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Durr K, Yadav K, Ho M, Lampron J, Tran A, Drew D, Petrosoniak A, Vaillancourt C, Nemnom MJ, Abdulaziz K, Perry JJ. Predicting the critical administration threshold in bleeding trauma patients. CAN J EMERG MED 2024:10.1007/s43678-024-00776-3. [PMID: 39343847 DOI: 10.1007/s43678-024-00776-3] [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: 05/06/2024] [Accepted: 08/27/2024] [Indexed: 10/01/2024]
Abstract
INTRODUCTION Delays in promptly recognizing and appropriately managing hemorrhagic injuries contribute to preventable trauma related deaths nationwide. We sought to identify patient variables available at the time of emergency department arrival associated with meeting the critical administration threshold. METHODOLOGY We conducted a trauma registry review from September 2016 to March 2020 of trauma team activations at The Ottawa Hospital, a Level 1 Trauma Center. Our primary outcome was the frequency of meeting the critical administration threshold. Secondary outcomes included time to critical administration threshold, 24-h all-cause mortality, and 30-day all-cause mortality. Multivariate logistic regression identified factors independently associated with meeting the critical administration threshold. RESULTS We assessed 762 patients, of which 78 (10.2%) met the critical administration threshold. The median time to critical administration threshold was 28.9 min. Mortality at 24 h occurred in 58 (7.6%) patients. Four variables available upon patient arrival predicted the critical administration threshold, including systolic blood pressure ≤ 90 mmHg (OR 6.6; 95% CI 3.7-12.0), Glasgow Coma Scale ≤ 8 (OR 5.9; 95% CI 3.2-10.6), heart rate ≥ 100 beats/minute (OR 4.4; 95% CI 2.4-8.1), and respiratory rate ≥ 20 breaths/min (OR 2.2; 95% CI 1.2-4.0). CONCLUSION We identified four clinical variables readily available to physicians upon patient arrival associated with meeting the critical administration threshold: systolic blood pressure ≤ 90 mmHg, Glasgow Coma Scale ≤ 8, heart rate ≥ 100 beats/minute, and respiratory rate ≥ 20 breaths/min. Patients presenting with any of these clinical parameters should prompt physicians to consider ordering blood products immediately.
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Affiliation(s)
- Kevin Durr
- Department of Emergency Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada.
- Department of Critical Care, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada.
| | - Krishan Yadav
- Department of Emergency Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Michael Ho
- Department of Emergency Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada
| | - Jacinthe Lampron
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Division of General Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada
| | - Alexandre Tran
- Department of Critical Care, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada
- Division of General Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada
| | - Doran Drew
- Department of Emergency Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada
- Division of General Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada
| | - Andrew Petrosoniak
- Department of Emergency Medicine, University of Toronto, St. Michael's Hospital, Toronto, ON, Canada
| | - Christian Vaillancourt
- Department of Emergency Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Marie-Joe Nemnom
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Kasim Abdulaziz
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Jeffrey J Perry
- Department of Emergency Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Fu P. Shock index do not work on a 72-year-Old male with multiple trauma due to a traffic accident: A case report. Asian J Surg 2024:S1015-9584(24)02151-1. [PMID: 39332956 DOI: 10.1016/j.asjsur.2024.09.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Accepted: 09/12/2024] [Indexed: 09/29/2024] Open
Affiliation(s)
- Pinguo Fu
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, China.
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Rafieezadeh A, Prabhakaran K, Kirsch J, Klein J, Shnaydman I, Bronstein M, Con J, Zangbar B. Shock Index is a Stronger Predictor of Outcomes in Older Compared to Younger Patients. J Surg Res 2024; 300:8-14. [PMID: 38788482 DOI: 10.1016/j.jss.2024.04.064] [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: 12/04/2023] [Revised: 04/26/2024] [Accepted: 04/29/2024] [Indexed: 05/26/2024]
Abstract
INTRODUCTION The shock index (SI) is a known predictor of unfavorable outcomes in trauma. This study seeks to examine and compare the SI values between geriatric patients and younger adults. METHODS We conducted a retrospective study of the Trauma Quality Improvement Program database from 2017 to 2019. All patients≥ 25 y with injury severity score ≥ 16 were included. Age groups were defined as 25-44 y (group A), 45-64 y (group B), and ≥65 y (group C). SI was calculated for all patients. The primary outcome was mortality and secondary outcomes were need for blood transfusion and need for major surgical intervention (consisting angiography, exploratory laparotomy, and thoracotomy). RESULTS A total of 244,943 patients were studied. The SI was highest in group A (0.82 ± 0.33) and lowest in group C (0.62 ± 0.30) (P < 0.001). Mortality rate of group C (17%) was significantly higher than group A (9.7%) and B (11.3%) (P < 0.001). In group A, each 0.1 increase in SI was associated with mortality (odds ratio [OR] = 1.079), need for blood transfusion (OR = 1.225) and need for major surgical intervention (OR = 1.347) (P < 0.001 for all). In group C, each 0.1 increase in SI was associated with mortality (OR = 1.126), need for blood transfusion (OR = 1.318), and need for major surgical intervention (OR = 1.648) (P < 0.001 for all). The area under the curve of SI was significantly higher in group C compared to other groups for needing a major surgical intervention and need for blood transfusion (P < 0.05 for both). CONCLUSIONS These results highlight the significance of the SI as a valuable indicator in geriatric patients with severe trauma. The findings show that SI predicts outcomes in geriatrics more strongly than in younger counterparts.
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Affiliation(s)
- Aryan Rafieezadeh
- Westchester Medical Center, New York Medical College, Valhalla, New York
| | - Kartik Prabhakaran
- Westchester Medical Center, New York Medical College, Valhalla, New York
| | - Jordan Kirsch
- Westchester Medical Center, New York Medical College, Valhalla, New York
| | - Joshua Klein
- Westchester Medical Center, New York Medical College, Valhalla, New York
| | - Ilya Shnaydman
- Westchester Medical Center, New York Medical College, Valhalla, New York
| | - Matthew Bronstein
- Westchester Medical Center, New York Medical College, Valhalla, New York
| | - Jorge Con
- Westchester Medical Center, New York Medical College, Valhalla, New York
| | - Bardiya Zangbar
- Westchester Medical Center, New York Medical College, Valhalla, New York.
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Yoon SH, Shin SJ, Kim H, Roh YH. Shock index and shock index, pediatric age-adjusted as predictors of mortality in pediatric patients with trauma: A systematic review and meta-analysis. PLoS One 2024; 19:e0307367. [PMID: 39024206 PMCID: PMC11257222 DOI: 10.1371/journal.pone.0307367] [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: 01/05/2024] [Accepted: 07/03/2024] [Indexed: 07/20/2024] Open
Abstract
This study aimed to assess the predictive ability of the shock index (SI) and the shock index, pediatric age-adjusted (SIPA) for mortality among pediatric patients with trauma (aged ≤ 18 years). A systematic search used PubMed, Embase, and Cochrane Library databases to identify pertinent articles published from their inception to 13 February 2023. For each SI and SIPA, the pooled sensitivity, specificity, diagnostic odds ratio (DOR), and area under the summary receiver operating characteristic curve (AUC) with the corresponding 95% confidence intervals were calculated. We planned a priori meta-regression analyses to explore heterogeneity using the following covariates: country, clinical setting, type of center, data source, and cutoff value. Twelve studies were included based on the inclusion criteria. Among them, nine studies with 195,469 patients were included for the SIPA at the hospital, four studies with 4,970 patients were included for the pre-hospital SIPA, and seven studies with 606,445 patients were included to assess the ability of the SI in predicting mortality. The pooled sensitivity and specificity with 95% confidence interval for predicting mortality were as follows: 0.58 (0.44-0.70) and 0.72 (0.60-0.82), respectively, for the SIPA at the hospital; 0.61 (0.47-0.74) and 0.67 (0.61-0.73), respectively, for the pre-hospital SIPA; and 0.71 (0.59-0.81) and 0.45 (0.31-0.59), respectively for the SI. The DOR were 3.80, 3.28, and 2.06 for the SIPA at the hospital, pre-hospital SIPA, and SI, respectively. The AUC were 0.693, 0.689, and 0.618 for the SIPA at the hospital, pre-hospital SIPA, and SI, respectively. The SI and SIPA are simple predictive tools with sufficient accuracy that can be readily applied to pediatric patients with trauma, but SIPA and SI should be utilized cautiously due to their limited sensitivity and specificity, respectively.
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Affiliation(s)
- Seo Hee Yoon
- Department of Pediatrics, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang-Jun Shin
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea
| | - Heeyeon Kim
- Department of Pediatrics, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yun Ho Roh
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea
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Liao TK, Ho CH, Lin YJ, Cheng LC, Huang HY. Shock index to predict outcomes in patients with trauma following traffic collisions: a retrospective cohort study. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02545-4. [PMID: 38819683 DOI: 10.1007/s00068-024-02545-4] [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: 02/29/2024] [Accepted: 05/03/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE Taiwan, which has a rate of high vehicle ownership, faces significant challenges in managing trauma caused by traffic collisions. In Taiwan, traffic collisions contribute significantly to morbidity and mortality, with a high incidence of severe bleeding trauma. The shock index (SI) and the modified shock index (MSI) have been proposed as early indicators of hemodynamic instability. In this study, we aimed to assess the efficacy of SI and MSI in predicting adverse outcomes in patients with trauma following traffic collisions. METHODS This retrospective cohort study was conducted at Chi Mei Hospital from January 2015 to December 2020. The comprehensive analysis included 662 patients, with data collected on vital signs and outcomes such as mortality, blood transfusion, emergent surgical intervention (ESI), transarterial embolization (TAE), and intensive care unit (ICU) admission. Optimal cutoff points for SI and MSI were identified by calculating the Youden index. Logistic regression analysis was used to assess outcomes, adjusting for demographic and injury severity variables. RESULTS An SI threshold of 1.11 was associated with an increased risk of mortality, while an SI of 0.84 predicted the need for blood transfusion in the context of traffic collisions. Both SI and MSI demonstrated high predictive power for mortality and blood transfusion, with acceptable accuracy for TAE, ESI, and ICU admission. Logistic regression analyses confirmed the independence of SI and MSI as risk factors for adverse outcomes, thus, providing valuable insights into their clinical utility. CONCLUSIONS SI and MSI are valuable tools for predicting mortality and blood transfusion needs in patients with trauma due to traffic collisions. These findings advance the quality of care for patients with trauma during their transition from the emergency room to the ICU, facilitating prompt and reliable decision-making processes and improving the care of patients with trauma.
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Affiliation(s)
- Te-Kai Liao
- Division of Traumatology, Department of Surgery, Chi Mei Medical Center, No. 901, Zhonghua Road, Yongkang District, 710, Tainan, Taiwan
| | - Chung-Han Ho
- Department of Medicine Research, Chi Mei Medical Center, Tainan, Taiwan
- Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Ying-Jia Lin
- Department of Medicine Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Li-Chin Cheng
- Division of Traumatology, Department of Surgery, Chi Mei Medical Center, No. 901, Zhonghua Road, Yongkang District, 710, Tainan, Taiwan
- Division of Colorectal Surgery, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan
| | - Hsuan-Yi Huang
- Division of Traumatology, Department of Surgery, Chi Mei Medical Center, No. 901, Zhonghua Road, Yongkang District, 710, Tainan, Taiwan.
- Division of Colorectal Surgery, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan.
- Center of General Education, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
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Park JS, Choi SJ, Kim MJ, Choi SY, Kim HY, Park YS, Chung SP, Lee JH. Cutoff of the reverse shock index multiplied by the Glasgow coma scale for predicting in-hospital mortality in adult patients with trauma: a retrospective cohort study. BMC Emerg Med 2024; 24:55. [PMID: 38584265 PMCID: PMC11000363 DOI: 10.1186/s12873-024-00978-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: 12/27/2023] [Accepted: 03/28/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Early identification of patients at risk of potential death and timely transfer to appropriate healthcare facilities are critical for reducing the number of preventable trauma deaths. This study aimed to establish a cutoff value to predict in-hospital mortality using the reverse shock index multiplied by the Glasgow Coma Scale (rSIG). METHODS This multicenter retrospective cohort study used data from 23 emergency departments in South Korea between January 2011 and December 2020. The outcome variable was the in-hospital mortality. The relationship between rSIG and in-hospital mortality was plotted using the shape-restricted regression spline method. To set a cutoff for rSIG, we found the point on the curve where mortality started to increase and the point where the slope of the mortality curve changed the most. We also calculated the cutoff value for rSIG using Youden's index. RESULTS A total of 318,506 adult patients with trauma were included. The shape-restricted regression spline curve showed that in-hospital mortality began to increase when the rSIG value was less than 18.86, and the slope of the graph increased the most at 12.57. The cutoff of 16.5, calculated using Youden's index, was closest to the target under-triage and over-triage rates, as suggested by the American College of Surgeons, when applied to patients with an rSIG of 20 or less. In addition, in patients with traumatic brain injury, when the rSIG value was over 25, in-hospital mortality tended to increase as the rSIG value increased. CONCLUSIONS We propose an rSIG cutoff value of 16.5 as a predictor of in-hospital mortality in adult patients with trauma. However, in patients with traumatic brain injury, a high rSIG is also associated with in-hospital mortality. Appropriate cutoffs should be established for this group in the future.
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Affiliation(s)
- Jun Seong Park
- Department of Emergency Medicine, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, 03722, Seoul, Republic of Korea
| | - Sol Ji Choi
- Department of Emergency Medicine, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, 03722, Seoul, Republic of Korea
| | - Min Joung Kim
- Department of Emergency Medicine, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, 03722, Seoul, Republic of Korea
| | - So Yeon Choi
- Department of Emergency Medicine, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, 03722, Seoul, Republic of Korea
| | - Ha Yan Kim
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yoo Seok Park
- Department of Emergency Medicine, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, 03722, Seoul, Republic of Korea
| | - Sung Phil Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, 03722, Seoul, Republic of Korea
| | - Ji Hwan Lee
- Department of Emergency Medicine, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, 03722, Seoul, Republic of Korea.
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Lier H, Hossfeld B. Massive transfusion in trauma. Curr Opin Anaesthesiol 2024; 37:117-124. [PMID: 38390985 DOI: 10.1097/aco.0000000000001347] [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: 02/24/2024]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an overview of currently recommended treatment approaches for traumatic hemorrhage shock, with a special focus on massive transfusion. RECENT FINDINGS Severe trauma patients require massive transfusion, but consensual international definitions for traumatic hemorrhage shock and massive transfusion are missing. Current literature defines a massive transfusion as transfusion of a minimum of 3-4 packed red blood cells within 1 h. Using standard laboratory and/or viscoelastic tests, earliest diagnosis and treatment should focus on trauma-induced coagulopathy and substitution of substantiated deficiencies. SUMMARY To initiate therapy immediately massive transfusion protocols are helpful focusing on early hemorrhage control using hemostatic dressing and tourniquets, correction of metabolic derangements to decrease coagulopathy and substitution according to viscoelastic assays and blood gases analysis with tranexamic acid, fibrinogen concentrate, red blood cells, plasma and platelets are recommended. Alternatively, the use of whole blood is possible. If needed, further support using prothrombin complex, factor XIII or desmopressin is suggested.
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Affiliation(s)
- Heiko Lier
- Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine, and University Hospital Cologne
| | - Björn Hossfeld
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Center of Emergency Medicine, HEMS 'Christoph 22', Armed Forces Hospital, Ulm, Germany
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MacArthur TA, Polites SF. How much is too much crystalloid? Building a foundation for the study of optimal resuscitation practices in pediatric trauma patients with severe traumatic brain injury: Authors' response to Ghasemian et al. J Trauma Acute Care Surg 2024; 96:e25-e26. [PMID: 38079249 DOI: 10.1097/ta.0000000000004236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
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Yousefi MR, Ghasemian M, Paydar S. Letter to the editor: Points to consider regarding crystalloid volume and short-term outcome in children with severe traumatic brain injury. J Trauma Acute Care Surg 2024; 96:e24-e25. [PMID: 38079272 DOI: 10.1097/ta.0000000000004201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
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Wu MY, Hou YT, Chung JY, Yiang GT. Reverse shock index multiplied by simplified motor score as a predictor of clinical outcomes for patients with COVID-19. BMC Emerg Med 2024; 24:26. [PMID: 38355419 PMCID: PMC10865660 DOI: 10.1186/s12873-024-00948-5] [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: 06/28/2023] [Accepted: 02/05/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND The reverse shock index (rSI) combined with the Simplified Motor Score (sMS), that is, the rSI-sMS, is a novel and efficient prehospital triage scoring system for patients with COVID-19. In this study, we evaluated the predictive accuracy of the rSI-sMS for general ward and intensive care unit (ICU) admission among patients with COVID-19 and compared it with that of other measures, including the shock index (SI), modified SI (mSI), rSI combined with the Glasgow Coma Scale (rSI-GCS), and rSI combined with the GCS motor subscale (rSI-GCSM). METHODS All patients who visited the emergency department of Taipei Tzu Chi Hospital between January 2021 and June 2022 were included in this retrospective cohort. A diagnosis of COVID-19 was confirmed through a SARS-CoV-2 reverse-transcription polymerase chain reaction test or SARS-CoV-2 rapid test with oropharyngeal or nasopharyngeal swabs and was double confirmed by checking International Classification of Diseases, Tenth Revision, Clinical Modification codes in electronic medical records. In-hospital mortality was regarded as the primary outcome, and sepsis, general ward or ICU admission, endotracheal intubation, and total hospital length of stay (LOS) were regarded as secondary outcomes. Multivariate logistic regression was used to determine the relationship between the scoring systems and the three major outcomes of patients with COVID-19, including. The discriminant ability of the predictive scoring systems was investigated using the area under the receiver operating characteristic curve, and the most favorable cutoff value of the rSI-sMS for each major outcome was determined using Youden's index. RESULTS After 74,183 patients younger than 20 years (n = 11,572) and without COVID-19 (n = 62,611) were excluded, 9,282 patients with COVID-19 (median age: 45 years, interquartile range: 33-60 years, 46.1% men) were identified as eligible for inclusion in the study. The rate of in-hospital mortality was determined to be 0.75%. The rSI-sMS scores were significantly lower in the patient groups with sepsis, hyperlactatemia, admission to a general ward, admission to the ICU, total length of stay ≥ 14 days, and mortality. Compared with the SI, mSI, and rSI-GCSM, the rSI-sMS exhibited a significantly higher accuracy for predicting general ward admission, ICU admission, and mortality but a similar accuracy to that of the rSI-GCS. The optimal cutoff values of the rSI-sMS for predicting general ward admission, ICU admission, and mortality were calculated to be 3.17, 3.45, and 3.15, respectively, with a predictive accuracy of 86.83%, 81.94%%, and 90.96%, respectively. CONCLUSIONS Compared with the SI, mSI, and rSI-GCSM, the rSI-sMS has a higher predictive accuracy for general ward admission, ICU admission, and mortality among patients with COVID-19.
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Affiliation(s)
- Meng-Yu Wu
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, 231, Taiwan
- Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien, 970, Taiwan
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan
| | - Yueh-Tseng Hou
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, 231, Taiwan
- Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien, 970, Taiwan
| | - Jui-Yuan Chung
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan
- Department of Emergency Medicine, Cathay General Hospital, Taipei, Taiwan
- School of Medicine, Fu Jen Catholic University, Taipei, Taiwan
- School of Medicine, National Tsing Hua University, Hsinchu, Taiwan
| | - Giou-Teng Yiang
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, 231, Taiwan.
- Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien, 970, Taiwan.
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Yanagawa Y, Nagasawa H, Ota S, Hamada M, Kawai K, Taniguchi H, Sakai T, Ohsaka H, Omori K. The Factors Associated With Decreasing Hemoglobin Levels and Platelet Counts After Trauma. Cureus 2024; 16:e55104. [PMID: 38558724 PMCID: PMC10978814 DOI: 10.7759/cureus.55104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 04/04/2024] Open
Abstract
Objective In this study, we investigated the factors related to anemia and platelet reduction in patients with moderate to severe trauma to gain a deeper understanding of these phenomena. Methods Our study spanned the period from April 2021 to September 2023, and it involved a retrospective review of the hospital medical charts of all emergency outpatients of all ages who were transported by a physician-staffed helicopter and treated at our hospital and were diagnosed with an Injury Severity Score (ISS) of >8 by CT on arrival. The following data were analyzed: sex; age; mechanism of injury; vital signs upon arrival at the hospital; ISS; hemoglobin level and platelet count on arrival and day two; fibrin degradation product (FDP) level, lactate dehydrogenase (LDH) level, and diameter of the inferior vena cava (IVC) on arrival; and infusion volume on day one. We then statistically calculated the independent risk factors for differences between hemoglobin levels and platelet counts on arrival and those on day two. Results The study included a total of 209 subjects, with an average age of 58 years and a male predominance. Multivariate analysis showed that the FDP level, IVC diameter, and age were significantly associated with changes in hemoglobin levels on arrival and day two, whereas the IVC diameter, LDH, age, systolic blood pressure, and sex were significantly associated with changes in the platelet count on arrival and day two. Conclusions A noteworthy correlation was found between certain factors and changes in hemoglobin levels and platelet counts between the initial assessment and the second day in our cohort. We recommend further prospective research to determine whether our findings hold true for a larger population of trauma patients.
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Affiliation(s)
- Youichi Yanagawa
- Acute Critical Care Medicine, Juntendo University Shizuoka Hospital, Izunokuni, JPN
| | - Hiroki Nagasawa
- Acute Critical Care Medicine, Juntendo University Shizuoka Hospital, Izunokuni, JPN
| | - Soichiro Ota
- Acute Critical Care Medicine, Juntendo University Shizuoka Hospital, Izunokuni, JPN
| | - Michika Hamada
- Acute Critical Care Medicine, Juntendo University Shizuoka Hospital, Izunokuni, JPN
| | - Kenji Kawai
- Acute Critical Care Medicine, Juntendo University Shizuoka Hospital, Izunokuni, JPN
| | - Hiroaki Taniguchi
- Acute Critical Care Medicine, Juntendo University Shizuoka Hospital, Izunokuni, JPN
| | - Tatsuro Sakai
- Acute Critical Care Medicine, Juntendo University Shizuoka Hospital, Izunokuni, JPN
| | - Hiromichi Ohsaka
- Acute Critical Care Medicine, Juntendo University Shizuoka Hospital, Izunokuni, JPN
| | - Kazuhiko Omori
- Acute Critical Care Medicine, Juntendo University Shizuoka Hospital, Izunokuni, JPN
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Mohammadi HR, Erfani A, Sadeghi S, Komlakh K, Otaghi M, Vasig A. Investigating Factors Affecting Mortality Due to Spinal Cord Trauma in Patients Admitted to the Intensive Care Unit. Bull Emerg Trauma 2024; 12:136-141. [PMID: 39391363 PMCID: PMC11462108 DOI: 10.30476/beat.2024.103079.1517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 04/02/2024] [Accepted: 05/15/2024] [Indexed: 10/12/2024] Open
Abstract
Objectives This study was conducted to investigate the factors affecting mortality due to spinal cord trauma in patients admitted to the intensive care unit (ICU). Methods This study was conducted in a group of patients who were admitted to the ICU with a Traumatic Spinal Injuries (TSI) diagnosis. The researcher started sampling by assessing the documents of the patients hospitalized in the ICU, and the diagnosis of TSI was confirmed for them. Besides, utilizing a researcher-made checklist, factors affecting the mortality of patients were identified. The data were analyzed using the SPSS software version 16. P<0.05 was considered statistically significant. Results About 412 (64.2%) patients were men, about 213 (33.2%) of the patients had GCS between 3-8 grade. There were injuries in the pelvis area. Moreover, there was a significant relationship between GCS score status and the number of injury follow-ups in addition to TSI. Therefore, the mortality rate was higher in patients who had lower GCS (Odds ratio=2.32, p<0.001). There was also a significant relationship between the number of injuries and the mortality rate, and patients who had multiple traumas had a higher mortality rate. Besides, a significant relationship was observed between the complications caused by trauma, including cerebrovascular accident, cardiac arrest, acute respiratory distress syndrome (ARDS), pneumonia, and the mortality of patients hospitalized in the SICU (p<0.05). Conclusion The patients' mortality was influenced by factors such as their level of consciousness, the number of traumas caused in the spinal cord, and the occurrence of comorbidities such as cerebrovascular accident, cardiac arrest, ARDS, and pneumonia. Therefore, it is necessary to take the essential measures to reduce these complications.
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Affiliation(s)
- Hassan Reza Mohammadi
- Department of Neurosurgery, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Erfani
- Department of Neurosurgery, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sohrab Sadeghi
- Department of Neurosurgery, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Khalil Komlakh
- Department of Neurosurgery, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoumeh Otaghi
- Department of Nursing, School of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran
| | - Aminollah Vasig
- Department of Anesthesiology, School of Allied Medical Sciences, Ilam University of Medical sciences, Ilam, Iran
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Shaya Y, Stein M, Gershovitz L, Furer A, Khalaf A, Drescher MJ, Gabbay U. Can cardiovascular reserve index (CVRI) on arrival to the trauma unit detects massive hemorrhage and predicts developing hemorrhage? observational prospective cohort study. Int J Surg 2024; 110:144-150. [PMID: 37800592 PMCID: PMC10793792 DOI: 10.1097/js9.0000000000000826] [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: 06/18/2023] [Accepted: 09/25/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND The detection of haemorrhage in trauma casualties may be delayed owing to compensatory mechanisms. This study aimed to evaluate whether the cardiovascular reserve index (CVRI) on arrival detects massive haemorrhage and predicts haemorrhage development in trauma casualties. METHODS This was an observational prospective cohort study of adult casualties (≥18 years) who were brought to a single level-1 trauma centre, enroled upon arrival and followed until discharge. Vital signs were monitored on arrival, from which the CVRI and shock index were retrospectively calculated (blinded to the caregivers). The outcome measure was the eventual haemorrhage classification group: massive haemorrhage on arrival (MHOA) (defined by massive transfusion on arrival of ≥6 [O+] packed cells units), developing haemorrhage (DH) (defined by a decrease in haemoglobin >1 g/dl in consecutive tests), and no significant haemorrhage noted throughout the hospital stay. The means of each variable on arrival by haemorrhage group were evaluated using the analysis of variance. The authors evaluated the detection of MHOA in the entire population and the prediction of DH in the remainders (given that MHOA had already been detected and treated) by C-statistic predefined strong prediction by area under the curve (AUC) greater than or equal to 0.8, P less than or equal to 0.05. RESULTS The study included 71 patients (after exclusion): males, 82%; average age 37.7 years. The leading cause of injuries was road accident (61%). Thirty-nine (54%) patients required hospital admission; distribution by haemorrhage classification: 5 (7%) MHOA, 5 (7%) DH, and 61 (86%) no significant haemorrhage. Detection of MHOA found a strong predictive model by CVRI and most variables (AUC 0.85-1.0). The prediction of DH on arrival showed that only lactate (AUC=0.88) and CVRI (0.82) showed strong predictive model. CONCLUSIONS CVRI showed a strong predictive model for detection of MHOA (AUC>0.8) as were most other variables. CVRI also showed a strong predictive model for detection of DH (AUC=0.82), only serum lactate predicted DH (AUC=0.88), while all other variables were not found predictive. CVRI has advantages over lactate in that it is feasible in pre-hospital and mass casualty settings. Moreover, its repeatability enables detection of deteriorating trend. The authors conclude that CVRI may be a useful additional tool in the evaluation of haemorrhage.
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Affiliation(s)
- Yossi Shaya
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
- Department of Emergency Medicine
| | - Michael Stein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
- Trauma Unit
| | - Liron Gershovitz
- Israel Defense Forces Medical Corps, Tel HaShomer, Israel
- Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ariel Furer
- Israel Defense Forces Medical Corps, Tel HaShomer, Israel
- Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Michael J. Drescher
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
- Department of Emergency Medicine
| | - Uri Gabbay
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
- Quality Unit, Rabin Medical Center, Beilinson Hospital, Petach Tikva
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Rincón Ferrari MD, Felipe Correoso MM, Candela Toha Á. [Assessment of the degree of knowledge of the massive transfusion protocol in four Spanish hospitals]. Med Clin (Barc) 2023; 161:312-313. [PMID: 37380548 DOI: 10.1016/j.medcli.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/27/2023] [Accepted: 05/29/2023] [Indexed: 06/30/2023]
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Suda AJ, Fritsch G. Traumatic pancreas, kidney, liver, spleen, gastric and diaphragma rupture with enterothorax after blunt trauma caused by falling in an adolescent: a case report. Arch Orthop Trauma Surg 2023:10.1007/s00402-023-04865-3. [PMID: 37029794 PMCID: PMC10082337 DOI: 10.1007/s00402-023-04865-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/25/2023] [Indexed: 04/09/2023]
Abstract
Injury of almost all intra-abdominal organs in blunt trauma without bone and brain injury is very rare. This is the case report of a 16-year-old adolescent with severe abdominal trauma who was hit on his abdomen by a falling maytree. After admission to a Level I trauma center, emergency room treatment according to ATLS and after this emergency surgery was performed. Blood coagulation diagnostics was done using thrombo-elastography and factors and blood products have been applied according to its results keeping guidelines in mind. Damage-control surgery stopped the bleeding, and he was admitted to ICU. After second and third look surgery, the abdomen was closed. Structured diagnostics and treatment were crucial in this case. The education of trauma surgeons should include general surgery skills. These skills and knowledge of blood coagulation diagnostics and therapy saved the patient's life in this case.
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Affiliation(s)
- Arnold J Suda
- Department of Orthopaedics and Trauma Surgery, AUVA Trauma Center Salzburg, Dr. Franz-Rehrl-Platz 5, 5010, Salzburg, Austria.
| | - Gerhard Fritsch
- Department of Anesthesiology and Intensive Care Medicine, AUVA Trauma Center Salzburg, Dr. Franz-Rehrl-Platz 5, 5010, Salzburg, Austria
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