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Neef S, Meinel FG, Lorbeer R, Ammermann F, Weber MA, Brunk M, Herlyn P, Beller E. Time trend analysis of Injury Severity score of adult trauma patients with emergent CT examination. Emerg Radiol 2024; 31:507-514. [PMID: 38880828 PMCID: PMC11288995 DOI: 10.1007/s10140-024-02253-x] [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: 05/01/2024] [Accepted: 06/03/2024] [Indexed: 06/18/2024]
Abstract
PURPOSE Controversy exists about whole-body computed tomography (CT) as a primary screening modality for suspected multiple trauma patients. Therefore, the aim of this study was to analyze time trends of CT examinations for trauma patients in relation to the Injury Severity Score (ISS). METHODS We retrospectively analyzed 561 adult trauma patients (mean age = 54 years) who were admitted to the trauma room of our hospital, immediately followed by a CT examination, in 2009, 2013 und 2017. Review of electronic patient charts was performed to determine the cause of injury. ISS was either calculated upon hospital charts and CT imaging reports or documented in the TraumaRegister DGU® for trauma patients with ICU treatment or ISS ≥ 16. RESULTS An increasing number of CT examinations of acute trauma patients were performed at our hospital with 117 patients in 2009 compared to 192 in 2013 and 252 in 2017. Their mean age increased (50 years in 2009, 54 in 2013 and 55 in 2017;p = 0.046), whereas their mean ISS decreased over time (15.2 in 2009 compared to 12.1 in 2013 and 10.6 in 2017;p = 0.001), especially in women (15.1 in 2009, 11.8 in 2013 and 7.4 in 2017;p = 0.001 both), younger age groups (18 to 24 years:15.6 in 2009, 6.5 in 2013 and 8.9 in 2017; p = 0.033 and 25 to 49 years:15.0 in 2009, 11.2 in 2013 and 8.3 in 2017;p = 0.001) as well as motor vehicle collision (MVC) victims (16.2 in 2009, 11.8 in 2013 and 6.1 in 2017; p < 0.001). Trauma patients with a high ISS were especially more likely of older age (OR 1.02,p < 0.001) and with the type of incident being a fall (< 3 m: OR3.84,p < 0.001;>3 m: OR6.22,p < 0.001) compared to MVC. CONCLUSION Previous studies suggesting a benefit of primary whole-body CT for trauma patients might not reflect the current patient population with decreasing ISS. Especially females, younger age groups and MVC patients might benefit from stricter selection criteria for receiving whole-body CT. Our results also emphasize the importance of prevention of fall or tumble for elderly people.
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Affiliation(s)
- Stefanie Neef
- Department of Anesthesiology, Intensive Care Medicine and Pain Management, Helios Weißeritztal- Kliniken, Klinikum Freital, Germany
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Felix G Meinel
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Roberto Lorbeer
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Felix Ammermann
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
- Department of Pedatrics, University Children's Hospital, Klinikum Oldenburg AäR, Rahel-Srauß-Street 10., 26133, Oldenburg, Germany
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany
| | - Manuela Brunk
- Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Rostock, Rostock, Germany
| | - Philipp Herlyn
- Clinic for Trauma, Reconstructive and Hand Surgery, Municipal Clinic Dresden, Dresden, Germany
| | - Ebba Beller
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Centre Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany.
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Fan L, Feng L, Gan J, Luo R, Qu H, Chen X. Clinical characteristics of cystic encephalomalacia in children. Front Pediatr 2024; 12:1280489. [PMID: 38840803 PMCID: PMC11150847 DOI: 10.3389/fped.2024.1280489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 05/10/2024] [Indexed: 06/07/2024] Open
Abstract
Purpose To investigate the primary causes and clinical characteristics of cystic encephalomalacia (CE) in children. Methods The clinical data of 50 children who were admitted to our hospital due to CE between January 2008 and December 2020 were retrospectively reviewed. Their primary causes, clinical manifestations and cranial magnetic resonance imaging features were analyzed. Results Among all patients, 5 had prematurity, 19 had hypoxic-ischemic encephalopathy (HIE), 13 had intracranial infection, 14 had traumatic brain injury and hemorrhage, 4 had cerebral infarction, 2 had congenital genetic diseases, and 1 had hypoglycemia. The average time from primary disease onset to CE diagnosis was 70.1 ± 61.0 days. The clinical manifestations included speech or motor developmental delay (n = 33), epilepsy (n = 31), dystonia (n = 27), limb paralysis (n = 16), and visual or auditory impairment (n = 5). Patients with HIE as the primary cause of CE had a significantly higher occurrence of dystonia, while a significantly higher incidence of paralysis was observed in those with cerebral infarction as the primary cause. Conclusion CE in children is mainly caused by HIE, intracranial infection, and cerebral hemorrhage. The major clinical manifestations included speech or motor developmental delay, epilepsy, and dystonia. Magnetic resonance imaging is an important tool for the diagnosis of CE.
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Affiliation(s)
- Lijuan Fan
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Development and Maternal and Child Diseases of Sichuan Province, Sichuan University, Chengdu, Sichuan, China
| | - Lianying Feng
- Department of Neurology, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Jing Gan
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Development and Maternal and Child Diseases of Sichuan Province, Sichuan University, Chengdu, Sichuan, China
| | - Rong Luo
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Development and Maternal and Child Diseases of Sichuan Province, Sichuan University, Chengdu, Sichuan, China
| | - Haibo Qu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Development and Maternal and Child Diseases of Sichuan Province, Sichuan University, Chengdu, Sichuan, China
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaolu Chen
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Development and Maternal and Child Diseases of Sichuan Province, Sichuan University, Chengdu, Sichuan, China
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Dujardin RWG, Kleinveld DJB, van den Brom CE, Geeraedts LMG, Beijer E, Gaarder C, Brohi K, Stanworth S, Johansson PI, Stensballe J, Maegele M, Juffermans NP. Older females have increased mortality after trauma as compared with younger females and males, associated with increased fibrinolysis. J Trauma Acute Care Surg 2024; 96:831-837. [PMID: 38079234 DOI: 10.1097/ta.0000000000004235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Female sex may provide a survival benefit after trauma, possibly attributable to protective effects of estrogen. This study aimed to compare markers of coagulation between male and female trauma patients across different ages. METHODS Secondary analysis of a prospective cohort study that was conducted at six trauma centers. Trauma patients presenting with full trauma team activation were eligible for inclusion. Patients with a penetrating trauma or traumatic brain injury were excluded. Upon hospital arrival, blood was drawn for measurement of endothelial and coagulation markers and for rotational thromboelastometry measurement. Trauma patients were divided into four categories: males younger than 45 years, males 45 years or older, females younger than 45 years, and females 45 years or older. In a sensitivity analysis, patients between 45 and 55 years old were excluded to control for menopausal transitioning. Groups were compared with a Kruskal-Wallis test with Bonferroni correction. A logistic regression was performed to assess whether the independent effect of sex and age on mortality. RESULTS A total of 1,345 patients were available for analysis. Compared with the other groups, mortality was highest in females 45 years or older, albeit not independent from injury severity and shock. In the group of females 45 years or older, there was increased fibrinolysis, demonstrated by increased levels of plasmin-antiplasmin complexes with a concomitant decrease in α2-antiplasmin. Also, a modest decrease in coagulation factors II and X was observed. Fibrinogen levels were comparable between groups. The sensitivity analysis in 1,104 patients demonstrated an independent relationship between female sex, age 55 years or older, and mortality. Rotational thromboelastometry profiles did not reflect the changes in coagulation tests. CONCLUSION Female trauma patients past their reproductive age have an increased risk of mortality compared with younger females and males, associated with augmented fibrinolysis and clotting factor consumption. Rotational thromboelastometry parameters did not reflect coagulation differences between groups. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level III.
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Affiliation(s)
- Romein W G Dujardin
- From the Laboratory of Experimental Intensive Care and Anesthesiology (R.W.G.D., D.J.B.K., C.E.v.d.B., E.B., N.P.J.), and Department of Intensive Care (R.W.G.D., C.E.v.d.B.), Amsterdam UMC, University of Amsterdam; OLVG Hospital, Department of Intensive Care Medicine (R.W.G.D., N.P.J.), Amsterdam; Erasmus MC, Department of Anesthesiology (D.J.B.K.), Rotterdam; Department of Anesthesiology (C.E.v.d.B., E.B.), Amsterdam UMC, Vrije Universiteit Amsterdam; Department of Surgery (L.M.G.G., E.B.), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Traumatology (C.G.), Oslo University Hospital, Oslo, Norway; Trauma Sciences (K.B.), Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom; NHS Blood and Transplant/Oxford University Hospital NHS Trust (S.S.), John Radcliffe Hospital, Oxford, United Kingdom; Radcliffe Department of Medicine (S.S.), University of Oxford, United Kingdom; Department of Anesthesiology and Trauma Center (P.I.J., J.S.), Center for Head and Orthopedics, and Section for Transfusion Medicine (P.I.J., J.S.), Capital Region Blood Bank, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; and Department of Traumatology and Orthopedic Surgery (M.M.), Cologne-Merheim Medical Center, University of Witten/Herdecke, Cologne, Germany
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Kolodziej JH, Spinella PC, Brown JB, Lu L, Josephson CD, Leonard JC, Leeper CM. Patient sex and outcomes in children with life-threatening hemorrhage. Transfusion 2024; 64 Suppl 2:S72-S84. [PMID: 38511654 PMCID: PMC11081818 DOI: 10.1111/trf.17805] [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: 01/03/2024] [Revised: 03/08/2024] [Accepted: 03/10/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Recent data suggest female sex imparts a survival benefit after trauma in adults. The independent associations between patient sex and age with outcomes have not been examined in children with life-threatening hemorrhage (LTH) from all etiologies. STUDY DESIGN AND METHODS In a secondary analysis of a multicenter prospective observational study of children with LTH, Massive Transfusion in Children (MATIC), we analyzed if patient sex and age were associated with differences in severity of illness, therapies, and outcomes. Primary outcomes were 24 hour mortality and weight-adjusted transfusion volume during LTH. Kruskal-Wallis, chi-square testing, and multivariable linear regression were used for adjusted analyses. RESULTS Of 449 children, 45% were females and 55% were males. Females were more commonly younger, white, and with less trauma as the etiology of LTH compared to males. Markers of clinical severity were similar between groups, except injury severity score (ISS) was higher in females in the trauma subgroup. In terms of resuscitative practices, females received greater weight-adjusted total transfusion volumes compared to males (76 (40-150) mL/kg vs. 53 (24-100) mL/kg), as well as increased red blood cells (RBCs), plasma, and platelets compared to males. After adjustment for confounders, female sex and age 0-11 years were independently associated with increased transfusion volume during LTH. There were no differences in mortality or adverse outcomes according to patient sex. CONCLUSION Patient sex and age may impact factors associated with LTH and therapies received. Studies in developmental hemostasis are needed to determine the optimal transfusion strategy for LTH according to patient sex and age.
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Affiliation(s)
- Julia H. Kolodziej
- Division of Pediatric Critical Care Medicine, Washington University in St. Louis School of Medicine, St. Louis Children’s Hospital, St. Louis, Missouri, USA
| | - Philip C. Spinella
- Trauma and Transfusion Medicine Center, Department of Surgery, University of Pittsburgh School of Medicine, Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Joshua B. Brown
- Trauma and Transfusion Medicine Center, Department of Surgery, University of Pittsburgh School of Medicine, Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Liling Lu
- Trauma and Transfusion Medicine Center, Department of Surgery, University of Pittsburgh School of Medicine, Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Cassandra D. Josephson
- Cancer and Blood Disorders Institute, Johns Hopkins All Children’s Hospital, St. Petersburg, Florida, USA
- Departments of Oncology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Julie C. Leonard
- Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Christine M. Leeper
- Trauma and Transfusion Medicine Center, Department of Surgery, University of Pittsburgh School of Medicine, Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Zeelenberg ML, Van Lieshout EMM, Polinder S, Panneman MJM, Verhofstad MHJ, Den Hartog D. Trends in incidence, health care use and costs for subtrochanteric femur fractures in the Netherlands 2000-2019. Injury 2024; 55:111461. [PMID: 38457999 DOI: 10.1016/j.injury.2024.111461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 02/01/2024] [Accepted: 02/25/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE This study aimed to provide population based trends in incidence rate, hospital length of stay (HLOS), trauma mechanism, and costs for healthcare and lost productivity of subtrochanteric femur fractures in the Netherlands. METHODS Data on patients with subtrochanteric femur fractures sustained between January 1, 2000 and December 31, 2019 were extracted from the National Medical Registration of the Dutch Hospital Database. Incidence rates, HLOS, health care and productivity costs were calculated in sex- and age-specific groups. RESULTS A total of 14,399 patients sustained a subtrochanteric fracture in the 20-year study period. Incidence rates in the entire population dropped by 15.5 % from 4.5 to 3.8 per 100,000 person years (py). This decline was larger in women (6.4 to 5.2 per 100,000 py, -19.8 %) than in men (2.6 to 2.5 per 100,000 py, -4.0 %). HLOS declined by 62.5 % from a mean of 21.6 days in 2000-2004 to 8.1 days in 2015-2019. Subtrochanteric fractures were associated with total annual costs of €15.5 M, of which 91 % (€14.1 M) were health care costs and €1.3 M were costs due to lost productivity. Mean healthcare costs per case were lower in men (€16,394) than in women (€23,154). CONCLUSION The incidence rates and HLOS of subtrochanteric fractures in the Netherlands have decreased in the 2000-2019 study period and subtrochanteric fractures are associated with a relatively small total annual cost of €15.5 M. Increasing incidence rates and a bimodal age distribution, described in previous studies from other European countries, were not found in the Dutch population.
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Affiliation(s)
- Miliaan L Zeelenberg
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Esther M M Van Lieshout
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - Michael H J Verhofstad
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Dennis Den Hartog
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Breeding T, Martinez B, Katz J, Nasef H, Santos RG, Zito T, Elkbuli A. The Association Between Gender and Clinical Outcomes in Patients With Moderate to Severe Traumatic Brain Injury: A Systematic Review and Meta-Analysis. J Surg Res 2024; 295:791-799. [PMID: 38157731 DOI: 10.1016/j.jss.2023.11.035] [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] [Received: 08/13/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Traumatic brain injuries (TBIs) are a significant cause of morbidity and mortality in the United States. but have a disproportionate impact on patients based on gender. This systematic review and meta-analysis aim to compare gender differences in clinical outcomes between male and female adult trauma patients with moderate and severe TBI. METHODS Studies assessing gender differences in outcomes following TBIs on PubMed, Google Scholar, EMBASE, and ProQuest were searched. Meta-analysis was performed for outcomes including in-hospital mortality, hospital length of stay, intensive care unit length of stay, and Glasgow outcome scale (GOS) at 6 mo. RESULTS Eight studies were included for analysis with 26,408 female and 63,393 male patients. Meta-analysis demonstrated that males had a significantly lower risk of mortality than females (RR: 0.88; 95% CI 0.78, 0.99; P = 0.0001). Females had a shorter hospital length of stay (mean difference -1.4 d; 95% CI - 1.6 d, -1.2 d). No significant differences were identified in intensive care unit length of stay (mean difference -3.0 d; 95% CI -7.0 d, 1.1 d; P = 0.94) or GOS at 6 mo (mean difference 0.2 d; 95% CI -0.9 d, 1.4 d; P = 1). CONCLUSIONS Compared to male patients, female patients with moderate and severe TBI had a significantly higher in-hospital mortality risk. There were no significant differences in long-term outcomes between genders based on GOS at 6 mo. These findings warrant further investigation into the etiology of these gender disparities and their impact on additional clinical outcome measures.
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Affiliation(s)
- Tessa Breeding
- NOVA Southeastern University, Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, Florida
| | - Brian Martinez
- NOVA Southeastern University, Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, Florida
| | - Joshua Katz
- NOVA Southeastern University, Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, Florida
| | - Hazem Nasef
- NOVA Southeastern University, Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, Florida
| | - Radleigh G Santos
- Department of Mathematics, NSU NOVA Southeastern University, Fort Lauderdale, Florida
| | - Tracy Zito
- Division of Trauma and Surgical Critical Care, Department of Surgery, Orlando Regional Medical Center, Orlando, Florida; Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida
| | - Adel Elkbuli
- Division of Trauma and Surgical Critical Care, Department of Surgery, Orlando Regional Medical Center, Orlando, Florida; Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida.
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Loudon AM, Rushing AP, Badrinathan A, Moorman ML. Benefit of balance? Odds of survival by unit transfused: Retrospective analysis of the ACS-TQIP database. Surgery 2024; 175:885-892. [PMID: 37852833 DOI: 10.1016/j.surg.2023.08.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/21/2023] [Accepted: 08/08/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND The critical blood shortage in January 2022 threatened the availability of blood. Utility of transfusion per unit was reported in a previous study, revealing patients receiving balanced transfusion are more likely to die after 16 units of packed red blood cells. We aimed to validate this study using a larger database. METHODS Retrospective analysis utilizing the American College of Surgeons Trauma Quality Improvement Program was performed. Trauma patients aged ≥16 receiving transfusion within 4 hours of arrival were included and excluded if they died in the emergency department, received <2 units of packed red blood cells, did not receive fresh frozen plasma, or were missing data. Primary outcome was mortality. Subgroups were balanced transfusion if receiving ≤2:1 ratio of packed red blood cells:fresh frozen plasma, and unbalanced transfusion if >2:1 ratio. RESULTS A total of 17,047 patients were evaluated with 28% mortality (4,822/17,408). Multivariable logistic regression identified advancing age (odds ratio 1.03 95% confidence interval 1.03-1.04), higher ISS (odds ratio 1.04, 95% confidence interval 1.03-1.04), and lower GCS (odds ratio 0.82, 95% confidence interval 0.82-0.83) as risk factors for mortality. Protective factors were balanced transfusion (odds ratio 0.81 95% confidence interval 0.71-0.93), male sex (odds ratio 0.90, 95% confidence interval 0.81-0.99), and blunt mechanism (odds ratio 0.74, 95% confidence interval 0.67-0.81). At 11 units of packed red blood cells, balanced transfusion patients were more likely to die (odds ratio 0.88, 95% confidence interval 0.80-0.98). Balanced transfusion patients survived at a higher rate for each unit of packed red blood cells, between 6 and 23 units of packed red blood cells. CONCLUSION Mortality increases with each unit of packed red blood cell transfused. At 11 units of packed red blood cells, mortality is the more likely outcome. Balanced transfusion improves the chance of survival through 23 units of packed red blood cells.
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Affiliation(s)
- Andrew M Loudon
- Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH.
| | - Amy P Rushing
- Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Avanti Badrinathan
- Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Matthew L Moorman
- Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
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Lotfalla A, Halm JA, Schepers T, Giannakópoulos GF. Parameters influencing health-related quality of life after severe trauma: a systematic review (part II). Eur J Trauma Emerg Surg 2024; 50:93-106. [PMID: 37188975 PMCID: PMC10923745 DOI: 10.1007/s00068-023-02276-y] [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] [Received: 02/17/2023] [Accepted: 05/02/2023] [Indexed: 05/17/2023]
Abstract
INTRODUCTION It is increasingly recognized that health-related quality of life (HRQoL) is a relevant outcome to study in populations comprising severely injured patients. Although some studies have readily demonstrated a compromised HRQoL in those patients, evidence regarding factors that predict HRQoL is scarce. This hinders attempts to prepare patient-specific plans that may aid in revalidation and improved life satisfaction. In this review, we present identified predictors of HRQoL in patients that have suffered severe trauma. METHODS The search strategy included a database search until the 1st of January 2022 in the Cochrane Library, EMBASE, PubMed, and Web of Science, and reference checking. Studies were eligible for inclusion when (HR)QoL was studied in patients with major, multiple, or severe injury and/or polytrauma, as defined by authors by means of an Injury Severity Score (ISS) cut-off value. The results will be discussed in a narrative manner. RESULTS A total of 1583 articles were reviewed. Of those, 90 were included and used for analysis. In total, 23 possible predictors were identified. The following parameters predicted reduced HRQoL in severely injured patients and came forward in at least more than three studies: higher age, female gender, lower extremity injuries, higher rate of injury severity, lower achieved educational level, presence of (pre-existing) comorbidities and mental illness, longer duration of hospital stay, and high level of disability. CONCLUSION Age, gender, injured body region, and severity of injury were found to be good predictors of health-related quality of life in severely injured patients. A patient-centered approach, based on individual, demographic, and disease-specific predictors, is highly recommended.
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Affiliation(s)
- Annesimone Lotfalla
- Department of Trauma Surgery, Trauma Unit, Amsterdam University Medical Center, Location Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Jens Anthony Halm
- Department of Trauma Surgery, Trauma Unit, Amsterdam University Medical Center, Location Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Tim Schepers
- Department of Trauma Surgery, Trauma Unit, Amsterdam University Medical Center, Location Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Georgios Fredericus Giannakópoulos
- Department of Trauma Surgery, Trauma Unit, Amsterdam University Medical Center, Location Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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Mohammad Ismail A, Forssten MP, Sarani B, Ribeiro MAF, Chang P, Cao Y, Hildebrand F, Mohseni S. Sex disparities in adverse outcomes after surgically managed isolated traumatic spinal injury. Eur J Trauma Emerg Surg 2024; 50:149-155. [PMID: 37191713 PMCID: PMC10923959 DOI: 10.1007/s00068-023-02275-z] [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: 02/13/2023] [Accepted: 05/02/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Traumatic spinal injury (TSI) encompasses a wide range of injuries affecting the spinal cord, nerve roots, bones, and soft tissues that result in pain, impaired mobility, paralysis, and death. There is some evidence suggesting that women may have different physiological responses to traumatic injury compared to men; therefore, this study aimed to investigate if there are any associations between sex and adverse outcomes following surgically managed isolated TSI. METHODS Using the 2013-2019 TQIP database, all adult patients with isolated TSI, defined as a spine AIS ≥ 2 with an AIS ≤ 1 in all other body regions, resulting from blunt force trauma requiring spinal surgery, were eligible for inclusion in the study. The association between the sex and in-hospital mortality as well as cardiopulmonary and venothromboembolic complications was determined by calculating the risk ratio (RR) after adjusting for potential confounding using inverse probability weighting. RESULTS A total of 43,756 patients were included. After adjusting for potential confounders, female sex was associated with a 37% lower risk of in-hospital mortality [adjusted RR (95% CI): 0.63 (0.57-0.69), p < 0.001], a 27% lower risk of myocardial infarction [adjusted RR (95% CI): 0.73 (0.56-0.95), p = 0.021], a 37% lower risk of cardiac arrest [adjusted RR (95% CI): 0.63 (0.55-0.72), p < 0.001], a 34% lower risk of deep vein thrombosis [adjusted RR (95% CI): 0.66 (0.59-0.74), p < 0.001], a 45% lower risk of pulmonary embolism [adjusted RR (95% CI): 0.55 (0.46-0.65), p < 0.001], a 36% lower risk of acute respiratory distress syndrome [adjusted RR (95% CI): 0.64 (0.54-0.76), p < 0.001], a 34% lower risk of pneumonia [adjusted RR (95% CI): 0.66 (0.60-0.72), p < 0.001], and a 22% lower risk of surgical site infection [adjusted RR (95% CI): 0.78 (0.62-0.98), p < 0.032], compared to male sex. CONCLUSION Female sex is associated with a significantly decreased risk of in-hospital mortality as well as cardiopulmonary and venothromboembolic complications following surgical management of traumatic spinal injuries. Further studies are needed to elucidate the cause of these differences.
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Affiliation(s)
- Ahmad Mohammad Ismail
- Department of Orthopedic Surgery, Orebro University Hospital, 701 85, Orebro, Sweden
- School of Medical Sciences, Orebro University, 702 81, Orebro, Sweden
| | - Maximilian Peter Forssten
- Department of Orthopedic Surgery, Orebro University Hospital, 701 85, Orebro, Sweden
- School of Medical Sciences, Orebro University, 702 81, Orebro, Sweden
| | - Babak Sarani
- Surgery and Emergency Medicine, Center of Trauma and Critical Care, George Washington University, Washington, DC, USA
| | - Marcelo A F Ribeiro
- Surgery, Pontifical Catholic University of São Paulo, São Paulo, Brazil
- Surgery, Khalifa University and Gulf Medical University, Abu Dhabi, United Arab Emirates
- Division of Trauma, Critical Care & Acute Care Surgery, Department of Surgery, Sheikh Shakhbout Medical City, Mayo Clinic, Abu Dhabi, United Arab Emirates
| | - Parker Chang
- Center for Trauma and Critical Care, Department of Surgery, George Washington University, Washington, DC, USA
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, Faculty of Medicine and Health, School of Medical Sciences, Orebro University, 701 82, Orebro, Sweden
| | - Frank Hildebrand
- Department of Orthopedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Shahin Mohseni
- School of Medical Sciences, Orebro University, 702 81, Orebro, Sweden.
- Division of Trauma, Critical Care & Acute Care Surgery, Department of Surgery, Sheikh Shakhbout Medical City, Mayo Clinic, Abu Dhabi, United Arab Emirates.
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10
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Gilaed A, Shorbaji N, Katzir O, Ankol S, Badarni K, Andrawus E, Roimi M, Katz A, Bar-Lavie Y, Raz A, Epstein D. Early risk factors for prolonged mechanical ventilation in patients with severe blunt thoracic trauma: A retrospective cohort study. Injury 2024; 55:111194. [PMID: 37978015 DOI: 10.1016/j.injury.2023.111194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 10/14/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND A significant proportion of patients with severe chest trauma require mechanical ventilation (MV). Early prediction of the duration of MV may influence clinical decisions. We aimed to determine early risk factors for prolonged MV among adults suffering from severe blunt thoracic trauma. METHODS This retrospective, single-center, cohort study included all patients admitted between January 2014 and December 2020 due to severe blunt chest trauma. The primary outcome was prolonged MV, defined as invasive MV lasting more than 14 days. Multivariable logistic regression was performed to identify independent risk factors for prolonged MV. RESULTS The final analysis included 378 patients. The median duration of MV was 9.7 (IQR 3.0-18.0) days. 221 (58.5 %) patients required MV for more than 7 days and 143 (37.8 %) for more than 14 days. Male gender (aOR 3.01, 95 % CI 1.63-5.58, p < 0.001), age (aOR 1.40, 95 % CI 1.21-1.63, p < 0.001, for each category above 30 years), presence of severe head trauma (aOR 3.77, 95 % CI 2.23-6.38, p < 0.001), and transfusion of >5 blood units on admission (aOR 2.85, 95 % CI 1.62-5.02, p < 0.001) were independently associated with prolonged MV. The number of fractured ribs and the extent of lung contusions were associated with MV for more than 7 days, but not for 14 days. In the subgroup of 134 patients without concomitant head trauma, age (aOR 1.63, 95 % CI 1.18-2.27, p = 0.004, for each category above 30 years), respiratory comorbidities (aOR 9.70, 95 % CI 1.49-63.01, p = 0.017), worse p/f ratio during the first 24 h (aOR 1.55, 95 % CI 1.15-2.09, p = 0.004), and transfusion of >5 blood units on admission (aOR 5.71 95 % CI 1.84-17.68, p = 0.003) were independently associated with MV for more than 14 days. CONCLUSIONS Several predictors have been identified as independently associated with prolonged MV. Patients who meet these criteria are at high risk for prolonged MV and should be considered for interventions that could potentially shorten MV duration and reduce associated complications. Hemodynamically stable, healthy young patients suffering from severe thoracic trauma but no head injury, including those with extensive lung contusions and rib fractures, have a low risk of prolonged MV.
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Affiliation(s)
- Aran Gilaed
- Department of General Thoracic Surgery, Rambam Health Care Campus, Israel
| | - Nadeem Shorbaji
- Department of Diagnostic Imaging, Rambam Health Care Center, Haifa, Israel
| | - Ori Katzir
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shaked Ankol
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Karawan Badarni
- Critical Care Division, Rambam Health Care Campus, Haifa, Israel
| | - Elias Andrawus
- Critical Care Division, Rambam Health Care Campus, Haifa, Israel
| | - Michael Roimi
- Critical Care Division, Rambam Health Care Campus, Haifa, Israel
| | - Amit Katz
- Department of General Thoracic Surgery, Rambam Health Care Campus, Israel
| | - Yaron Bar-Lavie
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; Critical Care Division, Rambam Health Care Campus, Haifa, Israel
| | - Aeyal Raz
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; Department of Anesthesiology, Rambam Health Care Campus, Haifa, Israel
| | - Danny Epstein
- Critical Care Division, Rambam Health Care Campus, Haifa, Israel.
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11
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Shariff M, Kumar A, Stulak JM. Twenty-year United States national, demographic and regional mortality trends from traumatic thoracic aortic injury, 1999 to 2019. Injury 2024; 55:111114. [PMID: 37945417 DOI: 10.1016/j.injury.2023.111114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 09/02/2023] [Accepted: 10/08/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Traumatic Thoracic Aortic Injury (TTAI) is associated with high mortality rates and is the second leading cause of death in traumatic patients. There has been a considerable advancement in the management of TTAI with novel and improved surgical procedures and imaging modalities. The aim of this study was to determine the national demographic and regional trends in mortality associated with TTAI in the United States across twenty years, 1999 to 2019. METHODS The multiple cause of death data on Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC-WONDER) database was utilized to query death certificates for TTAI from 1999 to 2019, in the United States. The International Classification of the Diseases, Tenth Revision (ICD-10) code S25.0 was used to identify and abstract data for TTAI related deaths. The data was further abstracted based on age, race, gender and Census-Bureau defined regions. The age-adjusted mortality rate (AAMR) per 100,000 population-year and Average Annual Percentage Change (AAPC) with 95 % Confidence Interval were computed. The JoinPoint software was utilized to compute the temporal trends in mortality based on a segmented change and AAPC calculation. RESULTS A total of 20,842 TTAI associated deaths occurred from 1999 to 2019 corresponding to an AAMR of 0.407(0.401-0.412) per 100,000 population-year. The overall AAMR reduced from 0.759 to 0.223 per 100,000 population-year from 1999 to 2019[average APC -6.5(-7.5; -5.5)]. The reduction was reported in both <45 age group [average APC -6.5(-7.9; -5.1)] and >45 age group [-6.2(-7.3; -5.0)]; among females [average APC -6.1(-7.8; -4.3)] and males [-6.1(-7.2; -5.0)]; among Whites [average APC -6.9(-7.8; -5.9)] and Blacks [-5.0(-7.4; -2.5)]. The reduction in mortality as per the census region was highest in the west followed by Mid-West, North-East and South [average APC -6.8(-8.6; -5.0); -6.2(-8.8; -3.6); -5.7(-7.0; -4.4); -5.5(-7.4; -3.6), respectively]. CONCLUSION There was a significant decrease in the TTAI associated mortality trends in the United States across 1999-2019 with a consistent decline in all demographic and regional subgroups.
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Affiliation(s)
| | - Ashish Kumar
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA; Section of Cardiovascular Research, Heart, Vascular, and Thoracic Department, Cleveland Clinic Akron General, Akron, OH, USA
| | - John M Stulak
- Department of Surgery, Mayo Clinic, Rochester, MN, USA; Department of Cardiovascular Surgery, Mayo Clinic, Rochester, USA.
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12
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Londoño M, Nahmias J, Dolich M, Lekawa M, Kong A, Schubl S, Inaba K, Grigorian A. Development of a novel scoring tool to predict the need for early cricothyroidotomy in trauma patients. Surg Open Sci 2023; 16:58-63. [PMID: 37808420 PMCID: PMC10550758 DOI: 10.1016/j.sopen.2023.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/08/2023] [Accepted: 09/17/2023] [Indexed: 10/10/2023] Open
Abstract
Background The lack of a widely-used tool for predicting early cricothyroidotomy in trauma patients prompted us to develop the Cricothyroidotomy After Trauma (CAT) score. We aimed to predict the need for cricothyroidotomy within one hour of trauma patient arrival. Methods Derivation and validation datasets were obtained from the Trauma Quality Improvement Program (TQIP) database. Logistic modeling identified predictors, and weighted averages were used to create the CAT score. The score's performance was assessed using AUROC. Results Among 1,373,823 derivation patients, <1 % (n = 339) underwent cricothyroidotomy within one hour. The CAT score, comprising nine predictors, achieved an AUROC of 0.88. Severe neck injury and gunshot wound were the strongest predictors. Cricothyroidotomy rates increased from 0.4 % to 9.3 % at scores of 5 and 8, respectively. In the validation set, the CAT tool yielded an AUROC of 0.9. Conclusion The CAT score is a validated tool for predicting the need for early cricothyroidotomy in trauma patients. Further research is necessary to enhance its utility and assess its value in trauma care.
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Affiliation(s)
- Mary Londoño
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Jeffry Nahmias
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Matthew Dolich
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Michael Lekawa
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Allen Kong
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Sebastian Schubl
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Kenji Inaba
- University of Southern California, Department of Surgery, Los Angeles, CA, USA
| | - Areg Grigorian
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
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13
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van Leeuwen ALI, Beijer E, Ibelings R, Dekker NAM, van der Steen MRA, Roelofs JJTH, van Meurs M, Molema G, van den Brom CE. Female sex protects against renal edema, but not lung edema, in mice with partial deletion of the endothelial barrier regulator Tie2 compared to male sex. PLoS One 2023; 18:e0293673. [PMID: 37972011 PMCID: PMC10653528 DOI: 10.1371/journal.pone.0293673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 10/18/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND The endothelial angiopoietin/Tie2 system is an important regulator of endothelial permeability and targeting Tie2 reduces hemorrhagic shock-induced organ edema in males. However, sexual dimorphism of the endothelium has not been taken into account. This study investigated whether there are sex-related differences in the endothelial angiopoietin/Tie2 system and edema formation. METHODS Adult male and female heterozygous Tie2 knockout mice (Tie2+/-) and wild-type controls (Tie2+/+) were included (n = 9 per group). Renal and pulmonary injury were determined by wet/dry weight ratio and H&E staining of tissue sections. Protein levels were studied in plasma by ELISA and pulmonary and renal mRNA expression levels by RT-qPCR. RESULTS In Tie2+/+ mice, females had higher circulating angiopoietin-2 (138%, p<0.05) compared to males. Gene expression of angiopoietin-1 (204%, p<0.01), angiopoietin-2 (542%, p<0.001) were higher in females compared to males in kidneys, but not in lungs. Gene expression of Tie2, Tie1 and VE-PTP were similar between males and females in both organs. Renal and pulmonary wet/dry weight ratio did not differ between Tie2+/+ females and males. Tie2+/+ females had lower circulating NGAL (41%, p<0.01) compared to males, whereas renal NGAL and KIM1 gene expression was unaffected. Interestingly, male Tie2+/- mice had 28% higher renal wet/dry weight ratio (p<0.05) compared to Tie2+/+ males, which was not observed in females nor in lungs. Partial deletion of Tie2 did not affect circulating angiopoietin-1 or angiopoietin-2, but soluble Tie2 was 44% and 53% lower in males and females, respectively, compared to Tie2+/+ mice of the same sex. Renal and pulmonary gene expression of angiopoietin-1, angiopoietin-2, estrogen receptors and other endothelial barrier regulators was comparable between Tie2+/- and Tie2+/+ mice in both sexes. CONCLUSION Female sex seems to protect against renal, but not pulmonary edema in heterozygous Tie2 knock-out mice. This could not be explained by sex dimorphism in the endothelial angiopoietin/Tie2 system.
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Affiliation(s)
- Anoek L. I. van Leeuwen
- Department of Anesthesiology, Amsterdam UMC, VU University, Amsterdam, The Netherlands
- Department of Physiology, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Elise Beijer
- Department of Anesthesiology, Amsterdam UMC, VU University, Amsterdam, The Netherlands
- Department of Surgery, Amsterdam UMC, VU University, Amsterdam, The Netherlands
- Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Roselique Ibelings
- Department of Anesthesiology, Amsterdam UMC, VU University, Amsterdam, The Netherlands
- Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Nicole A. M. Dekker
- Department of Anesthesiology, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | | | - Joris J. T. H. Roelofs
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Matijs van Meurs
- Department of Critical Care, University Medical Center Groningen, Groningen, the Netherlands
- Department of Pathology and Medical Biology, University Medical Center Groningen, Groningen, The Netherlands
| | - Grietje Molema
- Department of Pathology and Medical Biology, University Medical Center Groningen, Groningen, The Netherlands
| | - Charissa E. van den Brom
- Department of Anesthesiology, Amsterdam UMC, VU University, Amsterdam, The Netherlands
- Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Intensive Care Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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14
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Beijer E, van Wonderen SF, Zuidema WP, Visser MC, Edwards MJR, Verhofstad MHJ, Tromp TN, van den Brom CE, van Lieshout EMM, Bloemers FW, Geeraedts LMG. Sex Differences in Outcome of Trauma Patients Presented with Severe Traumatic Brain Injury: A Multicenter Cohort Study. J Clin Med 2023; 12:6892. [PMID: 37959357 PMCID: PMC10649467 DOI: 10.3390/jcm12216892] [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: 10/06/2023] [Revised: 10/22/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
The objective of this study was to determine whether there is an association between sex and outcome in trauma patients presented with severe traumatic brain injury (TBI). A retrospective multicenter study was performed in trauma patients aged ≥ 16 years who presented with severe TBI (Head Abbreviated Injury Scale (AIS) ≥ 4) over a 4-year-period. Subgroup analyses were performed for ages 16-44 and ≥45 years. Also, patients with isolated severe TBI (other AIS ≤ 2) were assessed, likewise, with subgroup analysis for age. Sex differences in mortality, Glasgow Outcome Score (GOS), ICU admission/length of stay (LOS), hospital LOS, and mechanical ventilation (MV) were examined. A total of 1566 severe TBI patients were included (831 patients with isolated TBI). Crude analysis shows an association between female sex and lower ICU admission rates, shorter ICU/hospital LOS, and less frequent and shorter MV in severe TBI patients ≥ 45 years. After adjusting, female sex appears to be associated with shorter ICU/hospital LOS. Sex differences in mortality and GOS were not found. In conclusion, this study found sex differences in patient outcomes following severe TBI, potentially favoring (older) females, which appear to indicate shorter ICU/hospital LOS (adjusted analysis). Large prospective studies are warranted to help unravel sex differences in outcomes after severe TBI.
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Affiliation(s)
- Elise Beijer
- Department of Trauma Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Department of Anesthesiology, Amsterdam UMC, Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Stefan F. van Wonderen
- Department of Trauma Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Department of Intensive Care Medicine, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Wietse P. Zuidema
- Department of Trauma Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Marieke C. Visser
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Michael J. R. Edwards
- Department of Trauma Surgery, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Michael H. J. Verhofstad
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Tjarda N. Tromp
- Department of Trauma Surgery, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Charissa E. van den Brom
- Department of Anesthesiology, Amsterdam UMC, Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Department of Intensive Care Medicine, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Esther M. M. van Lieshout
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Frank W. Bloemers
- Department of Trauma Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Leo M. G. Geeraedts
- Department of Trauma Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, 1105 AZ Amsterdam, The Netherlands
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15
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O'Brien A, Hopkins J, Boardman G, Stanley G, Daly P, Martin L, Wood F. A retrospective, cross-sectional analysis of delirium in burn injury compared to other surgical specialities. Burns 2023; 49:1676-1687. [PMID: 37821275 DOI: 10.1016/j.burns.2023.05.008] [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] [Received: 08/03/2022] [Revised: 04/12/2023] [Accepted: 05/06/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Delirium is an acute cerebral disorder characterised by a disturbance in cognition, attention, and awareness. Often, it's undiagnosed and associated with increased morbidity and mortality. For burn patients, the reported prevalence ranges from 16% to 39%, with a multifactorial aetiology, increasing when intensive care is required. A direct comparison of delirium between surgical specialities has not been made. AIM 1. To audit the use of the 4AT for those who become delirious during their stay. 2. Assess the proportion of patients diagnosed with delirium during hospitalisation by surgical specialities. 3. Identification of the factors associated with delirium in surgical patients. METHODS Investigators at a single centre conducted a two-phase study. An initial retrospective audit of delirious patients under burns, general, and orthopaedic specialities over 16months, as defined by ICD-10 coding, identified compliance screening with the 4 A's Test. This informed the design of a retrospective, observational cohort study to compare factors associated with delirium and statistical comparison between four specialities to identify delirium-associated factor, where an analysis corrects for age. RESULTS 37% of patients with an ICD-10 code indicating delirium had a 4AT test completed. Speciality, number of operations, LOS, ICU hours, age, and discharge destination were all statistically significant independent variables. When all other variables were equal, burns had the highest predicted probability of delirium diagnosis. CONCLUSIONS Further analysis to identify and diagnose across the specialties is required. From a patient viewpoint, their LOS, ICU hours, and operations are increased for patients coded as delirious compared to non-delirious across the specialities. On a hospital level, the mean difference in cost for a delirious compared to a non-delirious patient is AU$9317. Despite the low incidence of delirium amongst the observed specialities, burns patients were most likely to develop delirium when demographic and clinical profiles were the same, and were more likely to develop delirium at a younger age and if in ICU.
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Affiliation(s)
- Aoife O'Brien
- Burns Service of Western Australia, Fiona Stanley Hospital, Western Australia, Australia.
| | - Jane Hopkins
- Service 4, Fiona Stanley Fremantle Hospitals Group, Western Australia, Australia
| | - Glenn Boardman
- Research Support and Development Unit, Fiona Stanley Hospital, Western Australia, Australia
| | - Guy Stanley
- Burns Service of Western Australia, Fiona Stanley Hospital, Western Australia, Australia; Burn Injury Research Unit, University of Western Australia, Crawley, Western Australia, Australia
| | - Patrick Daly
- Burns Service of Western Australia, Fiona Stanley Hospital, Western Australia, Australia
| | - Lisa Martin
- Burn Injury Research Unit, University of Western Australia, Crawley, Western Australia, Australia
| | - Fiona Wood
- Burns Service of Western Australia, Fiona Stanley Hospital, Western Australia, Australia; Burn Injury Research Unit, University of Western Australia, Crawley, Western Australia, Australia
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16
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Mahdavi Sharif P, Merati M, Baigi V, Zafarghandi M, Rahimi-Movaghar V, Khormali M, Laal M, Salamati P. Comparison of epidemiologic features between upper and lower limb injuries and risk factors for intensive care unit admission in a university hospital affiliated with the National Trauma Registry of Iran. Chin J Traumatol 2023:S1008-1275(23)00100-1. [PMID: 37925271 DOI: 10.1016/j.cjtee.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 05/18/2023] [Accepted: 05/23/2023] [Indexed: 11/06/2023] Open
Abstract
PURPOSE Upper extremity injuries (UEIs) and lower extremity injuries (LEIs) constitute a considerable component of traumas. However, their epidemiologic differences and short-term in-hospital outcomes are not fully elucidated. This study aims to compare such discrepancies in a large-scale study. METHODS In this retrospective study, all patients with UEIs and/or LEIs hospitalized from 24th July 2016 to 16th May 2020 in Sina Hospital, Tehran, Iran, and registered at the National Trauma Registry of Iran were enrolled in the study. Relevant demographic and clinical characteristics were extracted from the National Trauma Registry of Iran database. Patients were grouped into either UEI or LEI. For those with concomitant UEIs and LEIs, the more severe one based on the abbreviated injury scale was defined as the principal diagnosis. In addition, cases with the abbreviated injury scale > 3 for both UEI and LEI or concomitant injuries to body areas other than the limbs were excluded. Independent samples t-test, Mann-Whitney U test, Chi-square test, quintile regression models, and logistic regression models with "margins" command were used for statistical analyses, as indicated. RESULTS In this research, 3170 eligible cases were identified. For the LEI group, there was a much higher proportion of male patients (86.7% vs. 82.0%) and higher mean age (years, 42.9 vs. 35.3) compared to the UEI group (both p < 0.001). Patients with an injury severity score (ISS) of 9 - 15 were outnumbered in the LEI group (22.9% vs. 1.6%, p < 0.001), while the proportion of those with an ISS < 9 was higher in the UEI group (98.1% vs. 76.8%, p < 0.001). The multiple logistic regression model showed a statistically significant association between intensive care unit (ICU) admission and ISS (odds ratio (OR) = 4.01 for ISS 9 - 15 vs. ISS <9, 95% confidence interval (CI)|: 3.01 - 5.35; OR = 17.65 for ISS ≥16 vs. ISS < 9, 95% CI: 4.03 - 77.27), age (OR = 1.02, 95% CI: 1.01 - 1.03), cause of injury (OR = 0.27 for blunt trauma vs. road traffic crash, 95% CI: 0.08 - 0.90; OR = 0.49 for cut/stab injuries vs. road traffic crash, 95% CI: 0.28 - 0.84) and body region (OR = 1.65 for lower extremity, 95% CI: 1.19 - 2.29). Having adjusted for other covariates, the odds of ICU admission in patients with LEIs was 1.65 times the odds in patients with UEIs. CONCLUSIONS Patients with LEIs were older and suffered from more severe injuries. In addition, the age- and ISS-adjusted ICU admission and length of hospital stay were significantly higher in LEI patients. The chance of ICU admission was associated with age, cause of injury, ISS, and body region. The findings of this study can aid in the meticulous selection of ICU-candidate patients. In addition, the role of factors other than ISS and age in ICU admission and prolongation of hospitalization should be addressed by prospective studies.
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Affiliation(s)
- Pouya Mahdavi Sharif
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohsen Merati
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Vali Baigi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Moein Khormali
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Marjan Laal
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Payman Salamati
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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17
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Maeng SJ, Kang J, Kim MC, Choi HZ. The impact of patient sex on survival after unintentional trauma in Korea: a retrospective, observational, case-control study. Clin Exp Emerg Med 2023; 10:296-305. [PMID: 37280051 PMCID: PMC10579737 DOI: 10.15441/ceem.23.002] [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: 01/05/2023] [Revised: 04/27/2023] [Accepted: 05/11/2023] [Indexed: 06/08/2023] Open
Abstract
OBJECTIVE This study aimed to describe the relationship between sex and survival in patients experiencing unintentional trauma. METHODS This retrospective, national population-based observational, case-control study involved a cohort of Korean trauma patients who were transferred to an emergency department by a Korean emergency medical service from January 1 to December 31, 2018. Propensity score matching was used. The primary outcome was survival until hospital discharge. RESULTS Of 25,743 patients with severe unintentional trauma, 17,771 were male and 7,972 were female. Prior to propensity score matching, there was no significant difference in survival among male and female patients (92.6% vs. 93.1%, P=0.105). After using propensity score matching to adjust for confounders, there was still no sex difference in survival (male, 93.6% vs. female, 93.1%; P=0.270). CONCLUSION Survival after severe trauma was not influenced by the sex of the patient. Further studies with patients of reproductive age and a larger study population are needed to analyze the effects of sex on survival in patients with trauma.
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Affiliation(s)
- Seung Jin Maeng
- Department of Emergency Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Jongkyeong Kang
- Department of Information Statistics, Kangwon National University, Chuncheon, Korea
| | - Myung Chun Kim
- Department of Emergency Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Han Zo Choi
- Department of Emergency Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
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18
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Papa L, Maguire L, Thundiyil JG, Ladde JG, Miller SA. Age and sex differences in blood product transfusions and mortality in trauma patients at a level I trauma center. Heliyon 2023; 9:e18890. [PMID: 37583761 PMCID: PMC10424079 DOI: 10.1016/j.heliyon.2023.e18890] [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: 07/12/2023] [Revised: 07/29/2023] [Accepted: 08/02/2023] [Indexed: 08/17/2023] Open
Abstract
Objectives Hemorrhage is a common complication of trauma. We evaluated age and sex differences in treatment with blood product transfusions and massive transfusions as well as in-hospital mortality following trauma at a Level 1 Trauma Center. Methods This cross-sectional study evaluated trauma data from a Level 1 trauma center registry from January 2013 to December 2017. The primary outcome was amount of blood products (packed red blood cells (PRBCs), plasma, platelets), and massive transfusion (MT) by biological sex and by age group: 16-24 (youth), 25-59 (middle age), and >=60 (older age) The secondary outcome was in-hospital mortality to hospital discharge. Results There were 13596 trauma patients in the registry, mean age was 48 years, 4589 (34%) female and 9007 (66%) male, and median ISS of 9. Male patients received significantly more PRBC transfusions than female patients within 4-hours 6.6% vs 4.4%, and 24-hours 6.7% vs 4.5% respectively. Older patients received significantly fewer PRBC transfusions within 4-hours and 24-hours than their younger counterparts, with 6.9% in the youth group, 6.8% in the middle age group, and 3.9% in the older group (p<0.001). When adjusted for injury severity, the odds of receiving a blood transfusion within 4 hours of injury was significantly lower in older females. Using multivariate analysis, predictors of mortality included (in order of significance) injury severity, older age, transfusion within 4 hours of injury, penetrating trauma, and male sex. Conclusion In this large trauma cohort, older female trauma patients were less likely to receive blood products compared to younger females and to their older male counterparts, even after adjusting for injury severity. Predictors of mortality included injury severity, older age, early transfusion, penetrating trauma, and male sex. Following trauma, older women appear vulnerable to undertreatment. Further study is needed to determine the reasons for these differences and their impact on patient outcomes.
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Affiliation(s)
- Linda Papa
- Department of Emergency Medicine, Orlando Regional Medical Center, Orlando, FL, USA
| | - Lindsay Maguire
- Department of Emergency Medicine, Orlando Regional Medical Center, Orlando, FL, USA
| | - Josef G. Thundiyil
- Department of Emergency Medicine, Orlando Regional Medical Center, Orlando, FL, USA
| | - Jay G. Ladde
- Department of Emergency Medicine, Orlando Regional Medical Center, Orlando, FL, USA
| | - Susan A. Miller
- Department of Emergency Medicine, Orlando Regional Medical Center, Orlando, FL, USA
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19
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Romijn ASC, Rastogi V, Marcaccio CL, Dorken-Gallastegi A, Giannakopoulos GF, Jongkind V, Bloemers FW, Verhagen HJM, Schermerhorn ML, Saillant NN. Sex Related Outcomes Following Thoracic Endovascular Aortic Repair for Blunt Thoracic Aortic Injury. Eur J Vasc Endovasc Surg 2023; 66:261-268. [PMID: 37088462 DOI: 10.1016/j.ejvs.2023.04.015] [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: 08/12/2022] [Revised: 04/06/2023] [Accepted: 04/14/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVE Current literature suggests that thoracic endovascular aortic repair (TEVAR) in older patients with aortic aneurysms results in higher peri-operative mortality and lower long term survival in females compared with males. However, sex related outcomes in younger patients with blunt thoracic aortic injury (BTAI) undergoing TEVAR remain unknown. This study examined the association between sex and outcomes after TEVAR for BTAI. METHODS A retrospective cohort study was performed of all patients who underwent TEVAR for BTAI in the American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) between 2016 and 2019. The primary outcome was in hospital death. Secondary outcomes were peri-operative complications. Multivariable logistic regression was used to adjust for demographics, comorbidities, injury severity score, and aortic injury grade. RESULTS Two thousand and twenty-two patients were included; 26% were female. Compared with males, females were older (46 [IQR 30, 62] vs. 39 [IQR 28, 56] years; p < .001), more often obese (41% vs. 33%; p = .005), had lower rates of alcohol use disorder (4.1% vs. 8.9%; p < .001) and a higher prevalence of hypertension (29% vs. 22%; p = .001). The injury severity was comparable between females and males (Injury Severity Score ≥ 25; 84% vs. 80%; p = .11) and there was no difference in aortic injury grades when comparing females with males (grade 1, 33% vs. 33%; grade 2, 24% vs. 25%; grade 3, 43% vs. 40%; grade 4, 0.8% vs. 1.3%; p = .53). Multivariable logistic regression demonstrated no difference for in hospital mortality between females and males (OR 1.02; 95% CI 0.67 - 1.53, p = .93). Compared with males, females were at lower risk of acute kidney injury (AKI) (OR 0.33; 95% CI 0.17 - 0.64; p = .001) and ventilator associated pneumonia (VAP) (OR 0.50; 95% CI 0.28 - 0.91; p = .023). CONCLUSION This study did not demonstrate a sex related in hospital mortality difference following TEVAR for BTAI. However, female sex was associated with a lower risk of AKI and VAP. Future studies should evaluate sex differences and long term outcomes following TEVAR in patients with BTAI.
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Affiliation(s)
- Anne-Sophie C Romijn
- Department of Surgery, Division of Trauma & Emergency Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Surgery, Division of Trauma & Emergency Surgery, Amsterdam University Medical Centre, location AMC, Amsterdam, The Netherlands.
| | - Vinamr Rastogi
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA, USA; Department of Surgery, Division of Vascular Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Christina L Marcaccio
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA, USA
| | - Ander Dorken-Gallastegi
- Department of Surgery, Division of Trauma & Emergency Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Georgios F Giannakopoulos
- Department of Surgery, Division of Trauma & Emergency Surgery, Amsterdam University Medical Centre, location AMC, Amsterdam, The Netherlands
| | - Vincent Jongkind
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Amsterdam Cardiovascular Sciences, Microcirculation, Amsterdam, The Netherlands
| | - Frank W Bloemers
- Department of Surgery, Division of Trauma & Emergency Surgery, Amsterdam University Medical Centre, location AMC, Amsterdam, The Netherlands
| | - Hence J M Verhagen
- Department of Surgery, Division of Vascular Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Marc L Schermerhorn
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA, USA
| | - Noelle N Saillant
- Department of Surgery, Division of Trauma & Emergency Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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20
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Shu HT, Yang VB, Badin D, Rogers DL, Covell MM, Osgood GM, Shafiq B. What Factors Are Associated With Delayed Wound Closure in Open Reduction and Internal Fixation of Adult Both-bone Forearm Fractures? Clin Orthop Relat Res 2023; 481:1388-1395. [PMID: 36722772 PMCID: PMC10263215 DOI: 10.1097/corr.0000000000002543] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/06/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Delayed wound closure is often used after open reduction and internal fixation (ORIF) of both-bone forearm fractures to reduce the risk of skin necrosis and subsequent infection caused by excessive swelling. However, no studies we are aware of have evaluated factors associated with the use of delayed wound closure after ORIF. QUESTIONS/PURPOSES (1) What proportion of patients undergo delayed wound closure after ORIF of adult both-bone forearm fractures? (2) What factors are associated with delayed wound closure? METHODS The medical records of all patients who underwent ORIF with plate fixation for both-bone fractures by the adult orthopaedic trauma service at our institution were considered potentially eligible for analysis. Between January 2010 and April 2022, we treated 74 patients with ORIF for both-bone forearm fractures. Patients were excluded if they had fractures that were fixed more than 2 weeks from injury (six patients), if their fracture was treated with an intramedullary nail (one patient), or if the patient experienced compartment syndrome preoperatively (one patient). No patients with Gustilo-Anderson Type IIIB and C open fractures were included. Based on these criteria, 89% (66 of 74) of the patients were eligible. No further patients were excluded for loss of follow-up because the primary endpoint was the use of delayed wound closure, which was performed at the time of ORIF. However, one further patient was excluded for having bilateral forearm fractures to ensure that each patient had a single fracture for statistical analysis. Thus, 88% (65 of 74) of patients were included in the analysis. These patients were captured by an electronic medical record search of CPT code 25575. The mean ± SD age was 34 ± 15 years and mean BMI was 28 ± 7 kg/m 2 . The mean follow-up duration was 4 ± 5 months. The primary endpoint was the use of delayed wound closure, which was determined at the time of definitive fixation if tension-free closure could not be achieved. All surgeons used a volar Henry or modified Henry approach and a dorsal subcutaneous approach to the ulna for ORIF. Univariate logistic regression was used to identify which factors might be associated with delayed wound closure. A multivariable logistic regression analysis was then performed for male gender, open fractures, age, and BMI. RESULTS Twenty percent (13 of 65) of patients underwent delayed wound closure, 18% (12 of 65) of which occurred in patients who had high-energy injuries and 14% (nine of 65) in patients who had open fractures. Being a man (adjusted odds ratio 9.9 [95% confidence interval 1 to 87]; p = 0.04) was independently associated with delayed wound closure, after adjusting for open fractures, age, and BMI. CONCLUSION One of five patients had delayed wound closure after ORIF of both-bone forearm fractures. Being a man was independently associated with greater odds of delayed wound closure. Surgeons should counsel all patients with these fractures about the possibility of delayed wound closure, with particular attention to men with high-energy and open fractures. Future larger-scale studies are necessary to confirm which factors are associated with the use of delayed wound closure in ORIF of both-bone fractures and its effects on fracture healing. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Henry T. Shu
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Victor B. Yang
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Daniel Badin
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Davis L. Rogers
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Greg M. Osgood
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Babar Shafiq
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
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21
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Alzerwi NA. Injury characteristics and predictors of mortality in patients undergoing pancreatic excision after abdominal trauma: A National Trauma Data Bank (NTDB) study. Medicine (Baltimore) 2023; 102:e33916. [PMID: 37327268 PMCID: PMC10270525 DOI: 10.1097/md.0000000000033916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/12/2023] [Indexed: 06/18/2023] Open
Abstract
Pancreatic tumors and pancreatitis are the main indications for pancreatic excision (PE). However, little is known about this type of intervention in the context of traumatic injuries. Surgical care for traumatic pancreatic injuries is challenging because of the location of the organ and the lack of information on trauma mechanisms, vital signs, hospital deposition characteristics, and associated injuries. This study examined the demographics, vital signs, associated injuries, clinical outcomes, and predictors of in-hospital mortality in patients with abdominal trauma who had undergone PE. Following the Strengthening the Reporting of Observational Studies in Epidemiology guidelines, we analyzed the National Trauma Data Bank and identified patients who underwent PE for penetrating or blunt trauma after an abdominal injury. Patients with significant injuries in other regions (abbreviated injury scale score ≥ 2) were excluded. Of the 403 patients who underwent PE, 232 had penetrating trauma (PT), and 171 had blunt trauma (BT). The concomitant splenic injury was more prevalent in the BT group; however, the frequency of splenectomy was comparable between groups. In particular, concomitant kidney, small intestine, stomach, colon, and liver injuries were more common in the PT group (all P < .05). Most injuries were observed in the pancreatic body and tail regions. The trauma mechanisms also differed between the groups, with motor vehicles accounting for most of the injuries in the BT group and gunshots accounting for most of the injuries in the PT group. In the PT group, major liver lacerations were approximately 3 times more common (P < .001). The in-hospital mortality rate was 12.4%, with no major differences between the PT and BT groups. Furthermore, there was no difference between BT and PT with respect to the location of the injuries in the pancreas, with the pancreatic tail and body accounting for almost 65% of injuries. Systolic blood pressure, Glasgow Coma Scale score, age, and major liver laceration were revealed by logistic regression as independent predictors of mortality, although trauma mechanisms and intent were not linked to mortality risk.
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Affiliation(s)
- Nasser A.N. Alzerwi
- Department of Surgery, College of Medicine, Majmaah University, Ministry of Education, AL-Majmaah City, Riyadh Region, Kingdom of Saudi Arabia
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22
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Van Wonderen SF, Pape M, Zuidema WP, Edwards MJR, Verhofstad MHJ, Tromp TN, Van Lieshout EMM, Bloemers FW, Geeraedts LMG. Sex Dimorphism in Outcome of Trauma Patients Presenting with Severe Shock: A Multicenter Cohort Study. J Clin Med 2023; 12:jcm12113701. [PMID: 37297896 DOI: 10.3390/jcm12113701] [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: 04/24/2023] [Revised: 05/19/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
Background: The objective of this study was to determine the association between sex and outcome among severely injured patients who were admitted in severe shock. Methods: A retrospective multicenter study was performed in trauma patients (Injury Severity Score (ISS) ≥ 16) aged ≥ 16 presenting with severe shock (Shock Index > 1.3) over a 4-year period. To determine if sex was associated with mortality, Intensive Care Unit (ICU) admission, mechanical ventilation, blood transfusion and in-hospital complications, multivariable logistic regressions were performed. Results: In total, 189 patients were admitted to the Emergency Department in severe shock. Multivariable logistic regression analysis showed that female sex was independently associated with a decreased likelihood of acute kidney injury (OR 0.184; 95% CI 0.041-0.823; p = 0.041) compared to the male sex. A significant association between female sex and mortality, ICU admission, mechanical ventilation, other complications and packed red blood cells transfusion after admission could not be confirmed. Conclusion: Female trauma patients in severe shock were significantly less likely to develop AKI during hospital stay. These results could suggest that female trauma patients may manifest a better-preserved physiologic response to severe shock when compared to their male counterparts. Prospective studies with a larger study population are warranted.
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Affiliation(s)
- Stefan F Van Wonderen
- Department of Trauma Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Merel Pape
- Department of Trauma Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Wietse P Zuidema
- Department of Trauma Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Michael J R Edwards
- Department of Trauma Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Michael H J Verhofstad
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Tjarda N Tromp
- Department of Trauma Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Esther M M Van Lieshout
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Frank W Bloemers
- Department of Trauma Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Leo M G Geeraedts
- Department of Trauma Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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23
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Barsky D, Radomislensky I, Talmy T, Gendler S, Almog O, Avital G. Association Between Profound Shock Signs and Peripheral Intravenous Access Success Rates in Trauma Patients in the Prehospital Scenario: A Retrospective Study. Anesth Analg 2023; 136:934-940. [PMID: 37058730 DOI: 10.1213/ane.0000000000006342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
BACKGROUND Hemorrhage is the leading cause of preventable death in trauma patients, and establishment of intravenous (IV) access is essential for volume resuscitation, a key component in the treatment of hemorrhagic shock. IV access among patients in shock is generally considered more challenging, although data to support this notion are lacking. METHODS In this retrospective registry-based study, data were collected from the Israeli Defense Forces Trauma Registry (IDF-TR) regarding all prehospital trauma patients treated by IDF medical forces between January 2020 and April 2022, for whom IV access was attempted. Patients younger than 16 years, nonurgent patients, and patients with no detectable heart rate or blood pressure were excluded. Profound shock was defined as a heart rate >130 or a systolic blood pressure <90 mm Hg, and comparisons were made between patients with profound shock and those not exhibiting such signs. The primary outcome was the number of attempts required for first IV access success, which was regarded as an ordinal categorical variable: 1, 2, 3 and higher and ultimate failure. A multivariable ordinal logistic regression was performed to adjust for potential confounders. Patients' sex, age, mechanism of injury and best consciousness level, as well as type of event (military/nonmilitary), and the presence of multiple patients were included in the ordinal logistic regression multivariable analysis model based on previous publications. RESULTS Five hundred thirty-seven patients were included, 15.7% of whom were recorded as having signs of profound shock. Peripheral IV access establishment first attempt success rates were higher in the nonshock group, and there was a lower rate of unsuccessful attempts in this group (80.8% vs 67.8% for the first attempt, 9.4% vs 16.7% for the second attempt, 3.8% vs 5.6% for the third and further attempts, and 6% vs 10% unsuccessful attempts, P = .04). In the univariable analysis, profound shock was associated with requirement for an increased number of IV attempts (odds ratio [OR], 1.94; confidence interval [CI], 1.17-3.15). The ordinal logistic regression multivariable analysis demonstrated that profound shock was associated with worse results regarding primary outcome (adjusted odds ratio [AOR], 1.84; CI, 1.07-3.10). CONCLUSIONS The presence of profound shock in trauma patients in the prehospital scenario is associated with an increased number of attempts required for IV access establishment.
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Affiliation(s)
- Daniel Barsky
- From The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel
- Institute for Research in Military Medicine (IRMM), Faculty of Medicine, The Hebrew University of Jerusalem and the Israel Defense Forces Medical Corps, Jerusalem, Israel
| | - Irina Radomislensky
- From The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel
- The National Center for Trauma and Emergency Medicine Research, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel-HaShomer, Israel
| | - Tomer Talmy
- From The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel
- Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sami Gendler
- From The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel
| | - Ofer Almog
- From The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel
- Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Division of Anesthesia, Intensive Care, and Pain Management, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Avital
- From The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel
- Division of Anesthesia, Intensive Care, and Pain Management, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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24
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Rastogi V, Romijn ASC, Yadavalli SD, Marcaccio CL, Jongkind V, Zettervall SL, Quiroga E, Saillant NN, Verhagen HJM, Schermerhorn ML. Males and females have similar mortality after thoracic endovascular aortic repair for blunt thoracic aortic injury. J Vasc Surg 2023; 77:997-1005. [PMID: 36565777 DOI: 10.1016/j.jvs.2022.12.026] [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: 10/29/2022] [Revised: 12/06/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Prior literature has demonstrated worse outcomes for female patients after abdominal aortic aneurysm repair. Also, prior studies in the context of thoracic endovascular aneurysm repair (TEVAR) for thoracic aortic aneurysms have reported conflicting results regarding sex-related outcomes. Because the influence of sex on the outcomes after TEVAR for blunt thoracic aortic injuries (BTAIs) remains understudied, we evaluated the association between sex and outcomes after TEVAR for BTAI. METHODS We identified patients who had undergone TEVAR for BTAIs in the Vascular Quality Initiative registry from 2013 to 2022 and included those who had undergone TEVAR within zones 2 to 5 of the thoracic aorta. Patients with missing information regarding the aortic injury grade (Society for Vascular Surgery aortic injury grading system) were excluded. We performed multivariable logistic regression and Cox regression to determine the influence of sex on the perioperative outcomes and long-term mortality, respectively. RESULTS We identified 1311 patients, of whom 27% were female. The female patients were significantly older (female, 47 years [interquartile range (IQR), 30-63 years]; male, 38 years [IQR, 28-55 years]; P < .001) with higher rates of comorbidities. Although the female patients had had higher Glasgow coma scale scores (median, 15 [IQR, 11-15]; vs 14 [IQR, 8-15]; P = .028), no differences were found in the aortic injury grade or other coexisting traumatic injuries between the sexes. Apart from the longer procedure duration for the female patients (median, 79 minutes [IQR, 52-119 minutes]; vs 69 minutes [IQR, 48-106 minutes]; P = .008), the procedural characteristics were comparable. After adjustment, no significant association was found between female sex and perioperative mortality (7.1% vs 8.1%; odds ratio, 0.76; 95% confidence interval [CI], 0.43-1.3; P = .34). The male and female patients had had comparable rates of postoperative complications (26% vs 29%; odds ratio, 0.89; 95% CI: 0.52-1.5]; P = .26) including access-related complications (0.5% vs 0.8%; P=.83). However, females had a significantly higher risk for reintervention during the index admission (odds ratio, 2.5; 95% CI, 1.1-5.5; P = .024). No significant difference was found between the male and female patients with respect to 5-year mortality (hazard ratio, 0.87; 95% CI, 0.57-1.35; P = .50). CONCLUSIONS Unlike the sex-based outcome disparities observed after thoracic aortic aneurysm repair, we found no significant association between sex and perioperative outcomes or long-term mortality after TEVAR for BTAIs. This contrast in the sex-related outcomes after other vascular pathologies might be explained by differences in the pathology, demographics, and anatomic factors in these patients.
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Affiliation(s)
- Vinamr Rastogi
- Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Anne-Sophie C Romijn
- Division of Trauma and Emergency Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Surgery, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands
| | - Sai Divya Yadavalli
- Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Christina L Marcaccio
- Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Vincent Jongkind
- Department of Surgery, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands
| | - Sara L Zettervall
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, WA
| | - Elina Quiroga
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, WA
| | - Noelle N Saillant
- Division of Trauma and Emergency Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Hence J M Verhagen
- Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marc L Schermerhorn
- Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
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25
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Davros AM, Gregory CW, Cockrell DM, Hall KE. Comparison of clinical outcomes in cases of blunt, penetrating, and combination trauma in dogs: A VetCOT registry study. J Vet Emerg Crit Care (San Antonio) 2023; 33:74-80. [PMID: 36082427 DOI: 10.1111/vec.13253] [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: 04/13/2021] [Revised: 11/30/2021] [Accepted: 12/11/2021] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To evaluate outcome (survival to discharge) among trauma types (blunt, penetrating, both) in dogs. The secondary objective was to evaluate if other trauma registry parameters differ between trauma types and influence survival. DESIGN Retrospective evaluation of veterinary trauma registry data. SETTING Veterinary Committee on Trauma (VetCOT) identified Veterinary Trauma Centers (VTCs). ANIMALS A total of 20,289 canine trauma patients with data entered in the VetCOT trauma registry from April 1, 2017 to December 31, 2019 INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS Data were obtained from the VetCOT database and included patient demographics, trauma type (blunt, penetrating, both), Animal Trauma Triage (ATT) score, modified Glasgow Coma Scale (mGCS), abdominal fluid score (AFS), loss of glide sign on thoracic focused assessment with sonography for trauma (TFAST), pleural effusion on TFAST, surgical procedure performed and in what location (emergency room vs operating room), and outcome. Data from 20,289 dogs were collected over a 30-month period. The most common type of trauma was penetrating (10,816, 53.3%), followed by blunt (8360, 41.2%) and then combined blunt and penetrating trauma (1113, 5.5%). Dogs suffering only penetrating trauma had a 96.5% survival rate, blunt trauma had an 89.5% survival rate, and combined trauma had an 86.3% survival rate. Dogs suffering from both types of trauma had higher ATT scores, lower mGCS scores, and were more likely to be admitted to the ICU. Trauma type, mGCS, and ATT score were found to be associated with survival. CONCLUSIONS The present study highlights that dogs suffering from a combination of blunt and penetrating trauma are more likely to suffer moderate to severe injuries, have lower survival rates, and are more likely to be admitted to the ICU compared to dogs suffering from only blunt or penetrating trauma. Trauma type, mGCS, and ATT scores were found to be associated with survival in all groups.
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Affiliation(s)
- Akaterina M Davros
- Department of Clinical Sciences, Colorado State University College of Veterinary Medicine, Fort Collins, Colorado, USA
| | - Carly W Gregory
- Department of Clinical Sciences, Colorado State University College of Veterinary Medicine, Fort Collins, Colorado, USA
| | - Darren M Cockrell
- Department of Agricultural Biology, Colorado State University, Fort Collins, Colorado, USA
| | - Kelly E Hall
- Department of Clinical Sciences, Colorado State University College of Veterinary Medicine, Fort Collins, Colorado, USA
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Soliman SS, Gaccione AG, Bilaniuk JW, Adams JM, DiFazio LT, Hakakian D, Kong K, Rolandelli RH, Nemeth ZH. The impact of gender on clinical outcomes after sustaining a pelvic fracture. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:177-183. [PMID: 34855003 DOI: 10.1007/s00590-021-03163-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/01/2021] [Indexed: 01/07/2023]
Abstract
INTRODUCTION In trauma care, pelvic fractures contribute to morbidity and mortality. Since men and women have different pelvic structures and hormonal milieu, we studied if these gender differences affect clinical outcomes after pelvic fractures. METHODS Using the 2016 American College of Surgeons Trauma Quality Improvement Program (ACS TQIP) database, we stratified 24,425 patients with pelvic fractures by gender. Male and female patients were analyzed for differences in comorbidities, mechanism of injury, complications, and other clinical parameters. RESULTS Female patients were older (p < 0.001) and had more comorbidities (p < 0.001), such as bleeding disorder, congestive heart failure, chronic obstructive pulmonary disorder, dementia, chronic renal failure, diabetes mellitus, and hypertension. Although female patients were sicker before sustaining pelvic fractures, male patients had higher rates of post-trauma complications (p < 0.001), such as acute kidney injury, deep vein thrombosis, unplanned admission to the intensive care unit (ICU), and unplanned return to the operating room (OR). Multivariate logistic regression further supports this as male gender was independently associated with a 26.1% higher risk of developing at least one complication (p < 0.001), despite having a higher average Injury Severity Score (ISS) (21.91 ± 0.09 versus 20.71 ± 0.11, p < 0.001). Interestingly, male patients also had a longer hospital length of stay than female patients (13.36 ± 0.12 days versus 11.8 2± 0.14 days, p < 0.001). CONCLUSION Even though female patients were older and had more pre-existing comorbidities, male patients developed more complications and had longer hospital stays. Trial registration number Not a clinical trial.
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Affiliation(s)
- Sara S Soliman
- Department of Surgery, Morristown Medical Center, 100 Madison Ave. #88, Morristown, NJ, 07960, USA
| | - Amanda G Gaccione
- Department of Surgery, Morristown Medical Center, 100 Madison Ave. #88, Morristown, NJ, 07960, USA
| | - Jaroslaw W Bilaniuk
- Department of Surgery, Morristown Medical Center, 100 Madison Ave. #88, Morristown, NJ, 07960, USA
| | - John M Adams
- Department of Surgery, Morristown Medical Center, 100 Madison Ave. #88, Morristown, NJ, 07960, USA
| | - Louis T DiFazio
- Department of Surgery, Morristown Medical Center, 100 Madison Ave. #88, Morristown, NJ, 07960, USA
| | - Daniel Hakakian
- Department of Surgery, Morristown Medical Center, 100 Madison Ave. #88, Morristown, NJ, 07960, USA
| | - Karen Kong
- Department of Surgery, Morristown Medical Center, 100 Madison Ave. #88, Morristown, NJ, 07960, USA
| | - Rolando H Rolandelli
- Department of Surgery, Morristown Medical Center, 100 Madison Ave. #88, Morristown, NJ, 07960, USA
| | - Zoltan H Nemeth
- Department of Surgery, Morristown Medical Center, 100 Madison Ave. #88, Morristown, NJ, 07960, USA. .,Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY, 10032, USA.
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Pendleton AA, Sarang B, Mohan M, Raykar N, Wärnberg MG, Khajanchi M, Dharap S, Fitzgerald M, Sharma N, Soni KD, O'Reilly G, Bhandarkar P, Misra M, Mathew J, Jarwani B, Howard T, Gupta A, Cameron P, Bhoi S, Roy N. A cohort study of differences in trauma outcomes between females and males at four Indian Urban Trauma Centers. Injury 2022; 53:3052-3058. [PMID: 35906117 DOI: 10.1016/j.injury.2022.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 06/21/2022] [Accepted: 07/12/2022] [Indexed: 02/02/2023]
Abstract
Background Studies from high income countries suggest improved survival for females as compared to males following trauma. However, data regarding differences in trauma outcomes between females and males is severely lacking from low- and middle-income countries. The objective of this study was to determine the association between sex and clinical outcomes amongst Indian trauma patients using the Australia-India Trauma Systems Collaboration database. Methods A prospective multicentre cohort study was performed across four urban public hospitals in India April 2016 through February 2018. Bivariate analyses compared admission physiological parameters and mechanism of injury. Logistic regression assessed association of sex with the primary outcomes of 30-day and 24-hour in-hospital mortality. Secondary outcomes included ICU admission, ICU length of stay, ventilator requirement, and time on a ventilator. Results Of 8,605 patients, 1,574 (18.3%) were females. The most common mechanism of injury was falls for females (52.0%) and road traffic injury for males (49.5%). On unadjusted analysis, there was no difference in 30-day in-hospital mortality between females (11.6%) and males (12.6%, p = 0.323). However, females demonstrated a lower mortality at 24-hours (1.1% vs males 2.1%, p = 0.011) on unadjusted analysis. Females were also less likely to require a ventilator (17.3% vs 21.0% males, p = 0.001) or ICU admission (34.4% vs 37.5%, p = 0.028). Stratification by age or by ISS demonstrated no difference in 30-day in-hospital mortality for males vs females across age and ISS categories. On multivariable regression analysis, sex was not associated significantly with 30-day or 24-hour in-hospital mortality. Conclusion This study did not demonstrate a significant difference in the 30-day trauma mortality or 24-hour trauma mortality between female and male trauma patients in India on adjusted analyses. A more granular data is needed to understand the interplay of injury severity, immediate post-traumatic hormonal and immunological alterations, and the impact of gender-based disparities in acute care settings.
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Affiliation(s)
- Anna Alaska Pendleton
- Harvard Program for Global Surgery and Social Change, Harvard Medical School, Boston, United States
| | - Bhakti Sarang
- Trauma Research Group, WHO Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, India
| | - Monali Mohan
- Trauma Research Group, WHO Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, India
| | - Nakul Raykar
- Trauma and Emergency General Surgery, Brigham and Women's Hospital, Boston, United States
| | | | - Monty Khajanchi
- Harvard Program for Global Surgery and Social Change, Harvard Medical School, Boston, United States
| | - Satish Dharap
- Department of General Surgery, Topiwala National Medical College & B.Y.L. Nair Ch. Hospital, Mumbai, India
| | | | - Naveen Sharma
- Department of Surgery, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Kapil Dev Soni
- Critical and Intensive Care, JPN Apex Trauma Centre, AIIMS, New Delhi, India
| | - Gerard O'Reilly
- Department of Epidemiology and Biostatistics, National Trauma Research Institute, The Alfred, Melbourne, Australia
| | - Prashant Bhandarkar
- Department of Statistics, Bhabha Atomic Research Centre Hospital, Mumbai, India
| | - Mahesh Misra
- JPN Apex Trauma Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Joseph Mathew
- The Alfred Hospital, Emergency and Trauma Centre, Melbourne, Australia
| | | | | | - Amit Gupta
- Division of Trauma Surgery & Critical Care, JPN Apex Trauma Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Peter Cameron
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne Australia
| | - Sanjeev Bhoi
- Department of Emergency Medicine, JPN Apex Trauma Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Nobhojit Roy
- Harvard Program for Global Surgery and Social Change, Harvard Medical School, Boston, United States; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden SE-171 77; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
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Elkbuli A, Fanfan D, Newsome K, Sutherland M, Liu H, McKenney M, Ang D. A national evaluation of emergency department thoracotomy practices: Will a high-risk, low-yield procedure reveal potential management practice bias? Surgery 2022; 172:410-420. [PMID: 34972592 DOI: 10.1016/j.surg.2021.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 11/17/2021] [Accepted: 11/29/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Emergency department thoracotomy is often performed on patients in extremis from traumatic exsanguination. Thus, inherent biases may play a role in whether or not the emergency department thoracotomy is performed. We aimed to investigate race, socioeconomic status, and gender disparities in the use of emergency department thoracotomy and to investigate outcomes of these patients to assess for possible surgeon practice bias. METHOD A nationwide retrospective cohort analysis of the American College of Surgeons Trauma Quality Programs Participant Use Profile 2016-2018. Adult patients who suffered blunt, penetrating, or other injuries secondary to falls/firearms/motor vehicle collision/other mechanisms of injury and presented to a trauma center pulseless, with or without signs of life after injury. Rates of thoracotomy, time to thoracotomy, transfer to operating room, emergency department disposition, intensive care unit length of stay, hospital length of stay, complications, mortality, and hospital disposition. Univariate analyses and adjusted multivariable regression were performed to account for confounders with significance defined as P < .05. RESULTS A total of 6,453 patients were analyzed. Emergency department thoracotomy and mortality were significantly higher in minorities and uninsured patients, even after risk adjustment. There were no differences in timing among race groups to emergency department thoracotomy. White/Caucasian patients experienced the highest rate of emergency department initial disposition to the intensive care unit (10.3%, P < .0001) and lowest mortality rate (89.2%, P < .0001). CONCLUSION Surgeon bias was not seen in the practice of emergency department thoracotomy for patients arriving pulseless. However, poorer outcomes were associated with minorities and lower socioeconomic status patients. Thoracotomy rates were higher in minorities and lower socioeconomic status patients due to more penetrating trauma.
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Affiliation(s)
- Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL.
| | - Dino Fanfan
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL
| | - Kevin Newsome
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL
| | - Mason Sutherland
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL
| | - Huazhi Liu
- Department of Surgery, Ocala Regional Medical Center, FL
| | - Mark McKenney
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL; Department of Surgery, University of South Florida, Tampa, FL
| | - Darwin Ang
- Department of Surgery, Ocala Regional Medical Center, FL; Department of Surgery, University of Central Florida, Ocala, FL
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Cole E, Curry N, Davenport R. Sex discrimination after injury: is inequity in tranexamic acid administration just the tip of the iceberg? Br J Anaesth 2022; 129:144-147. [PMID: 35753808 DOI: 10.1016/j.bja.2022.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 05/13/2022] [Accepted: 05/14/2022] [Indexed: 11/02/2022] Open
Abstract
There is emerging evidence of inequalities in healthcare provision between women and men. Trauma care is no exception with a number of studies indicating lower levels of prioritisation for injured female patients. The antifibrinolytic drug tranexamic acid, reduced trauma deaths to a similar extent in females and males in the international Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage (CRASH) randomised controlled trials, but in real-world practice, national registry data shows females are less likely to receive tranexamic acid than males. Inequity in the provision of tranexamic acid may extend beyond sex (and gender), and further study is required to examine the effect of age and mechanism of injury differences between men and women in the decision to treat.
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Affiliation(s)
- Elaine Cole
- Centre for Trauma Sciences, Blizard Institute, Bart's & the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Nicola Curry
- Oxford Haemophilia & Thrombosis Centre, Oxford University Hospitals NHS Trust, Nuffield Orthopaedic Hospital, Oxford and Oxford University, Oxford, UK
| | - Ross Davenport
- Centre for Trauma Sciences, Blizard Institute, Bart's & the London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Royal London Major Trauma Centre, Bart's Health NHS Trust, London, UK.
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Hrebinko KA, Strotmeyer S, Richardson W, Gaines BA, Leeper CM. Sex dimorphisms in coagulation characteristics in the pediatric trauma population appear after puberty. J Trauma Acute Care Surg 2022; 92:675-682. [PMID: 34936590 DOI: 10.1097/ta.0000000000003508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The role of age and sex in mediating coagulation characteristics in injured children is not well defined. We hypothesize that thromboelastography (TEG) profiles are equivalent across sex in younger children and diverge after puberty. METHODS Consecutive trauma patients younger than 18 years were identified from a university-affiliated, Level I, pediatric trauma center (2016-2020) database. Demographics, injury characteristics, and TEG parameters were recorded. Children were categorized by sex and age (younger, ≤10 years; older, ≥11 years). Baseline characteristics, outcomes, and TEG parameters were compared using nonparametric tests as appropriate. To account for the effects of confounding variables, analysis of covariance was performed controlling for Injury Severity Score (ISS), admission Glasgow Coma Scale score, and pediatric age-adjusted shock index. RESULTS Six hundred forty-seven subjects were identified (70.2% male, median ISS, 10; interquartile range, 5-24; blunt mechanism, 75.4%). Among 395 younger children (≤10 years), there were no differences in TEG characteristics between sexes. Among 252 adolescents (≥11 years), males had greater kinetic times (1.8 vs. 1.4 min; p < 0.001), decreased alpha angles (69.6° vs73.7°; p < 0.001), and lower maximum amplitudes (59.4 vs. 61.5 mm; p = 0.01). Fibrinolysis was significantly lower in older females compared with younger females (0.4% vs. 1.5%, p < 0.001) and age-matched males (0.4% vs. 1.0%, p = 0.02). Compared with younger male children, adolescent males had greater kinetic times (1.8 vs. 1.4 min; p < 0.001), decreased alpha angles (73.5° vs. 69.6°, p < 0.001), lower maximum amplitudes (59.4 vs. 62 mm, p < 0.001), and less fibrinolysis (1.0% vs. 1.3%, p = 0.03). This interaction persisted after controlling for ISS, Glasgow Coma Scale, and pediatric age-adjusted shock index. CONCLUSION Sex dimorphisms in TEG coagulation profiles appear after puberty. This divergence appears to be driven by a shift in male coagulation profiles to a relatively hypocoagulable state and female coagulation profiles to a relatively hypercoagulable state after puberty. LEVEL OF EVIDENCE Prognostic and Epidemiologic, Level III.
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Affiliation(s)
- Katherine A Hrebinko
- From the Department of Surgery (K.A.H.), University of Pittsburgh; Division of Pediatric General and Thoracic Surgery (S.S., W.R., B.A.G.), University of Pittsburgh Medical Center Children's Hospital of Pittsburgh; and Division of Trauma and Acute Care Surgery, Department of Surgery (C.M.L.), University of Pittsburgh, Pittsburgh, Pennsylvania
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Mobinizadeh M, Berenjian F, Mohamadi E, Habibi F, Olyaeemanesh A, Zendedel K, Sharif-Alhoseini M. Trauma Registry Data as a Policy-Making Tool: A Systematic Review on the Research Dimensions. Bull Emerg Trauma 2022; 10:49-58. [PMID: 35434165 PMCID: PMC9008338 DOI: 10.30476/beat.2021.91755.1286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/18/2021] [Accepted: 08/02/2021] [Indexed: 11/23/2022] Open
Abstract
Objective: To review the research dimensions of trauma registry data on health policy making. Methods: PubMed and EMBASE were searched until July 2020. Keywords were used on the search process included Trauma, Injury, Registry and Research, which were searched by using appropriate search strategies. The included articles had to: 1. be extracted from data related to trauma registries; 2- be written in English; 3- define a time period and a patient population; 4- preferably have more details and policy recommendations; and 5- preferably have a discussion on how to improve diagnosis and treatment. The results obtained from the included studies were qualitatively analyzed using thematic synthesis and comparative tables. Results: In the primary round of search, 19559 studies were retrieved. According to PRISMA statement and also performing quality appraisal process, 30 studies were included in the final phase of analysis. In the final papers’ synthesis, 14 main research domains were extracted and classified in terms of the policy implication and research priority. The domains with the highest frequency were “The relationship between trauma registry data and hospital care protocols for trauma patients” and “The causes of Disability Adjusted Life Years (DALYs) due to trauma”. Conclusion: Using trauma registry data as a tool for policy-making could be helpful in several ways, namely increasing the quality of patient care, preventing injuries and decreasing their number, figuring out the details of socioeconomic status effects, and improving the quality of researches in practical ways. Also, follow-up of patients after trauma surgery as one of the positive effects of the trauma registry can be the focus of attention of policy-making bodies.
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Affiliation(s)
| | - Farzan Berenjian
- Department of Health Economics and Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Efat Mohamadi
- Health Equity Research Center (HERC), Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Habibi
- Department of Health Economics and Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Olyaeemanesh
- National Institute for Health Research and Health Equity Research Center (HERC), Tehran University of Medical Sciences, Tehran, Iran
| | - Kazem Zendedel
- Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Sharif-Alhoseini
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Umo I, James K, Didilemu F, Sinen B, Borchem I, Inaido D, Ikasa R. The direct medical cost of trauma aetiologies and injuries in a resource limited setting of Papua New Guinea: A prospective cost of illness study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 20:100379. [PMID: 35146466 PMCID: PMC8802040 DOI: 10.1016/j.lanwpc.2021.100379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Injuries are a significant public health concern globally. Papua New Guinea has failed to achieve all eight health millennium development goals, and in doing so has not prioritized injuries in previous health policies. Understanding costs related to injuries can ultimately guide policies for surgical service delivery in achieving local, and universal health coverage objectives. Methods A prospective cost of illness study was conducted at Alotau Provincial Hospital (only major referral hospital), in the Milne Bay Province of Papua New Guinea, from the 1st of June 2020 to the 21st of December 2020. A bottom up approach of micro costing was used to estimate the direct medical cost of trauma aetiologies, and injuries of patients admitted to the surgical ward at Alotau Provincial Hospital. Findings The mean cost of managing traumatic injuries was K45, 900.40 (US$13,311.12) per patient. The most common cause of injury was alcohol related injuries (n=32) with a total direct medical cost of K1, 417, 023.73 (US$410,936.88). The most common injury was fractures (n=40) with a total direct medical cost of K1, 907, 531.88 (US$553,184.25). The highest cost for trauma aetiologies were MVAs with a mean cost of K48, 687.40 (US$14, 119.35) per patient. The highest cost for injuries was abdominal trauma with a mean cost K55,929.69(US$16,219.61) per patient. Interpretation Poor regulation of alcohol and road safety is associated with high surgical costs. In an era of financial instability, reducing injuries is economical in acheiving health care objectives that rely heavily on adequate funding, and financing. Funding No funding source.
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van Leeuwen ALI, Borgdorff MP, Dekker NAM, van den Brom CE. Therapeutically Targeting Microvascular Leakage in Experimental Hemorrhagic SHOCK: A Systematic Review and Meta-Analysis. Shock 2021; 56:890-900. [PMID: 33927137 DOI: 10.1097/shk.0000000000001796] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND Microvascular leakage is proposed as main contributor to disturbed microcirculatory perfusion following hemorrhagic shock and fluid resuscitation, leading to organ dysfunction and unfavorable outcome. Currently, no drugs are available to reduce or prevent microvascular leakage in clinical practice. We therefore aimed to provide an overview of therapeutic agents targeting microvascular leakage following experimental hemorrhagic shock and fluid resuscitation. METHODS PubMed, EMBASE.com, and Cochrane Library were searched in January 2021 for preclinical studies of hemorrhagic shock using any therapeutic agent on top of standard fluid resuscitation. Primary outcome was vascular leakage, defined as edema, macromolecule extravasation, or glycocalyx degradation. Drugs were classified by targeting pathways and subgroup analyses were performed per organ. RESULTS Forty-five studies, published between 1973 and 2020, fulfilled eligibility criteria. The included studies tested 54 different therapeutics mainly in pulmonary and intestinal vascular beds. Most studies induced trauma besides hemorrhagic shock. Forty-four therapeutics (81%) were found effective to reduce microvascular leakage, edema formation, or glycocalyx degradation in at least one organ. Targeting oxidative stress and apoptosis was the predominantly effective strategy (SMD: -2.18, CI [-3.21, -1.16], P < 0.0001). Vasoactive agents were found noneffective in reducing microvascular leakage (SMD: -0.86, CI [-3.07, 1.36], P = 0.45). CONCLUSION Pharmacological modulation of pathways involved in cell metabolism, inflammation, endothelial barrier regulation, sex hormones and especially oxidative stress and apoptosis were effective in reducing microvascular leakage in experimental hemorrhagic shock with fluid resuscitation. Future studies should investigate whether targeting these pathways can restore microcirculatory perfusion and reduce organ injury following hemorrhagic shock. SYSTEMATIC REVIEW REGISTRATION NUMBER CRD42018095432.
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Affiliation(s)
- Anoek L I van Leeuwen
- Department of Anesthesiology, Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
- Department of Physiology, Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Marieke P Borgdorff
- Department of Anesthesiology, Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Nicole A M Dekker
- Department of Anesthesiology, Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
- Department of Physiology, Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Charissa E van den Brom
- Department of Anesthesiology, Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
- Department of Physiology, Amsterdam UMC, VU University, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
- Department of Intensive Care, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Ariss AB, Bachir R, El Sayed M. Factors associated with survival in adult patients with traumatic arrest: a retrospective cohort study from US trauma centers. BMC Emerg Med 2021; 21:77. [PMID: 34225649 PMCID: PMC8256602 DOI: 10.1186/s12873-021-00473-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 06/23/2021] [Indexed: 11/10/2022] Open
Abstract
Background Traumatic arrests increasingly affect young adults worldwide with low reported survival rates. This study examines factors associated with survival (to hospital discharge) in traumatic arrests transported to US trauma centers. Methods This retrospective cohort study used the US National Trauma Databank 2015 dataset and included patients who presented to trauma centers with “no signs of life”. Univariate and bivariate analyses were done. Factors associated with survival were identified using multivariate regression analyses. Results The study included 5980 patients with traumatic arrests. Only 664 patients (11.1%) survived to hospital discharge. Patients were predominantly in age group 16–64 (84.6%), were mostly males (77.8%) and white (55.1%). Most were admitted to Level I (55.5%) or Level II trauma centers (31.6%). Injuries were mostly blunt (56.7%) or penetrating (39.3%). The median of the injury severity score (ISS) was 19 (interquartile range [IQR]: 9–30). Factors associated with decreased survival included: Age group ≥ 65 (Ref: 16–24), male gender, self-inflicted and other or undetermined types of injuries (Ref: assault), injuries to head and neck, injuries to torso and ISS ≥ 16 (Ref: < 16) and ED thoracotomy. While factors associated with increased survival included: All injury mechanisms (with the exception of motor vehicle transportation) (Ref: firearm), injuries to extremities or spine and back and all methods of coverage (Ref: self-pay). Conclusion Patients with traumatic arrests have poor outcomes with only 11.1% surviving to hospital discharge. Factors associated with survival in traumatic arrests were identified. These findings are important for devising injury prevention strategies and help guide trauma management protocols to improve outcomes in traumatic arrests. Level of evidence Level III.
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Affiliation(s)
- Abdel-Badih Ariss
- Department of Emergency Medicine, American University of Beirut Medical Center, Riad El Solh, P.O. Box - 11-0236, Beirut, 1107 2020, Lebanon
| | - Rana Bachir
- Department of Emergency Medicine, American University of Beirut Medical Center, Riad El Solh, P.O. Box - 11-0236, Beirut, 1107 2020, Lebanon
| | - Mazen El Sayed
- Department of Emergency Medicine, American University of Beirut Medical Center, Riad El Solh, P.O. Box - 11-0236, Beirut, 1107 2020, Lebanon. .,Emergency Medical Services and Prehospital Care Program, American University of Beirut Medical Center, Beirut, Lebanon.
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Kondo Y, Miyazato A, Okamoto K, Tanaka H. Impact of Sex Differences on Mortality in Patients With Sepsis After Trauma: A Nationwide Cohort Study. Front Immunol 2021; 12:678156. [PMID: 34267751 PMCID: PMC8276106 DOI: 10.3389/fimmu.2021.678156] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/14/2021] [Indexed: 12/29/2022] Open
Abstract
Objective Sepsis is the leading cause of death in intensive care units, and sepsis after trauma is associated with increased mortality rates. However, the characteristics of sepsis after trauma remain unknown, and the influence of sex on mortality remains controversial. This study aimed to assess the role of sex in in-hospital mortality in patients with sepsis after trauma. Methods We performed a retrospective cohort study involving several emergency hospitals (n=288) in Japan. The data of patients with trauma who developed sepsis after admission from 2004 to 2019 were obtained from the Japan Trauma Data Bank. We divided the patients into two groups according to sex and compared their in-hospital mortality. We also performed subgroup analysis limited to the elderly population (age ≥ 65 years) and evaluated in-hospital mortality between men and women. Results A total of 1935 patients met the inclusion criteria during the study period. Of these, 1204 (62.2%) were allocated to the male group and 731 (37.8%) to the female group. Multivariable Cox proportional-hazards analysis showed a significantly lower risk of in-hospital mortality in the female group than in the male group (hazard ratio (HR): 0.74, 95% confidence interval (CI): 0.62–0.89; p=0.001). In the subgroup analysis, multivariable Cox proportional hazards still showed significantly lower risks of in-hospital mortality in the female group than in the male group (HR: 0.72, 95% CI: 0.58–0.88; p=0.002). Conclusion The present study shows a significantly increased survival in the female group when compared to that in the male group of patients with sepsis after trauma. The underlying mechanism remains unclear, and further investigations are required.
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Affiliation(s)
- Yutaka Kondo
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Atsushi Miyazato
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Ken Okamoto
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Hiroshi Tanaka
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Chiba, Japan
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Salamati P, Saberian L, Baigi V, Zafarghandi M, Naghdi K, Ozlaty M, Bahrami S, Madadi N, Rahimi-Movaghar V, Sadeghi-Bazargani H, Fakharian E, Pahlavanhosseini H, Piri S, Khormali M, Mirzamohamadi S. Gender-based trauma outcomes and predictors of postinjury in-hospital mortalities: A multicenter analysis from the national trauma registry of Iran. ARCHIVES OF TRAUMA RESEARCH 2021. [DOI: 10.4103/atr.atr_64_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Upadhyaya GK, Iyengar KP, Jain VK, Garg R. Evolving concepts and strategies in the management of polytrauma patients. J Clin Orthop Trauma 2021; 12:58-65. [PMID: 33716429 PMCID: PMC7920163 DOI: 10.1016/j.jcot.2020.10.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/04/2020] [Accepted: 10/12/2020] [Indexed: 02/07/2023] Open
Abstract
Major trauma is one of the leading causes of morbidity and mortality in young adults. The impact of disability on the quality of life and functionality in this younger population is worrisome. This remains a major public health concern across the globe. Immediate and early deaths account for nearly 80% of trauma deaths occurring within the first few hours of injury to the first few days, usually because of traumatic brain injury or major exsanguination and subsequently due to shock or hypoxia. Worldwide adoption of comprehensive trauma systems and evolving models of trauma care including prehospital interventions have led improvements in trauma and critical care over the last few decades. Resuscitation and damage control orthopaedics are two key pillars in the management of polytrauma patient. Trauma-related coagulopathy can be an emerging complication during resuscitation of such patients which should be recognized early so appropriate corrective measures can be undertaken. We describe the evolving models of care in the management of polytrauma and trauma associated coagulopathy.
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Affiliation(s)
- Gaurav K. Upadhyaya
- Department of Orthopaedics, All India Institute of Medical Sciences, Raebareli, UP, 229405, India
| | | | - Vijay Kumar Jain
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India
- Corresponding author. Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India.
| | - Rakesh Garg
- Department of Onco-Anaesthesiology and Palliative Medicine, Dr BRAIRCH, All India Institute of Medical Sciences, New Delhi, 110029, India
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Gravesteijn BY, Sewalt CA, Nieboer D, Menon DK, Maas A, Lecky F, Klimek M, Lingsma HF. Tracheal intubation in traumatic brain injury: a multicentre prospective observational study. Br J Anaesth 2020; 125:505-517. [PMID: 32747075 PMCID: PMC7565908 DOI: 10.1016/j.bja.2020.05.067] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/22/2020] [Accepted: 05/28/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND We aimed to study the associations between pre- and in-hospital tracheal intubation and outcomes in traumatic brain injury (TBI), and whether the association varied according to injury severity. METHODS Data from the international prospective pan-European cohort study, Collaborative European NeuroTrauma Effectiveness Research for TBI (CENTER-TBI), were used (n=4509). For prehospital intubation, we excluded self-presenters. For in-hospital intubation, patients whose tracheas were intubated on-scene were excluded. The association between intubation and outcome was analysed with ordinal regression with adjustment for the International Mission for Prognosis and Analysis of Clinical Trials in TBI variables and extracranial injury. We assessed whether the effect of intubation varied by injury severity by testing the added value of an interaction term with likelihood ratio tests. RESULTS In the prehospital analysis, 890/3736 (24%) patients had their tracheas intubated at scene. In the in-hospital analysis, 460/2930 (16%) patients had their tracheas intubated in the emergency department. There was no adjusted overall effect on functional outcome of prehospital intubation (odds ratio=1.01; 95% confidence interval, 0.79-1.28; P=0.96), and the adjusted overall effect of in-hospital intubation was not significant (odds ratio=0.86; 95% confidence interval, 0.65-1.13; P=0.28). However, prehospital intubation was associated with better functional outcome in patients with higher thorax and abdominal Abbreviated Injury Scale scores (P=0.009 and P=0.02, respectively), whereas in-hospital intubation was associated with better outcome in patients with lower Glasgow Coma Scale scores (P=0.01): in-hospital intubation was associated with better functional outcome in patients with Glasgow Coma Scale scores of 10 or lower. CONCLUSION The benefits and harms of tracheal intubation should be carefully evaluated in patients with TBI to optimise benefit. This study suggests that extracranial injury should influence the decision in the prehospital setting, and level of consciousness in the in-hospital setting. CLINICAL TRIAL REGISTRATION NCT02210221.
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Affiliation(s)
- Benjamin Yael Gravesteijn
- Department of Anaesthesiology, Erasmus University Medical Centre, Rotterdam, the Netherlands; Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands.
| | - Charlie Aletta Sewalt
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Daan Nieboer
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | | | - Andrew Maas
- Department of Neurosurgery, University Hospital Antwerp, Antwerp, Belgium
| | - Fiona Lecky
- Emergency Medicine Research in Sheffield (EMRiS), School of Health and Related Research (ScHARR), Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, UK
| | - Markus Klimek
- Department of Anaesthesiology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Hester Floor Lingsma
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands
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van Leeuwen ALI, Dekker NAM, Jansma EP, Boer C, van den Brom CE. Therapeutic interventions to restore microcirculatory perfusion following experimental hemorrhagic shock and fluid resuscitation: A systematic review. Microcirculation 2020; 27:e12650. [PMID: 32688443 PMCID: PMC7757213 DOI: 10.1111/micc.12650] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/07/2020] [Accepted: 07/13/2020] [Indexed: 12/11/2022]
Abstract
Objective Microcirculatory perfusion disturbances following hemorrhagic shock and fluid resuscitation contribute to multiple organ dysfunction and mortality. Standard fluid resuscitation is insufficient to restore microcirculatory perfusion; however, additional therapies are lacking. We conducted a systematic search to provide an overview of potential non‐fluid‐based therapeutic interventions to restore microcirculatory perfusion following hemorrhagic shock. Methods A structured search of PubMed, EMBASE, and Cochrane Library was performed in March 2020. Animal studies needed to report at least one parameter of microcirculatory flow (perfusion, red blood cell velocity, functional capillary density). Results The search identified 1269 records of which 48 fulfilled all eligibility criteria. In total, 62 drugs were tested of which 29 were able to restore microcirculatory perfusion. Particularly, complement inhibitors (75% of drugs tested successfully restored blood flow), endothelial barrier modulators (100% successful), antioxidants (66% successful), drugs targeting cell metabolism (83% successful), and sex hormones (75% successful) restored microcirculatory perfusion. Other drugs consisted of attenuation of inflammation (100% not successful), vasoactive agents (68% not successful), and steroid hormones (75% not successful). Conclusion Improving mitochondrial function, inhibition of complement inhibition, and reducing microvascular leakage via restoration of endothelial barrier function seem beneficial to restore microcirculatory perfusion following hemorrhagic shock and fluid resuscitation.
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Affiliation(s)
- Anoek L I van Leeuwen
- Department of Anesthesiology, Experimental Laboratory for VItal Signs, Amsterdam UMC, Vrije Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.,Department of Physiology, Amsterdam UMC, Vrije Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Nicole A M Dekker
- Department of Anesthesiology, Experimental Laboratory for VItal Signs, Amsterdam UMC, Vrije Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.,Department of Physiology, Amsterdam UMC, Vrije Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Elise P Jansma
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit, Amsterdam Public Health research institute, Amsterdam, The Netherlands.,Medical Library, Vrije Universiteit, Amsterdam, The Netherlands
| | - Christa Boer
- Department of Anesthesiology, Experimental Laboratory for VItal Signs, Amsterdam UMC, Vrije Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Charissa E van den Brom
- Department of Anesthesiology, Experimental Laboratory for VItal Signs, Amsterdam UMC, Vrije Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.,Department of Physiology, Amsterdam UMC, Vrije Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
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Yao R, Hou W, Shen T, Zhao S, He X, Sun Y, Ma B, Wu G, Xia Z. The Impact of Blood Type O on Major Outcomes in Patients With Severe Burns. J Burn Care Res 2020; 41:1111-1117. [PMID: 32249907 DOI: 10.1093/jbcr/iraa059] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
ABO blood type has been reported to be a predictor of poor prognosis in critically ill patients. Here, we aim to correlate different blood types with clinical outcomes in patients with severe burns. We conducted a single-center retrospective cohort study by enrolling patients with severe burn injuries (≥40% TBSA) between January 2012 and December 2017. Baseline characteristics and clinical outcomes were compared between disparate ABO blood types (type O vs non-O type). Multivariate logistic and linear regression analyses were performed to identify an association between ABO blood type and clinical outcomes, including in-hospital mortality, the development of acute kidney injury (AKI), and hospital or ICU length of stay. A total of 141 patients were finally enrolled in the current study. Mortality was significantly higher in patients with type O blood compared with those of other blood types. The development of AKI was significantly higher in patients with blood type O vs non-O blood type (P = .001). Multivariate analysis demonstrated that blood type O was independently associated with in-hospital mortality and AKI occurrence after adjusting for other potential confounders. Our findings indicated the blood type O was an independent risk factor of both increased mortality and the development of AKI postburn. More prudent and specific treatments are required in treating these patients to avoid poor prognosis.
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Affiliation(s)
- Renqi Yao
- Department of Burn Surgery, Changhai Hospital, Navy Medical University, Shanghai, People's Republic of China.,Trauma Research Center, Fourth Medical Center of the Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Wenjia Hou
- Department of Burn Surgery, Changhai Hospital, Navy Medical University, Shanghai, People's Republic of China
| | - Tuo Shen
- Department of Burn Surgery, Changhai Hospital, Navy Medical University, Shanghai, People's Republic of China
| | - Shuo Zhao
- Department of Laboratory Diagnosis, Changhai Hospital, Navy Medical University, Shanghai, People's Republic of China
| | - Xingfeng He
- Department of Burn Surgery, Changhai Hospital, Navy Medical University, Shanghai, People's Republic of China
| | - Yu Sun
- Department of Burn Surgery, Changhai Hospital, Navy Medical University, Shanghai, People's Republic of China
| | - Bing Ma
- Department of Burn Surgery, Changhai Hospital, Navy Medical University, Shanghai, People's Republic of China
| | - Guosheng Wu
- Department of Burn Surgery, Changhai Hospital, Navy Medical University, Shanghai, People's Republic of China
| | - Zhaofan Xia
- Department of Burn Surgery, Changhai Hospital, Navy Medical University, Shanghai, People's Republic of China
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Mattingly AS, Lerman BJ, Popat R, Wren SM. Association of Sex With Postoperative Mortality Among Patients With Heart Failure Who Underwent Elective Noncardiac Operations. JAMA Netw Open 2019; 2:e1914420. [PMID: 31675085 PMCID: PMC6826642 DOI: 10.1001/jamanetworkopen.2019.14420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IMPORTANCE Sex differences in postoperative outcomes in patients with heart failure (HF) have not been well characterized. Women generally experience a lower postoperative mortality risk after noncardiac operations. It is unclear if this pattern holds among patients with HF. OBJECTIVES To determine if the risk of postoperative mortality is associated with sex among patients with HF who underwent noncardiac operations and to determine if sex is associated with the relationship between HF and postoperative mortality. DESIGN, SETTING, AND PARTICIPANTS This multisite cohort study used data from the US Department of Veterans Affairs Surgical Quality Improvement Project database for all patients who underwent elective noncardiac operations from October 1, 2009, to September 30, 2016, with a minimum of 1 year follow-up. The data analysis was conducted from May 1, 2018, to August 31, 2018. EXPOSURES Heart failure, left ventricular ejection fraction, and sex. MAIN OUTCOMES AND MEASURES Postoperative mortality at 90 days. RESULTS Among 609 735 patients who underwent elective noncardiac operations from 2009 to 2016, 47 997 patients had HF (7.9%; mean [SD] age, 68.6 [10.1] years; 1391 [2.9%] women) and 561 738 patients did not have HF (92.1%; mean [SD] age, 59.4 [13.4] years; 50 862 [9.1%] women). Among patients with HF, female sex was not independently associated with 90-day postoperative mortality (adjusted odds ratio [aOR], 0.97; 95% CI, 0.71-1.32). Although HF was associated with increased odds of postoperative mortality in both sexes compared with their peers without HF, the odds of postoperative mortality were higher among women with HF (aOR, 2.44; 95% CI, 1.73-3.45) than men with HF (aOR, 1.64; 95% CI, 1.54-1.74), suggesting that HF may negate the general protective association of female sex with postoperative mortality (P for interaction of HF × sex = .03). This pattern was consistent across all levels of left ventricular ejection fraction. CONCLUSIONS AND RELEVANCE Although HF was associated with increased odds of postoperative mortality in both sexes compared with their peers without HF, the odds of postoperative mortality were higher among women with HF than men with HF, suggesting that HF may negate the general protective association of female sex with postoperative mortality risk in noncardiac operations.
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Affiliation(s)
| | - Benjamin J. Lerman
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
| | - Rita Popat
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
| | - Sherry M. Wren
- Surgical Service, Palo Alto Veterans Affairs Health Care System, Palo Alto, California
- Department of Surgery, Stanford University School of Medicine, Stanford, California
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