración de la calidad asistencial al traumatismo grave mediante comparación con estándares internacionales. Med Intensiva 2020; 44:325-332. [DOI: 10.1016/j.medin.2019.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 01/17/2019] [Accepted: 02/05/2019] [Indexed: 12/23/2022]
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Visser E, Gosens T, Den Oudsten B, De Vries J. Physical Trauma Patients with Symptoms of an Acute and Posttraumatic Stress Disorder: Protocol for an Observational Prospective Cohort Study. JMIR Res Protoc 2018; 7:e88. [PMID: 29599104 PMCID: PMC5897623 DOI: 10.2196/resprot.9006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 12/21/2017] [Accepted: 12/21/2017] [Indexed: 11/24/2022] Open
Abstract
Background Injury, medical treatment, and rehabilitation can have major impacts on patients’ wellbeing. About 25-33% of the patients experience an acute stress disorder (ASD) or a posttraumatic stress disorder (PTSD) after injury. ASD is a relatively new diagnosis. Therefore, knowledge about patients’ experiences, the course of ASD and PTSD, and who is at risk for developing ASD or PTSD is lacking. Objective The aims of this multi-method study are to explore patients’ experiences with injury (and their care) using a focus group study. Then, in the observational study, different courses of ASD, PTSD, and quality of life will be examined. In addition, this study will examine if these courses could be characterized by socio-demographic, clinical, and psychological variables. Consequently, a risk profile will be developed to determine which patients are at risk for developing ASD or PTSD during the 12 months after injury. Methods Trauma patients treated in the shock room (in 2015) of the Elisabeth-TweeSteden Hospital will share their experiences with injury in the focus group study. Open, axial, and selective coding will be used to analyze the data. Concerning the observational study, patients treated in the shock room (during 2016 and 2017, Elisabeth-TweeSteden Hospital and Erasmus Medical Centre) will be asked to participate. The inclusion period is 12 months. Participants will complete the Impact of Event Scale-Revised, MINI-plus, the Hospital Anxiety and Depression Scale, and the World Health Organization Quality of Life-BREF after inclusion and at 3, 6, 9, and 12 months after injury. The NEO-Five Factor Inventory and the State-Trait Anxiety Inventory-Trait are completed after inclusion only. Repeated measures of latent class analysis and linear mixed models will be used to examine the research aims. Results This project was funded in August 2015 by ZonMw. The results of the focus group study are expected in the first trimester of 2018. With regard to the observational study, recruitment is currently underway. Data collection will be completed in November 2018. The first results will be expected in the first trimester of 2019. Conclusions This is the first multi-method study in trauma patients that examines patients’ experiences (qualitative design) as well as psychological disorders (observational prospective). This study will contribute to necessary information on psychological consequences after injury. Moreover, it provides knowledge about which patients to include in future psychological intervention research. Finally, awareness in clinicians about the psychological consequences can be created, so they are able to act more effectively to provide patient-oriented care. Trial Registration Netherlands Trial Registry NTR6258; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=6258 (Archived by WebCite at http://www.webcitation.org/6xSCiO1bS)
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Affiliation(s)
- Eva Visser
- Trauma TopCare, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands
| | - Taco Gosens
- Department of Orthopaedics, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands
| | - Brenda Den Oudsten
- Center of Research on Psychological and Somatic Disorders, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
| | - Jolanda De Vries
- Department of Medical Psychology, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands
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The course, prediction, and treatment of acute and posttraumatic stress in trauma patients. J Trauma Acute Care Surg 2017; 82:1158-1183. [DOI: 10.1097/ta.0000000000001447] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Abstract
BACKGROUND Injury patterns may differ in trauma patients when age is considered. This information is relevant in the management of trauma patients and for planning preventive measures. METHODS We included in the study all patients admitted for traumatic disease in the participating ICUs from November 23rd, 2012 to July 31st, 2015 with complete records. Data on epidemiology, injury patterns, severity scores, acute management, resources utilisation and outcome were recorded and compared in the following groups of age: ≤55years (young adults), 56-65 years (adults), 66-75 years (elderly), >75years (very elderly). Quantitative data were reported as median (Interquartile Range (IQR) 25-75) and categorical data as number and percentage. Comparison between groups of age with quantitative variables was performed using the analysis of variance (ANOVA) test. Differences between groups with categorical variables were compared using the chi-square test. A value of p<0.05 was considered significant. RESULTS We included 2700 patients (78.9% male). Median age was 46 (31-62) years. Blunt trauma was present in 93.7% of the patients. Median RTS was 7.55 (5.97-7.84). Median ISS was 20 (13-26). High-energy trauma secondary to motor-vehicle accident with rhabdomyolysis and drugs abuse showed an inverse linear association with ageing, whilst pedestrian falls with isolated brain injury, being run-over and pre-injury antiplatelets or anticoagulant treatment increased with age (in all cases p<0.001). Multiple injuries were more common in young adults (p<0.001). Acute kidney injury prevalence was higher in elderly and very elderly patients (p<0.001). ICU Mortality increased with age in spite of similar severity scores in all groups (p<0.001). The main cause of death in all groups was intracranial hypertension. CONCLUSIONS Different injury patterns exist in relation with ageing in trauma ICU patients. Adult patients were more likely to present high-energy trauma with significant injuries in different areas whilst elderly patients were prone to low-energy falls, complicated by antiplatelets or anticoagulants use, resulting in severe brain injury and increased mortality.
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Chico-Fernández M, Llompart-Pou JA, Sánchez-Casado M, Alberdi-Odriozola F, Guerrero-López F, Mayor-García MD, Egea-Guerrero JJ, Fernández-Ortega JF, Bueno-González A, González-Robledo J, Servià-Goixart L, Roldán-Ramírez J, Ballesteros-Sanz MÁ, Tejerina-Alvarez E, Pino-Sánchez FI, Homar-Ramírez J. Mortality prediction using TRISS methodology in the Spanish ICU Trauma Registry (RETRAUCI). Med Intensiva 2016; 40:395-402. [PMID: 27068001 DOI: 10.1016/j.medin.2015.11.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 11/09/2015] [Accepted: 11/20/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To validate Trauma and Injury Severity Score (TRISS) methodology as an auditing tool in the Spanish ICU Trauma Registry (RETRAUCI). DESIGN A prospective, multicenter registry evaluation was carried out. SETTING Thirteen Spanish Intensive Care Units (ICUs). PATIENTS Individuals with traumatic disease and available data admitted to the participating ICUs. INTERVENTIONS Predicted mortality using TRISS methodology was compared with that observed in the pilot phase of the RETRAUCI from November 2012 to January 2015. Discrimination was evaluated using receiver operating characteristic (ROC) curves and the corresponding areas under the curves (AUCs) (95% CI), with calibration using the Hosmer-Lemeshow (HL) goodness-of-fit test. A value of p<0.05 was considered significant. MAIN VARIABLES OF INTEREST Predicted and observed mortality. RESULTS A total of 1405 patients were analyzed. The observed mortality rate was 18% (253 patients), while the predicted mortality rate was 16.9%. The area under the ROC curve was 0.889 (95% CI: 0.867-0.911). Patients with blunt trauma (n=1305) had an area under the ROC curve of 0.887 (95% CI: 0.864-0.910), and those with penetrating trauma (n=100) presented an area under the curve of 0.919 (95% CI: 0.859-0.979). In the global sample, the HL test yielded a value of 25.38 (p=0.001): 27.35 (p<0.0001) in blunt trauma and 5.91 (p=0.658) in penetrating trauma. TRISS methodology underestimated mortality in patients with low predicted mortality and overestimated mortality in patients with high predicted mortality. CONCLUSIONS TRISS methodology in the evaluation of severe trauma in Spanish ICUs showed good discrimination, with inadequate calibration - particularly in blunt trauma.
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Affiliation(s)
- M Chico-Fernández
- Trauma and Emergencies ICU, Department of Intensive Care Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J A Llompart-Pou
- Department of Intensive Care Medicine, Hospital Universitari Son Espases, Palma de Mallorca, Spain.
| | - M Sánchez-Casado
- Department of Intensive Care Medicine, Hospital Virgen de la Salud, Toledo, Spain
| | - F Alberdi-Odriozola
- Department of Intensive Care Medicine, Hospital Universitario de Donostia, San Sebastián, Spain
| | - F Guerrero-López
- Department of Intensive Care Medicine, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - M D Mayor-García
- Department of Intensive Care Medicine, Complejo Hospitalario de Torrecárdenas, Almería, Spain
| | - J J Egea-Guerrero
- Department of Intensive Care Medicine, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - J F Fernández-Ortega
- Department of Intensive Care Medicine, Hospital Universitario Carlos Haya, Málaga, Spain
| | - A Bueno-González
- Department of Intensive Care Medicine, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - J González-Robledo
- Department of Intensive Care Medicine, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - L Servià-Goixart
- Department of Intensive Care Medicine, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - J Roldán-Ramírez
- Department of Intensive Care Medicine, Complejo Hospitalario de Pamplona, Navarra, Spain
| | - M Á Ballesteros-Sanz
- Department of Intensive Care Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - E Tejerina-Alvarez
- Department of Intensive Care Medicine, Hospital Universitario de Getafe, Madrid, Spain
| | - F I Pino-Sánchez
- Department of Intensive Care Medicine, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - J Homar-Ramírez
- Department of Intensive Care Medicine, Hospital Universitari Son Espases, Palma de Mallorca, Spain
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Chico-Fernández M, Llompart-Pou JA, Alberdi-Odriozolo F, Guerrero-López F, Sánchez-Casado M, Mayor-García MD, Egea-Guerrero J, Fernández-Ortega JF, Bueno-González A, González-Robledo J, Servià-Goixart L, Roldán-Ramírez J, Ballesteros-Sanz MÁ, Tejerina-Álvarez E. Spanish trauma icu registry (RETRAUCI). final results of the pilot phase. Intensive Care Med Exp 2015. [PMCID: PMC4798319 DOI: 10.1186/2197-425x-3-s1-a377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Chico-Fernández M, Llompart-Pou JA, Guerrero-López F, Sánchez-Casado M, García-Sáez I, Mayor-García MD, Egea-Guerrero J, Fernández-Ortega JF, Bueno-González A, González-Robledo J, Servià-Goixart L, Roldán-Ramírez J, Ballesteros-Sanz MÁ, Tejerina-Alvarez E, García-Fuentes C, Alberdi-Odriozola F. Epidemiology of severe trauma in Spain. Registry of trauma in the ICU (RETRAUCI). Pilot phase. Med Intensiva 2015; 40:327-47. [PMID: 26440993 DOI: 10.1016/j.medin.2015.07.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 07/20/2015] [Accepted: 07/25/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To describe the characteristics and management of severe trauma disease in Spanish Intensive Care Units (ICUs). Registry of trauma in the ICU (RETRAUCI). Pilot phase. DESIGN A prospective, multicenter registry. SETTING Thirteen Spanish ICUs. PATIENTS Patients with trauma disease admitted to the ICU. INTERVENTIONS None. MAIN VARIABLES OF INTEREST Epidemiology, out-of-hospital attention, registry of injuries, resources utilization, complications and outcome were evaluated. RESULTS Patients, n=2242. Mean age 47.1±19.02 years. Males 79%. Blunt trauma 93.9%. Injury Severity Score 22.2±12.1, Revised Trauma Score 6.7±1.6. Non-intentional in 84.4% of the cases. The most common causes of trauma were traffic accidents followed by pedestrian and high-energy falls. Up to 12.4% were taking antiplatelet medication or anticoagulants. Almost 28% had a suspected or confirmed toxic influence in trauma. Up to 31.5% required an out-of-hospital artificial airway. The time from trauma to ICU admission was 4.7±5.3hours. At ICU admission, 68.5% were hemodynamically stable. Brain and chest injuries predominated. A large number of complications were documented. Mechanical ventilation was used in 69.5% of the patients (mean 8.2±9.9 days), of which 24.9% finally required a tracheostomy. The median duration of stay in the ICU and in hospital was 5 (range 3-13) and 9 (5-19) days, respectively. The ICU mortality rate was 12.3%, while the in-hospital mortality rate was 16.0%. CONCLUSIONS The pilot phase of the RETRAUCI offers a first impression of the epidemiology and management of trauma disease in Spanish ICUs.
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Affiliation(s)
- M Chico-Fernández
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España.
| | - J A Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, España
| | - F Guerrero-López
- Servicio de Medicina Intensiva, Hospital Universitario Virgen de las Nieves, Granada, España
| | - M Sánchez-Casado
- Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo, España
| | - I García-Sáez
- Servicio de Medicina Intensiva, Hospital Universitario de Donostia, San Sebastián, España
| | - M D Mayor-García
- Servicio de Medicina Intensiva, Complejo Hospitalario de Torrecárdenas, Almería, España
| | - J Egea-Guerrero
- Servicio de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - J F Fernández-Ortega
- Servicio de Medicina Intensiva, Hospital Universitario Carlos Haya, Málaga, España
| | - A Bueno-González
- Servicio de Medicina Intensiva, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | - J González-Robledo
- Servicio de Medicina Intensiva, Complejo Asistencial Universitario de Salamanca, Salamanca, España
| | - L Servià-Goixart
- Servei de Medicina Intensiva, Hospital Universitari Arnau de Vilanova, Lérida, España
| | | | - M Á Ballesteros-Sanz
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - E Tejerina-Alvarez
- Servicio de Medicina Intensiva, Hospital Universitario de Getafe, Getafe (Madrid), España
| | - C García-Fuentes
- UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España
| | - F Alberdi-Odriozola
- Servicio de Medicina Intensiva, Hospital Universitario de Donostia, San Sebastián, España
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