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Lee A, Kroeker J, Evans DC. Complication reporting in trauma: An environmental scan and comparison of nationwide trauma registry data. Am J Surg 2024; 231:11-15. [PMID: 38360500 DOI: 10.1016/j.amjsurg.2024.01.025] [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: 11/15/2023] [Revised: 12/26/2023] [Accepted: 01/24/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND To explore variability in quality measurement, this study aimed to compare abstraction and definitions of complications reported across trauma registries in Canada. METHODS A literature search was performed to identify active trauma registries used in Canadian hospitals. Registry characteristics, data abstraction, and reported complications and definitions based on registry data dictionaries were compared. RESULTS Nine registries were included, most of which were provincial-level registries (67 %). A total of 53 individual complications were identified. Twenty-one (40 %) were recorded by only one registry each whereas 5 (9 %) were collected by all. Of the 32 complications collected by > 1 registry, 18 (56 %) had different definitions. Of the 18 with different definitions, 12 (67 %), 5 (28 %), and 1 (6 %) had 2, 3, and 4 different definitions across registries, respectively. CONCLUSIONS Complications reported by trauma registries are variable. Reliable benchmarking is likely challenging, and efforts to standardize complication reporting may be a valuable undertaking.
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Affiliation(s)
- Alex Lee
- Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, 855 West 12th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Jenna Kroeker
- Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, 855 West 12th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - David C Evans
- Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, 855 West 12th Avenue, Vancouver, BC, V5Z 1M9, Canada.
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Chopko A, Tian M, L'Huillier JC, Filipescu R, Yu J, Guo WA. Utility of intracranial pressure monitoring in patients with traumatic brain injuries: a propensity score matching analysis of TQIP data. Eur J Trauma Emerg Surg 2024; 50:173-184. [PMID: 36795136 DOI: 10.1007/s00068-023-02239-3] [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: 11/22/2022] [Accepted: 01/27/2023] [Indexed: 02/17/2023]
Abstract
PURPOSE Intracranial pressure monitoring (ICPM) is central to traumatic brain injury (TBI) management, but its utility is controversial. METHODS The 2016-2017 TQIP database was queried for isolated TBI. Patients with ICPM [(ICPM (+)] were propensity-score matched (PSM) to those without ICPM [ICPM (-)] and divided into three age groups by years (< 18, 18-54, ≥ 55). RESULTS PSM yielded 2125 patients in each group. Patients aged < 18 years had a higher survival probability (p = 0.013) and decreased mortality (p = 0.016) in the ICPM (+) group. Complications were higher and LOS was longer in ICPM (+) patients aged 18-54 years and ≥ 55 years, but not in patients aged < 18 years. CONCLUSIONS ICPM (+) is associated with a survival benefit without an increase in complications in patents aged < 18 years. In patients aged ≥ 18 years, ICPM (+) is associated with more complications and longer LOS without a survival benefit.
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Affiliation(s)
- Ashley Chopko
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Buffalo, NY, 14203, USA
| | - Mingmei Tian
- Department of Biostatistics, School of Public Health and Health Professions, University at Buffalo, 401 Kimball Tower, Buffalo, NY, 14214, USA
| | - Joseph C L'Huillier
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Buffalo, NY, 14203, USA
- Department of Epidemiology and Environmental Health, Division of Health Services Policy and Practice, School of Public Health and Health Professions, University at Buffalo, 270 Farber Hall, Buffalo, NY, 14214, USA
| | - Radu Filipescu
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, 818 Ellicott Street, Buffalo, NY, 14203, USA
| | - Jinhee Yu
- Department of Biostatistics, School of Public Health and Health Professions, University at Buffalo, 401 Kimball Tower, Buffalo, NY, 14214, USA
| | - Weidun A Guo
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Buffalo, NY, 14203, USA.
- Erie County Medical Center, 462 Grider Street, Buffalo, NY, 14215, USA.
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Wah W, Berecki-Gisolf J, Walker-Bone K. In-hospital complications of work-related musculoskeletal injuries. Injury 2024; 55:111211. [PMID: 37984014 DOI: 10.1016/j.injury.2023.111211] [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: 09/18/2023] [Revised: 11/07/2023] [Accepted: 11/12/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND, OBJECTIVES Work-related musculoskeletal (MSK) injuries are a major contributor to morbidity worldwide and frequently result in hospitalisation. Hospital complications are common, costly, and largely preventable, but relevant data is required to address this. This study aimed to identify the incidence and factors associated with in-hospital complications of work-related MSK injuries. METHODS This study is based on work-related MSK hospital admission data from Victorian Admitted Episodes Database, 2016-2022. Complications were identified based on ICD-10-AM coding using CHADx (Classification of Hospital Acquired Diagnoses). Negative binomial and logistic regression analyses were performed to identify factors related to in-hospital complications. RESULTS In-hospital complications occurred in 6.3 % of work-related MSK injury admissions. In the adjusted models, ages ≥45 years, female sex, and area-level disadvantage were associated with in-hospital complications. Stay at public (vs private) hospitals, comorbidity, emergency admissions, and general anaesthesia were also associated. Complication rates were higher in hospitalised workers with direct head, neck, and trunk injuries and cumulative MSK disorders than those with direct extremities injuries and acute MSK conditions. The most common complications were cardiovascular, gastrointestinal complications and adverse drug events. CONCLUSION This study identified patient, injury and hospital-related characteristics associated with in-hospital complications of work-related MSK injuries for informing prevention strategies and risk estimation by hospital staff and workers' compensation schemes. The results demonstrate a sizable rate of complications given the relatively young and healthy study population.
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Affiliation(s)
- Win Wah
- Monash Centre for Occupational and Environmental Health, School of Public Health and Preventive Medicine, Monash University, 553St Kilda road, Melbourne, Victoria 3004, Australia.
| | - Janneke Berecki-Gisolf
- Monash Centre for Occupational and Environmental Health, School of Public Health and Preventive Medicine, Monash University, 553St Kilda road, Melbourne, Victoria 3004, Australia; Victorian Injury Surveillance Unit, Monash University Accident Research Centre, Monash University, 21 Alliance Ln, Clayton, Melbourne, Victoria 3168, Australia
| | - Karen Walker-Bone
- Monash Centre for Occupational and Environmental Health, School of Public Health and Preventive Medicine, Monash University, 553St Kilda road, Melbourne, Victoria 3004, Australia
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Gillies GS, Munley JA, Kelly LS, Kirkpatrick SL, Pons EE, Kannan KB, Bible LE, Efron PA, Mohr AM. Posttraumatic pneumonia exacerbates bone marrow erythropoietic dysfunction. J Trauma Acute Care Surg 2024; 96:17-25. [PMID: 37853556 PMCID: PMC10842431 DOI: 10.1097/ta.0000000000004157] [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] [Indexed: 10/20/2023]
Abstract
INTRODUCTION Pneumonia is a common complication after severe trauma that is associated with worse outcomes with increased mortality. Critically ill trauma patients also have persistent inflammation and bone marrow dysfunction that manifests as persistent anemia. Terminal erythropoiesis, which occurs in bone marrow structures called erythroblastic islands (EBIs), has been shown to be impacted by trauma. Using a preclinical model of polytrauma (PT) and pneumonia, we sought to determine the effect of infection on bone marrow dysfunction and terminal erythropoiesis. METHODS Male and female Sprague-Dawley rats aged 9 to 11 weeks were subjected to either PT (lung contusion, hemorrhagic shock, cecectomy, and bifemoral pseudofracture) or PT with postinjury day 1 Pseudomonas pneumonia (PT-PNA) and compared with a naive cohort. Erythroblastic islands were isolated from bone marrow samples and imaged via confocal microscopy. Hemoglobin, early bone marrow erythroid progenitors, erythroid cells/EBI, and % reticulocytes/EBI were measured on day 7. Significance was defined as p < 0.05. RESULTS Day 7 hemoglobin was significantly lower in both PT and PT-PNA groups compared with naive (10.8 ± 0.6 and 10.9 ± 0.7 vs. 12.1 ± 0.7 g/dL [ p < 0.05]). Growth of bone marrow early erythroid progenitors (colony-forming units-granulocyte, erythrocyte, monocyte, megakaryocyte; erythroid burst-forming unit; and erythroid colony-forming unit) on day 7 was significantly reduced in PT-PNA compared with both PT and naive. Despite a peripheral reticulocytosis following PT and PT-PNA, the percentage of reticulocytes/EBI was not different between naive, PT, and PT-PNA. However, the number of erythroblasts/EBI was significantly lower in PT-PNA compared with naive (2.9 ± 1.5 [ p < 0.05] vs. 8.9 ± 1.1 cells/EBI macrophage). In addition to changes in EBI composition, EBIs were also found to have significant structural changes following PT and PT-PNA. CONCLUSION Multicompartmental PT altered late-stage erythropoiesis, and these changes were augmented with the addition of pneumonia. To improve outcomes following trauma and pneumonia, we need to better understand how alterations in EBI structure and function impact persistent bone marrow dysfunction and anemia.
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Affiliation(s)
- Gwendolyn S. Gillies
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, Florida
| | - Jennifer A. Munley
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, Florida
| | - Lauren S. Kelly
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, Florida
| | - Stacey L. Kirkpatrick
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, Florida
| | - Erick E. Pons
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, Florida
| | - Kolenkode B. Kannan
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, Florida
| | - Letitia E. Bible
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, Florida
| | - Philip A. Efron
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, Florida
| | - Alicia M. Mohr
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, Florida
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Simske NM, Rivera T, Ren BO, Breslin MA, Furdock R, Vallier HA. Impact of novel psychosocial programming on readmission and recidivism rates among patients with violence-related trauma. Arch Orthop Trauma Surg 2023; 143:7043-7052. [PMID: 37558824 DOI: 10.1007/s00402-023-05019-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 07/25/2023] [Indexed: 08/11/2023]
Abstract
INTRODUCTION The Victims of Crime Advocacy and Recovery Program (VOCARP) provides advocacy, mental health resources, and educational materials. This study will report complications, readmissions, and recidivism among crime victims, and who used or did not use victim services. MATERIALS AND METHODS Patients engaged with programming from 3/1/17 until 12/31/18 were included. Control groups were patients injured by violent trauma without VOCARP use (N = 212) and patients injured by unintentional injuries (N = 201). Readmissions, complications, reoperations, and trauma recidivism were reported. RESULTS 1019 patients (83%) used VOCARP. VOCARP users were less often male (56% vs. 71%), less commonly married (12% vs. 41%), and had fewer gunshot wounds (GSWs, 26% vs. 37%) and sexual assaults (4.1% vs. 8%), all p < 0.05. Of all 1,423 patients, 6.6% had a readmission and 7.4% developed a complication. VOCARP patients had fewer complications (4.5% vs. 13.7%), infections (2% vs. 9%), wound healing problems (1% vs. 3.3%), and deep vein thromboses (0.3% vs. 1.9%), all p < 0.05, but no differences in unplanned operations (4.5%). GSW victims had the most complications, readmissions, and unplanned surgeries. Prior trauma recidivism was frequent among all groups, with crime victim patients having 40% prior violence-related injury (vs 9.0% control, p < 0.0001). Trauma recidivism following VOCARP use occurred in 8.5% (vs 5.7% for non-users, p = 0.16). CONCLUSION Crime victims differ from other trauma patients, more often with younger age, single marital status, and unemployment at baseline. Complications were lower for VOCARP patients. GSW patients had the most complications, readmissions, and unplanned secondary procedures, representing a population for future attention.
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Affiliation(s)
| | - Trenton Rivera
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, USA
| | - Bryan O Ren
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, USA
| | - Mary A Breslin
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, USA
| | - Ryan Furdock
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, USA
| | - Heather A Vallier
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, USA.
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Dasdar S, Yousefifard M, Ranjbar MF, Forouzanfar M, Mazloom H, Safari S. Frequency of posttrauma complications during hospital admission and their association with Injury Severity Score. Clin Exp Emerg Med 2023; 10:410-417. [PMID: 37439140 PMCID: PMC10790065 DOI: 10.15441/ceem.23.053] [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: 05/01/2023] [Revised: 07/03/2023] [Accepted: 07/03/2023] [Indexed: 07/14/2023] Open
Abstract
OBJECTIVE Multiple trauma is associated with a remarkable risk of in-hospital complications, which harm healthcare services and patients. This study aimed to assess the incidence of posttrauma complications, their relationship with poor outcomes, and the effect of the Injury Severity Score (ISS) on their occurrence. METHODS This retrospective cohort study was conducted at a pair of trauma centers, between January 2020 and December 2022. All hospitalized adult patients with multiple trauma were included in this study. Multivariable logistic regression was used to identify factors related to posttrauma complications. RESULTS Among 727 multiple trauma patients, 90 (12.4%) developed in-hospital complications. The most frequent complications were pneumonia (4.8%), atelectasis (3.7%), and superficial surgical site infection (2.5%). According to multivariable logistic regression, ISS, the length of stay in the intensive care unit (ICU), the length of stay in the hospital, and mortality were significantly associated with complications. The complication rate increased by 17% with every single-unit increase in ISS (adjusted odds ratio [OR], 1.17; 95% confidence interval [CI], 1.00-1.38). Per every 1-day increase in the ICU or hospital stay, the complication rate increased by 65% (adjusted OR, 1.65; 95% CI, 1.00-2.73) and 20% (adjusted OR, 1.20; 95% CI, 1.03-1.41), respectively. Posttrauma complications were also significantly more common in patients with mortality (adjusted OR, 163.30; 95% CI, 3.04-8,779.32). In multiple trauma patients with a higher ISS, the frequency, severity, and number of complications were significantly increased. CONCLUSION In-hospital complications in multiple trauma patients are frequent and associated with poor outcomes and mortality. ISS is an important factor associated with posttrauma complications.
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Affiliation(s)
- Shayan Dasdar
- Men’s Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahmoud Yousefifard
- Pediatric Chronic Kidney Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mehri Farhang Ranjbar
- Research Center for Trauma in Police Operations, Directorate of Health, Rescue and Treatment, Police Headquarter, Tehran, Iran
| | - Mehdi Forouzanfar
- Department of Emergency, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Mazloom
- Department of Emergency, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Safari
- Men’s Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Research Center for Trauma in Police Operations, Directorate of Health, Rescue and Treatment, Police Headquarter, Tehran, Iran
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Lohiya R, Deotale V. Surveillance of health-care associated infections in an intensive care unit at a tertiary care hospital in Central India. GMS HYGIENE AND INFECTION CONTROL 2023; 18:Doc28. [PMID: 38111598 PMCID: PMC10726722 DOI: 10.3205/dgkh000454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
Introduction Because the risk of health-care associated infections (HAIs) is high in intensive care units, and HAIs are one of the causes of morbidity and mortality and affects the overall quality of health care, the continuous monitoring of HAIs in intensive care patients is essential. Aim and objectives This descriptive cross-sectional study was carried out over a period of five years in a tertiary-care teaching hospital. The aim of the study was to investigate the main and specific types of health-care associated Infections and determine the microbiological profile and antimicrobial susceptibility rates of isolates in patients with HAI. Methods : The active surveillance method was used to detect HAIs in patients who spent over 48 hr in a targeted ICU. Patients with blood stream infections (BSI), central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infections (CAUTI) and ventilator-associated events (VAE) were included in the study. HAI were diagnosed based on the Centre for Disease Control (CDC)'s National Healthcare Safety Network (NHSN) updated definitions of HAIs. Results A total of 121,051 patient days, including 7,989 central line days, 64,557 urinary catheter days, and 18,443 ventilator days, were recorded in the study population and 832 HAIs were diagnosed (incidence rate 6.9%). The overall rates of BSI, CLABSI, CAUTI and possible ventilator-associated pneumonia (p-VAP) were 3.7, 10.6, 2.1 and 13.4/1,000 device days, respectively. The most common organism isolated from BSI was Acinetobacter baumanii (n=322, 29%), followed by Klebsiella pneumoniae 225 (n=225, 20.3%). 79.8% of Acinetobacter baumanii strains were resistant to imipenem, 77.1% to ciprofloxacin and 76.4% to ampicillin. The most common organisms isolated from CAUTI were non-albicans Candida species (n=38, 18%), followed by E. coli and Citrobacter spp. (each n=33, each 15.7%). Conclusions A trend of increasing resistance of Acinetobacter baumannii to carbapenems was observed. Risk factor analysis showed invasive procedures during sepsis and organophosphorous poisoning as significant factors.
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Affiliation(s)
- Ruchita Lohiya
- Dept of Microbiology, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Maharashtra, India
| | - Vijayshri Deotale
- Dept of Microbiology, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Maharashtra, India
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Albaaj H, Attergrim J, Strömmer L, Brattström O, Jacobsson M, Wihlke G, Västerbo L, Joneborg E, Gerdin Wärnberg M. Patient and process factors associated with opportunities for improvement in trauma care: a registry-based study. Scand J Trauma Resusc Emerg Med 2023; 31:87. [PMID: 38012791 PMCID: PMC10680227 DOI: 10.1186/s13049-023-01157-y] [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: 08/30/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Trauma is one of the leading causes of morbidity and mortality worldwide. Morbidity and mortality review of selected patient cases is used to improve the quality of trauma care by identifying opportunities for improvement (OFI). The aim of this study was to assess how patient and process factors are associated with OFI in trauma care. METHODS We conducted a registry-based study using all patients between 2017 and 2021 from the Karolinska University Hospital who had been reviewed regarding the presence of OFI as defined by a morbidity and mortality conference. We used bi- and multivariable logistic regression to assess the associations between the following patient and process factors and OFI: age, sex, respiratory rate, systolic blood pressure, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), survival at 30 days, highest hospital care level, arrival on working hours, arrival on weekends, intubation status and time to first computed tomography (CT). RESULTS OFI was identified in 300 (5.8%) out of 5182 patients. Age, missing Glasgow Coma Scale, time to first CT, highest hospital care level and ISS were statistically significantly associated with OFI. CONCLUSION Several patient and process factors were found to be associated with OFI, indicating that patients with moderate to severe trauma and those with delays to first CT are at the highest odds of OFI.
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Affiliation(s)
- Hussein Albaaj
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden.
| | - Jonatan Attergrim
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden
| | - Lovisa Strömmer
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Olof Brattström
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Martin Jacobsson
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Huddinge, Sweden
| | - Gunilla Wihlke
- Trauma and Reparative Medicine, Karolinska University Hospital, Solna, Sweden
| | - Liselott Västerbo
- Trauma and Reparative Medicine, Karolinska University Hospital, Solna, Sweden
| | - Elias Joneborg
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - Martin Gerdin Wärnberg
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden
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Kim JY, Yoon YH, Park SJ, Hong WP, Ro YS. Mortality and incidence rate of acute severe trauma patients in the emergency department: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018-2022. Clin Exp Emerg Med 2023; 10:S55-S62. [PMID: 37967864 PMCID: PMC10662521 DOI: 10.15441/ceem.23.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 10/15/2023] [Indexed: 11/17/2023] Open
Affiliation(s)
- Jung-Youn Kim
- Department of Emergency Medicine, Korea University College of Medicine, Seoul, Korea
| | - Young-Hoon Yoon
- Department of Emergency Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sung Joon Park
- Department of Emergency Medicine, Korea University College of Medicine, Seoul, Korea
| | - Won Pyo Hong
- National Emergency Medical Center, National Medical Center, Seoul, Korea
| | - Young Sun Ro
- National Emergency Medical Center, National Medical Center, Seoul, Korea
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
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Almarhabi M, Cornish J, Raleigh M, Philippou J. In-service education in trauma care for intensive care unit nurses: An exploratory multiple case study. Nurse Educ Pract 2023; 72:103752. [PMID: 37619286 DOI: 10.1016/j.nepr.2023.103752] [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: 05/17/2023] [Revised: 07/25/2023] [Accepted: 08/17/2023] [Indexed: 08/26/2023]
Abstract
AIM This study explores the perceptions of intensive care units (ICUs) nurses with different educational backgrounds regarding their abilities in trauma care and the in-service education they receive to support it. BACKGROUND The advanced care of patients with traumatic injuries in ICU environments requires skilled and knowledgeable nurses, who need continuing and in-service education to provide the best care. Therefore, it is essential to understand the competencies and educational support these nurses may need in the ICUs to ensure safe and effective care delivery. DESIGN An exploratory multiple case study design was used, comprising three hospitals located in two different regions of Saudi Arabia. METHODS The study was conducted between October 2021 and March 2022. A total of forty ICU clinical staff, twelve managers, nine leaders and seven clinical educators participated in semi-structured interviews, which were complemented by a review of available documents on the trauma care in-service education syllabi, competencies and protocols. Interview data were analysed according to the Framework analysis approach, while documents were reviewed using qualitative content analysis. FINDINGS The data analysis revealed two interrelated categories relevant to trauma care: (i) care practice and (ii) education practice. The trauma care practice category highlighted the limited competencies and education in trauma care, as well as the perceived challenges and educational needs of nurses. The education practice category described the staff learning behaviours, supervision practices and in-service education systems in the participants' settings. CONCLUSIONS The study concludes that there is a lack of trauma care education at the examined sites. It suggests the need for further research to develop a theoretical foundation for trauma care education that can meet ICU nurses' educational needs while this being feasible to implement in the specific ICU context and practice.
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Affiliation(s)
- Maha Almarhabi
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK; Faculty of Nursing, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Jocelyn Cornish
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK
| | - Mary Raleigh
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK
| | - Julia Philippou
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK
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Alzerwi NAN. Traumatic injuries to the renal blood vessels and in-hospital renal complications in patients with penetrating or blunt trauma. Front Surg 2023; 10:1134945. [PMID: 37325418 PMCID: PMC10264777 DOI: 10.3389/fsurg.2023.1134945] [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: 12/31/2022] [Accepted: 05/16/2023] [Indexed: 06/17/2023] Open
Abstract
Background Traumatic injuries to renal blood vessels (IRBV) can have significant consequences for patients, impacting their mortality, morbidity, and quality of life. Objective This study aimed to compare trauma types and injury characteristics, vital signs, and outcomes in patients with and without IRBV (nIRBV) and examine whether IRBV and pre-existing renal dysfunction affected the likelihood of in-hospital renal complications (iHRC). Materials and Methods After identifying penetrating and blunt trauma victims with IRBV in the National Trauma Data Bank, patient demographics, injury-related variables, treatment outcomes, and deaths under care were analyzed and compared. Results Of the 994,184 trauma victims, 610 (0.6%) experienced IRBV. Victims in the IRBV group (IRBVG) had a significantly higher frequency of penetrating injuries (19.5% vs. 9.2%, P < 0.001) and higher injury severity score (ISS ≥25, 61.5% vs. 6.7%). Most injuries in both groups were unintentional, although a higher frequency of assault was noted in the IRBVG. The incidence of iHRC was higher in the IRBVG (6.6%) than in the nIRBVG (0.4%; P < 0.001). The IRBV {OR = 3.5 [95% CI = (2.4-5.0)]}, preexisting renal disorders {OR = 2.5 [95% CI = (2.1-2.9)]}, and in-hospital cardiac arrest {OR = 8.6 [95% CI = (7.7-9.5)]} were found to be among the factors associated with a higher risk of iHRC. Conclusions IRBV and pre-existing renal disorders considerably increased the risk of developing iHRC. Due to the long- and short-term consequences of associated cardiovascular, renal, and hemodynamic complications, victims of IRBV require specialized renal management and close monitoring.
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Williams EC, Estime S, Kuza CM. Delirium in trauma ICUs: a review of incidence, risk factors, outcomes, and management. Curr Opin Anaesthesiol 2023; 36:137-146. [PMID: 36607823 DOI: 10.1097/aco.0000000000001233] [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: 01/07/2023]
Abstract
PURPOSE OF REVIEW This article reviews the impact and importance of delirium on patients admitted to the ICU after trauma, including the latest work on prevention and treatment of this condition. As the population ages, the incidence of geriatric trauma will continue to increase with a concomitant rise in the patient and healthcare costs of delirium in this population. RECENT FINDINGS Recent studies have further defined the risk factors for delirium in the trauma ICU patient population, as well as better demonstrated the poor outcomes associated with the diagnosis of delirium in these patients. Recent trials and meta-analysis offer some new evidence for the use of dexmedetomidine and quetiapine as preferred agents for prevention and treatment of delirium and add music interventions as a promising part of nonpharmacologic bundles. SUMMARY Trauma patients requiring admission to the ICU are at significant risk of developing delirium, an acute neuropsychiatric disorder associated with increased healthcare costs and worse outcomes including increased mortality. Ideal methods for prevention and treatment of delirium are not well established, especially in this population, but recent research helps to clarify optimal prevention and treatment strategies.
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Affiliation(s)
- Elliot C Williams
- Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Stephen Estime
- Department of Anesthesiology and Critical Care, University of Chicago Medicine, Chicago, Illinois
| | - Catherine M Kuza
- Department of Anesthesiology and Critical Care, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
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Messelu MA, Tilahun AD, Beko ZW, Endris H, Belayneh AG, Tesema GA. Incidence and predictors of mortality among adult trauma patients admitted to the intensive care units of comprehensive specialized hospitals in Northwest Ethiopia. Eur J Med Res 2023; 28:113. [PMID: 36895008 PMCID: PMC9999519 DOI: 10.1186/s40001-023-01056-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/09/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Trauma is the leading cause of morbidity and mortality among adult population in the world. Despite many improvements in technology and care, mortality among trauma patients in the intensive care unit is still high particularly in Ethiopia. However, there is limited evidence on the incidence and predictors of mortality among trauma patients in Ethiopia. Therefore, this study aimed to assess the incidence and predictors of mortality among adult trauma patients admitted to intensive care units. METHODS Institutional-based retrospective follow-up study was conducted from January 9, 2019 to January 8, 2022. A total of 421 samples were chosen using simple random sampling. Data were collected with Kobo toolbox software and exported to STATA version 14.1 software for data analysis. Kaplan-Meier failure curve and log-rank test were fitted to explore the survival difference among groups. After the bivariable and multivariable Cox regression analysis, an Adjusted Hazard Ratio (AHR) with 95% Confidence Intervals (CI) was reported to declare the strength of association and statistical significance, respectively. RESULT The overall incidence rate of mortality was 5.47 per 100 person-day observation with a median survival time of 14 days. Did not get pre-hospital care (AHR = 2.00, 95%CI 1.13, 3.53), Glasgow Coma Scale (GCS) score < 9 (AHR = 3.89, 95%CI 1.67, 9.06), presence of complications (AHR = 3.71, 95%CI 1.29, 10.64), hypothermia at admission (AHR = 2.11, 95%CI 1.13, 3.93) and hypotension at admission (AHR = 1.93, 95%CI 1.01, 3.66) were found significant predictors of mortality among trauma patients. CONCLUSION The incidence rate of mortality among trauma patients in the ICU was high. Did not get pre-hospital care, GCS < 9, presence of complications, hypothermia, and hypotension at admission were significant predictors of mortality. Therefore, healthcare providers should give special attention to trauma patients with low GCS scores, complications, hypotension, and hypothermia and better to strengthen pre-hospital services to reduce the incidence of mortality.
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Affiliation(s)
- Mengistu Abebe Messelu
- Department of Nursing, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia.
| | - Ambaye Dejen Tilahun
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zerko Wako Beko
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Hussien Endris
- Department of Anesthesia, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Asnake Gashaw Belayneh
- Department of Emergency and Critical Care Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Age-dependent thrombin generation predicts 30-day mortality and symptomatic thromboembolism after multiple trauma. Sci Rep 2023; 13:1681. [PMID: 36717730 PMCID: PMC9886925 DOI: 10.1038/s41598-023-28474-7] [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: 09/12/2022] [Accepted: 01/19/2023] [Indexed: 01/31/2023] Open
Abstract
Trauma-induced coagulopathy (TIC) is a risk factor for death and is associated with deviations in thrombin generation. TIC prevalence and thrombin levels increase with age. We assayed in vivo and ex vivo thrombin generation in injured patients (n = 418) to specifically investigate how age impacts thrombin generation in trauma and to address the prognostic ability of thrombin generation. Biomarkers of thrombin generation were elevated in young (< 40 years) and older (≥ 40 years) trauma patients. In vivo thrombin generation was associated with Injury Severity Score (ISS) and this association was stronger in young than older patients. In vivo thrombin generation decreased faster after trauma in the young than the older patients. Across age groups, in vivo thrombin generation separated patients dying/surviving within 30 days at a level comparable to the ISS score (AUC 0.80 vs. 0.82, p > 0.76). In vivo and ex vivo thrombin generation also predicted development of thromboembolic events within the first 30 days after the trauma (AUC 0.70-0.84). In conclusion, younger trauma patients mount a stronger and more dynamic in vivo thrombin response than older patients. Across age groups, in vivo thrombin generation has a strong ability to predict death and/or thromboembolic events 30 days after injury.
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Developing a National Trauma Research Action Plan: Results from the postadmission critical care research gap Delphi survey. J Trauma Acute Care Surg 2022; 93:846-853. [PMID: 35916626 DOI: 10.1097/ta.0000000000003754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The 2016 National Academies of Science, Engineering and Medicine report included a proposal to establish a National Trauma Research Action Plan. In response, the Department of Defense funded the Coalition for National Trauma Research to generate a comprehensive research agenda spanning the continuum of trauma and burn care from prehospital care to rehabilitation as part of an overall strategy to achieve zero preventable deaths and disability after injury. The Postadmission Critical Care Research panel was 1 of 11 panels constituted to develop this research agenda. METHODS We recruited interdisciplinary experts in surgical critical care and recruited them to identify current gaps in clinical critical care research, generate research questions, and establish the priority of these questions using a consensus-driven Delphi survey approach. The first of four survey rounds asked participants to generate key research questions. On subsequent rounds, we asked survey participants to rank the priority of each research question on a 9-point Likert scale, categorized to represent low-, medium-, and high-priority items. Consensus was defined as ≥60% of panelists agreeing on the priority category. RESULTS Twenty-five subject matter experts generated 595 questions. By Round 3, 249 questions reached ≥60% consensus. Of these, 22 questions were high, 185 were medium, and 42 were low priority. The clinical states of hypovolemic shock and delirium were most represented in the high-priority questions. Traumatic brain injury was the only specific injury pattern with a high-priority question. CONCLUSION The National Trauma Research Action Plan critical care research panel identified 22 high-priority research questions, which, if answered, would reduce preventable death and disability after injury. LEVEL OF EVIDENCE Diagnostic Tests or Criteria; Level IV.
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Do direct admissions to trauma centers have a survival benefit compared to inter-hospital transfers in severe trauma? Eur J Trauma Emerg Surg 2022; 49:1145-1156. [PMID: 36451025 DOI: 10.1007/s00068-022-02182-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/16/2022] [Indexed: 12/04/2022]
Abstract
PURPOSE To compare mortality among severe and critically injured patients who were directly admitted (DA) to level I trauma center (TCI) or level II trauma center (TCII) with those who were transferred to a TCI after being initially admitted to a TCII. METHODS A cohort study of severe and critically injured patients (Injury Severity Score 16-75) hospitalized between 2010 and 2019 using data from the National Program for Trauma Registration. Multivariate logistic regression models estimated mortality risk, including stratified analyses. RESULTS Of the 27,131 hospitalizations, 9.5% were transfers, 60.1% were DA to TCI and 30.4% were DA to TCII. Children ages ≤ 17 years, Non-Jews (minority), critical injuries (ISS 25-75), head injuries (AIS ≥ 3) and fall injuries were significantly more frequent among transfers, compared with the DA groups. Evacuation by emergency medical services was less frequent among transfers. After accounting for possible confounders, transfers had a greater risk of in-hospital mortality [DA to TCI vs transfer, OR (95% CI) 0.61 (0.52-0.72); DA to TCII vs transfer, OR (95% CI) 0.78 (0.65-0.94)]. In stratified analyses, these mortality differences persisted among the sub-group of patients who sustained critical injuries, among the patients with non-penetrating injuries, among the elderly ages ≥ 65 year and during the first 2 weeks of hospitalization. CONCLUSION This study has intervention implications that should be directed primarily at prehospital triage and the inter-hospital transfer processes. In addition, there may be a need to optimize the capabilities of regional trauma systems along with continuous performance evaluations and actions as required.
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Banerjee N, Bagaria D, Agarwal H, Kumar Katiyar A, Kumar S, Sagar S, Mishra B, Gupta A. Validation of the adapted clavien dindo in trauma (ACDiT) scale to grade management related complications at a level I trauma center. Turk J Surg 2022; 38:391-400. [PMID: 36875271 PMCID: PMC9979560 DOI: 10.47717/turkjsurg.2022.5793] [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: 05/26/2022] [Accepted: 11/01/2022] [Indexed: 01/11/2023]
Abstract
Objectives Complications during trauma management are the main factor responsible for the overall increase in treatment cost. There are very few grading systems to measure the burden of complications in trauma patients. A prospective study was conducted using the Adapted Clavien Dindo in Trauma (ACDiT) scale, with the primary aim of validating it at our center. As a secondary aim, it was also wanted to measure the mortality burden among our admitted patients. Material and Methods The study was conducted at a dedicated trauma center. All patients with acute injuries, who were admitted, were included. An initial treatment plan was made within 24 hours of admission. Any deviation from this was recorded and graded according to the ACDiT. The grading was correlated with hospital-free days and ICU-free days within 30 days. Results A total of 505 patients were included in this study, with a mean age of 31 years. The most common mechanism of injury was road traffic injury, with a median ISS and NISS of 13 and 14, respectively. Two hundred and forty-eight out of 505 patients had some grade of complication as determined by the ACDiT scale. Hospital-free days (13.5 vs. 25; p <0.001) were significantly lower in patients with complications than those without complications, and so were ICU-free days (29 vs. 30; p <0.001). Significant differences were also observed when comparing mean hospital free and ICU free days across various ACDiT grades. Overall mortality of the population was 8.3 %, the majority of whom were hypotensive on arrival and required ICU care. Conclusion We successfully validated the ACDiT scale at our center. We recommend using this scale to objectively measure in-hospital complications and improve trauma management quality. ACDiT scale should be one of the data points in any trauma database/registry.
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Affiliation(s)
- Niladri Banerjee
- Department of General Surgery, All India Institute of Medical Sciences, Jodhpur, India
| | - Dinesh Bagaria
- Division of Trauma Surgery & Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Harshit Agarwal
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Rae Bareli, India
| | | | - Subodh Kumar
- Division of Trauma Surgery & Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Sagar
- Division of Trauma Surgery & Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Biplab Mishra
- Division of Trauma Surgery & Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Gupta
- Division of Trauma Surgery & Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
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Lee PT, Krecko LK, Savage S, O'Rourke AP, Jung HS, Ingraham A, Zarzaur BL, Scarborough JE. Which hospital-acquired conditions matter the most in trauma? An evidence-based approach for prioritizing trauma program improvement. J Trauma Acute Care Surg 2022; 93:446-452. [PMID: 35393378 PMCID: PMC9489599 DOI: 10.1097/ta.0000000000003645] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND Prevention of hospital-acquired conditions (HACs) is a focus of trauma center quality improvement. The relative contributions of various HACs to postinjury hospital outcomes are unclear. We sought to quantify and compare the impacts of six HACs on early clinical outcomes and resource utilization in hospitalized trauma patients. METHODS Adult patients from the 2013 to 2016 American College of Surgeons Trauma Quality Improvement Program Participant Use Data Files who required 5 days or longer of hospitalization and had an Injury Severity Score of 9 or greater were included. Multiple imputation with chained equations was used for observations with missing data. The frequencies of six HACs and five adverse outcomes were determined. Multivariable Poisson regression with log link and robust error variance was used to produce relative risk estimates, adjusting for patient-, hospital-, and injury-related factors. Risk-adjusted population attributable fractions estimates were derived for each HAC-outcome pair, with the adjusted population attributable fraction estimate for a given HAC-outcome pair representing the estimated percentage decrease in adverse outcome that would be expected if exposure to the HAC had been prevented. RESULTS A total of 529,856 patients requiring 5 days or longer of hospitalization were included. The incidences of HACs were as follows: pneumonia, 5.2%; urinary tract infection, 3.4%; venous thromboembolism, 3.3%; surgical site infection, 1.3%; pressure ulcer, 1.3%; and central line-associated blood stream infection, 0.2%. Pneumonia demonstrated the strongest association with in-hospital outcomes and resource utilization. Prevention of pneumonia in our cohort would have resulted in estimated reductions of the following: 22.1% for end organ dysfunction, 7.8% for mortality, 8.7% for prolonged hospitalization, 7.1% for prolonged intensive care unit stay, and 6.8% for need for mechanical ventilation. The impact of other HACs was comparatively small. CONCLUSION We describe a method for comparing the contributions of HACs to outcomes of hospitalized trauma patients. Our findings suggest that trauma program improvement efforts should prioritize pneumonia prevention. LEVEL OF EVIDENCE Therapeutic/Care Management; Level IV.
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Affiliation(s)
- Patrick T Lee
- From the Department of Surgery (P.T.L., L.K.K.), University of Wisconsin School of Medicine and Public Health; and Department of Surgery (S.S., A.P.O., H.S.J., A.I., B.L.Z., J.E.S.), Division of Acute Care and Regional General Surgery, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
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Soni KD, Bansal V, Arora H, Verma S, Wärnberg MG, Roy N. The State of Global Trauma and Acute Care Surgery/Surgical Critical Care. Crit Care Clin 2022; 38:695-706. [PMID: 36162905 DOI: 10.1016/j.ccc.2022.06.011] [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] [Indexed: 11/25/2022]
Abstract
Trauma is a leading cause of morbidity and mortality globally, with a significant burden attributable to the low- and middle-income countries (LMICs), where more than 90% of injury-related deaths occur. Road injuries contribute largely to the economic burden from trauma and are prevalent among adolescents and young adults. Trauma systems vary widely across the world in their capacity of providing basic and critical care to injured patients, with delays in treatment being present at multiple levels at LMICs. Strengthening existing systems by providing cost-effective and efficient solutions can help mitigate the injury burden in LMICs.
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Affiliation(s)
- Kapil Dev Soni
- Critical & Intensive Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, Ring Road, Raj Nagar, Safdarjung Enclave, New Delhi, Delhi 110029, India
| | - Varun Bansal
- Department of General Surgery, 2nd Floor Registration Building, Seth G.S.M.C. and K.E.M. Hospital, Parel, Mumbai 400012, India
| | - Harshit Arora
- Department of Surgery, Punjab Institute of Medical Sciences, Gadha Road, Jalandhar, Punjab 144006, India
| | - Sukriti Verma
- Department of Blood Bank, Guru Teg Bahadur Hospital, Tahirpur Rd, GTB Enclave, Dilshad Garden, New Delhi, Delhi 110095, India; WHO Collaborating Center for Research on Surgical Care Delivery in LMICs, Department of Surgery, BARC Hospital, Anushaktinagar, Mumbai 400094, India
| | - Martin Gerdin Wärnberg
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18, 171 65 Solna, Stockholm 171 65, Sweden; Function Perioperative Medicine and Intensive Care, Karolinska University Hospital Solna, SE - 171 76, Stockholm, Sweden
| | - Nobhojit Roy
- WHO Collaborating Center for Research on Surgical Care Delivery in LMICs, Department of Surgery, BARC Hospital, Anushaktinagar, Mumbai 400094, India; The George Institute of Global Health India, F-BLOCK, 311-312, Third Floor, Jasola Vihar, New Delhi, Delhi 110025, India.
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Shah G, Dhakal GR, Gupta A, Hamal PK, Dhungana S, Poudel S. Outcome of Cervical Spine Trauma Patients Admitted to the Intensive Care Unit at a Tertiary Government Referral Trauma Center in Nepal. Global Spine J 2022; 12:1388-1391. [PMID: 33455459 PMCID: PMC9393990 DOI: 10.1177/2192568220980703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective study. OBJECTIVES Cervical spinal cord injury (SCI) is a devastating event for patient and family. It has a huge impact on society because of intensive resources required to manage the patient in both acute and rehabilitation phases. With the limited resource setting in underdeveloped countries like Nepal, questions are often raised regarding whether the outcome justifies the expenses of their care. The objective was to assess the outcomes of cervical SCI patients admitted to intensive care unit (ICU). METHODS All cervical SCI admitted in ICU during May 2017 to August 2018 were included in this study. Demographic details, mode, morphology, and neurological level of injury, intervention performed and outcomes of ICU stay were analyzed. RESULTS Out of 48 patients, 36 (75%) were male and 12 female with mean age 43.9 ± 15.9 years. Fall injury was the commonest mode of injury (83.3%). Most patients presented within 1 to 3 days of injury and C5-C6 (33.3%) was the most common involved level and 75% presented with ASIA A neurology. Mechanical ventilation was required in 95.8% of the patients and 22 patients were operated upon. The average stay in ICU was 15 days and 13 patients died in the ICU. CONCLUSIONS Majority of cervical SCI with complete motor paraplegia required ICU care. Inspite of the intensive care, a subset of these patients succumbed to the complications of the injury. Therefore, it is essential to establish trauma ICU care with specific protocols on managing cervical spine injuries.
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Affiliation(s)
| | - Gaurav Raj Dhakal
- National Trauma Center, Kathmandu, Nepal,Gaurav Raj Dhakal, National Trauma Center, Kathmandu 14126, Nepal.
| | - Anil Gupta
- National Trauma Center, Kathmandu, Nepal
| | | | | | - Santosh Poudel
- Department of Orthopaedics, National Trauma Center, National Academy of Medical Sciences, Kathmandu, Nepal
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Thompson MA, Zuniga K, Sousse L, Christy R, Gurney J. The Role of Vitamin E in Thermal Burn Injuries, Infection, and Sepsis: A Review. J Burn Care Res 2022; 43:1260-1270. [PMID: 35863690 PMCID: PMC9629418 DOI: 10.1093/jbcr/irac100] [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] [Indexed: 11/25/2022]
Abstract
Thermal burn injuries are still a serious public health concern in the United States, due to the initial insult and resulting comorbidities. Burned patients are increasingly susceptible to colonization by endogenous and exogenous microorganisms after having lost skin, which acts as the primary protective barrier to environmental contaminants. Furthermore, the onset of additional pathophysiologies, specifically sepsis, becomes more likely in burned patients compared to other injuries. Despite improvements in the early care of burn patients, infections, and sepsis, these pathophysiologies remain major causes of morbidity and mortality and warrant further investigation of potential therapies. Vitamin E may be one such therapy. We aimed to identify publications of studies that evaluated the effectiveness of vitamin E as it pertains to thermal burn injuries, infection, and sepsis. Several investigations ranging from in vitro bench work to clinical studies have examined the impact on, or influence of, vitamin E in vitro, in vivo, and in the clinical setting. To the benefit of subjects it has been shown that enteral or parenteral vitamin E supplementation can prevent, mitigate, and even reverse the effects of thermal burn injuries, infection, and sepsis. Therefore, a large-scale prospective observational study to assess the potential benefits of vitamin E supplementation in patients is warranted and could result in clinical care practice paradigm changes.
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Affiliation(s)
- Marc A Thompson
- US Army Institute of Surgical Research, JBSA Ft Sam Houston, San Antonio, TX
| | - Kameel Zuniga
- US Army Institute of Surgical Research, JBSA Ft Sam Houston, San Antonio, TX
| | - Linda Sousse
- US Army Institute of Surgical Research, JBSA Ft Sam Houston, San Antonio, TX
| | - Robert Christy
- US Army Institute of Surgical Research, JBSA Ft Sam Houston, San Antonio, TX
| | - Jennifer Gurney
- Burn Center, United States Army Institute of Surgical Research, JBSA Ft. Sam Houston, TX, USA
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Juárez-Vela R, Andrés-Esteban EM, Santolalla-Arnedo I, Ruiz de Viñaspre-Hernández R, Benito-Puncel C, Serrano-Lázaro A, Marcos-Neira P, López-Fernández A, Tejada-Garrido CI, Sánchez-González JL, Quintana-Díaz M, García-Erce JA. Epidemiology and Associated Factors in Transfusion Management in Intensive Care Unit. J Clin Med 2022; 11:jcm11123532. [PMID: 35743602 PMCID: PMC9225042 DOI: 10.3390/jcm11123532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/16/2022] [Accepted: 06/16/2022] [Indexed: 11/16/2022] Open
Abstract
Severe traumatic injury is one of the main global health issues which annually causes more than 5.8 million worldwide deaths. Uncontrolled haemorrhage is the main avoidable cause of death among severely injured individuals. Management of trauma patients is the greatest challenge in trauma emergency care, and its proper diagnosis and early management of bleeding trauma patients, including blood transfusion, are critical for patient outcomes. Aim: We aimed to describe the epidemiology of transfusion practices in severe trauma patients admitted into Spanish Intensive Care Units. Material and Methods: We performed a multicenter cross-sectional study in 111 Intensive Care Units across Spain. Adult patients with moderate or severe trauma were eligible. Distribution of frequencies was used for qualitative variables and the mean, with its 95% CI, for quantitative variables. Transfusion programmes, the number of transfusions performed, and the blood component transfused were recorded. Demographic variables, mortality rate, hospital stay, SOFA-score and haemoglobin levels were also gathered. Results: We obtained results from 109 patients. The most transfused blood component was packet red blood cells with 93.8% of total transfusions versus 43.8% of platelets and 37.5% of fresh plasma. The main criteria for transfusion were analytical criteria (43.75%), and acute anaemia with shock (18.75%) and without haemodynamic impact (18.75%). Conclusion: Clinical practice shows a ratio of red blood cells, platelets, and Fresh Frozen Plasma (FFP) of 2:1:1. It is necessary to implement Massive Transfusion Protocols as they appear to improve outcomes. Our study suggests that transfusion of RBC, platelets and FFP in a 2:1:1 ratio could be beneficial for trauma patients.
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Affiliation(s)
- Raúl Juárez-Vela
- Doctoral Programme in Medicine and Surgery, Faculty of Medicine, Autonomous University of Madrid, 28049 Madrid, Spain;
- GRUPAC, Department of Nursing, University of La Rioja, 26004 Logroño, Spain; (I.S.-A.); (R.R.d.V.-H.)
- Research Institute IdiPaz, 28029 Madrid, Spain;
| | - Eva María Andrés-Esteban
- Research Institute IdiPaz, 28029 Madrid, Spain;
- Department of Business Economics and Applied Economy, Faculty of Legal and Economic Sciences, Rey Juan Carlos University, 28933 Madrid, Spain
| | - Ivan Santolalla-Arnedo
- GRUPAC, Department of Nursing, University of La Rioja, 26004 Logroño, Spain; (I.S.-A.); (R.R.d.V.-H.)
| | | | | | | | - Pilar Marcos-Neira
- Intensive Care Unit, Hospital Germans Trias i Pujol, 08916 Badalona, Spain;
| | | | - Clara Isabel Tejada-Garrido
- GRUPAC, Department of Nursing, University of La Rioja, 26004 Logroño, Spain; (I.S.-A.); (R.R.d.V.-H.)
- Correspondence: (C.I.T.-G.); (M.Q.-D.)
| | | | - Manuel Quintana-Díaz
- Research Institute IdiPaz, 28029 Madrid, Spain;
- Intensive Care Unit, University Hospital of La Paz, 28046 Madrid, Spain;
- Correspondence: (C.I.T.-G.); (M.Q.-D.)
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Haddam M, Kubacsi L, Hamada S, Harrois A, James A, Langeron O, Boutonnet M, Holleville M, Garrigue D, Leclercq M, Hanouz JL, Pottecher J, Audibert G, Cardinale M, Vinour H, Zieleskiewicz L, Resseguier N, Leone M. Withholding and withdrawal of life-sustaining therapy in 8569 trauma patients: A multicentre, analytical registry study. Eur J Anaesthesiol 2022; 39:418-426. [PMID: 35166244 DOI: 10.1097/eja.0000000000001671] [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: 11/26/2022]
Abstract
BACKGROUND This study aimed to determine the prevalence of withholding or withdrawal of life-sustaining therapy (WLST) decisions in trauma ICU patients, using a large registry. We hypothesised that this prevalence is similar to that of the general population admitted to an ICU. As secondary aims, it sought to describe the trauma patients for whom the decision was made for WLST and the factors associated with this decision. DESIGN This observational study assessed data from 14 French centres listed in the TraumaBaseTM registry. All trauma patients hospitalised for more than 48 h were pro-spectively included. RESULTS Data from 8569 trauma patients, obtained from January 2016 to December 2018, were included in this study. A WLST decision was made in 6% of all cases. In the WLST group, 67% of the patients were older men (age: 62 versus 36, P < 0.001); more often they had a prior medical history and higher median severity scores than the patients in the no WLST decision group; SAPS II 58 (46 to 69) versus 21 (13 to 35) and ISS 26 (22 to 24) versus 12 (5 to 22), P < 0.001. Neurological status was strongly associated with WLST decisions. The geographic area of the ICUs affected the rate of the WLST decisions. The ICU mortality was 11% (n = 907) of which 47% (n = 422) were preceded by WLST decisions. Fourteen percent of WLST orders were not associated to the death. CONCLUSION Among 8569 patients, medical history, trauma severity criteria, notably neurological status and geographical areas were associated with WLST. These regional differences deserve to be investigated in future studies.
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Affiliation(s)
- Malik Haddam
- From the Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Department of Anaesthesia and Intensive Care, Hôpital Nord (MH, LK, LZ, ML), Support Unit for Clinical Research and Economic Evaluation, Assistance Publique-Hôpitaux de Marseille - CERESS, Aix Marseille University, Marseille (NR), Kremlin Bicêtre University Hospital, Assistance Publique Hôpitaux de Paris, Department of Anaesthesia and Intensive Care, Le Kremlin-Bicêtre (AH), Department of Anaesthesia and Intensive Care, Assistance Publique Hôpitaux de Paris, Pitié Salpêtrière University Hospital (AJ), Department of Anaesthesia and Intensive Care, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou University Hospital, Paris (SH, ML), Department of Anaesthesia and Intensive Care, Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Créteil (OL), Department of Anaesthesiology and Critical Care Medicine, DMU Parabol, Beaujon Hospital, APHP. Nord-Université de Paris, 100 Bd du General Leclerc 92110 Clichy (MHo), Department of Anaesthesia and Intensive Care, Clamart Army Training Hospital Percy, Clamart (MB), Toulon Army Training Hospital Sainte-Anne, Toulon (MC), Department of Anaesthesia and Intensive Care, Toulouse University Hospital, Toulouse (HV), Department of Anesthesia and Critical Care Medicine, Université de Lorraine, CHRU Nancy, Nancy (GA), Lille University Hospital, Pôle de l'Urgence, Pôle d'Anesthésie Réanimation, Lille (DG), Department of Anaesthesia and Intensive Care, Reims University Hospital, Reims (MLec), Department of Anaesthesia and Intensive Care, Caen University Hospital, Caen (JLH) and Department of Anaesthesia and Perioperative Medicine, Strasbourg University Hospital, Strasbourg, France (JP)
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Saberian SM, Chester DJ, Udobi KF, Childs EW, Danner OK, Sola R. A Comparative Analysis of Hospital Triage Systems in the Geriatric Adult Trauma Patients: A Quality Improvement Pilot Study. Am Surg 2022:31348221087907. [PMID: 35451871 DOI: 10.1177/00031348221087907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The objective of our study is to compare the predicted hospital admission disposition based on the level of risk as determined by the modified Trauma-Specific Frailty Index (mTSFI) score with those determined by arbitrary decisions made based on the Emergency Severity Index (ESI) severity level. METHODS We surveyed 100 trauma patients ages 50 and older, admitted to a level 1 trauma center between April 2019 and July 2019. We retrospectively reviewed the hospital admission disposition of each patient under the ESI, which was then compared to the mTSFI-predicted hospital admission disposition. The mTSFI scores were calculated by surveying each patient. Statistical analysis was performed to identify any statistical significance of concordance and discordance when comparing the mTSFI and ESI. RESULTS The average age was 57.6 ± 4.2 years old in the non-geriatric group vs 76.3 ± 7.3 years old in the geriatric group. There was a male predominance in both groups (61% vs 69.5%). The mTSFI identified a higher percentage of triage discordance in the non-geriatric group (73%) compared to the geriatric cohort (53%) (95% difference CI, [39.6-40], P = .05). DISCUSSION Non-geriatric patients have higher recorded rate of frailty than previously recognized and screening should begin at age 50, not 65. The mTSFI may be an effective tool to appropriately triage adult trauma patients at increased risk due to frailty and may reduce in-hospital complications.
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Affiliation(s)
- Sepehr M Saberian
- Department of Surgery, 1374Morehouse School of Medicine, Atlanta, GA, USA
| | - Daniel J Chester
- Department of Surgery, 1374Morehouse School of Medicine, Atlanta, GA, USA
| | - Kahdi F Udobi
- Department of Surgery, 1374Morehouse School of Medicine, Atlanta, GA, USA
| | - Ed W Childs
- Department of Surgery, 1374Morehouse School of Medicine, Atlanta, GA, USA
| | - Omar K Danner
- Department of Surgery, 1374Morehouse School of Medicine, Atlanta, GA, USA
| | - Richard Sola
- Department of Surgery, 1374Morehouse School of Medicine, Atlanta, GA, USA
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Goh SSN, Siang KC, Tay WM. The impact of obesity on Singaporean trauma patients and their venous thromboembolism risk. ANZ J Surg 2022; 92:1706-1713. [PMID: 35481662 DOI: 10.1111/ans.17679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 11/21/2021] [Accepted: 11/27/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Serene Si Ning Goh
- Department of General Surgery Tan Tock Seng Hospital Singapore Singapore
| | - Kai Chan Siang
- Department of General Surgery Tan Tock Seng Hospital Singapore Singapore
| | - Wee Ming Tay
- Department of General Surgery Tan Tock Seng Hospital Singapore Singapore
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Soliman SS, Durling-Grover R, Bilaniuk JW, Kong K, Renna L, Hakakian D, Rolandelli RH, Antonioli L, Nemeth ZH. Association Between Body Mass Index and Morbidity and Mortality During Hospitalization After Trauma. J Trauma Nurs 2022; 29:80-85. [PMID: 35275109 DOI: 10.1097/jtn.0000000000000639] [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: 11/26/2022]
Abstract
BACKGROUND Literature suggests that unhealthy body mass index is a risk factor for adverse clinical outcomes. OBJECTIVES To study the association between unhealthy body mass index and morbidity and mortality after trauma using the 2016 American College of Surgeons Trauma Quality Improvement Program database. METHODS A retrospective review was conducted comparing the normal weight control group to the underweight, overweight, obese, severely obese, and morbidly obese groups for differences in demographic factors, injury severity score, comorbidities, length of stay, and complications. RESULTS Underweight, overweight, obese, severely obese, and morbidly obese body mass indexes, in comparison to normal weight body mass index, were associated with a higher probability of developing at least one complication after trauma. Additionally, we observed a J-shaped curve when analyzing body mass index and mortality, suggesting that both high and low body mass indexes are positively associated with mortality. In fact, morbidly obese patients had the highest mortality rate, followed by underweight patients (p < .001). Interestingly, however, multivariate logistic regression demonstrated that, compared with normal weight body mass index, overweight and obese body mass indexes were independently associated with 9.6% and 10.5% lower odds of mortality, respectively (p < .001 and p = .001). CONCLUSION Irrespective of preexisting comorbidities, injury severity score, and mechanism of injury, underweight, overweight, obese, severely obese, and morbidly obese body mass indexes were independently associated with higher risks of morbidity, whereas overweight and obese body mass indexes were associated with lower mortality risks. These findings emphasize the complex relationship between body mass index and clinical outcomes for trauma patients.
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Affiliation(s)
- Sara S Soliman
- Department of Surgery, Morristown Medical Center, Morristown, New Jersey (Mss Soliman, Kong, and Renna, Drs Durling-Grover, Bilaniuk, Rolandelli, and Nemeth and Mr Hakakian); Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy (Dr Antonioli); and Department of Anesthesiology, Columbia University Medical Center, New York, New York (Dr Nemeth)
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ICU Length of Stay and Factors Associated with Longer Stay of Major Trauma Patients with Multiple Rib Fractures: A Retrospective Observational Study. Crit Care Res Pract 2022; 2022:6547849. [PMID: 35273812 PMCID: PMC8904129 DOI: 10.1155/2022/6547849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/24/2022] [Accepted: 02/14/2022] [Indexed: 11/17/2022] Open
Abstract
Background. Chest injury with multiple rib fractures is the most common injury among major trauma patients in New South Wales (23%) and is associated with a high rate of mortality and morbidity. The aim of this study was to determine the intensive care unit (ICU) length of stay (LOS) among major trauma patients with multiple rib fractures and to identify factors associated with a prolonged ICU LOS. Materials and Methods. Single-centre, retrospective observational cohort study of adult patients with 3 or more traumatic rib fractures, who were admitted to ICU between June 2014 and June 2019. A comparison was made between patients who stayed in ICU for less than 7 days and those that stay for 7 or more days. Results. Among 215 patients who were enrolled, 150 (69.7%) were male, the median Injury Severity Score (ISS) was 24 (interquartile range (IQR): 17–32). The median ICU LOS was 4 (IQR: 2–7) days and the average ICU LOS was 6.5 (SD 8.5; 95% CI 5.3–7.6) days. The median number of rib fractures was 6 (IQR: 5–9) and 76 (35.3%) patients had a flail chest. Patients who stayed longer than 7 days in ICU had higher ISS, higher APACHE-II score, greater number of rib fractures, higher rate of lung contusions, and required more respiratory support of any type. Conclusions. ISS, number of rib fractures, lung contusion, and flail chest were associated with prolonged ICU LOS in patients with traumatic multiple rib fractures.
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Bloom SR, Grigorian A, Schubl S, Thangathurai D, Kuza CM, Swentek L, Nahmias J. Title: Marijuana Use Associated with Decreased Mortality in Trauma Patients. Am Surg 2022; 88:1601-1606. [PMID: 35114802 DOI: 10.1177/00031348211069789] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The incidence of trauma patients with a positive marijuana screen (pMS) is increasing but the effects of marijuana on outcomes have varied in previous studies. A recent statewide analysis demonstrated decreased mortality for intensive care unit (ICU) trauma patients with pMS. Thus, we hypothesized a pMS to be associated with a decreased risk of mortality for all trauma patients. METHODS The 2017 Trauma Quality Improvement Program (TQIP) database was queried for adult (≥18 years-old) pMS patients, who were compared to patients negative for all drugs and alcohol (nDS). Patients not drug tested or testing positive for drug(s)/alcohol other than marijuana were excluded. Multivariable logistic regression was used to evaluate risk of mortality after controlling for known predictors of mortality including age, sex, injury severity, vital signs, and comorbidities. Additional subgroup analyses were performed for ICU patients and younger adults (<40 years-old). RESULTS From 141 737 tested patients, 23 310 (16.4%) had an isolated pMS. Patients with pMS were younger (P < .001) but had a similar median injury severity score (ISS) (9, P = .42) compared to nDS patients. On multivariable analysis the associated risk of mortality was lower for pMS (OR .79, .71-.87, P < .001) compared to nDS patients. Subgroups analyses also demonstrated decreased associated risk of mortality for ICU and younger patients (both P < .05). DISCUSSION Patients with a pMS had decreased associated risk of mortality compared to nDS patients, including subgroups of ICU and younger patients. These findings require corroboration with future prospective clinical study and basic science evaluation to ascertain the exact pathophysiologic basis and thereby target potential interventions.
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Affiliation(s)
- Samuel R Bloom
- Department of Surgery, 8788University of California, Irvine, Orange, CA, USA
| | - Areg Grigorian
- Department of Surgery, 5116University of Southern California Department of Surgery, Los Angeles, CA, USA
| | - Sebastian Schubl
- Department of Surgery, 8788University of California, Irvine, Orange, CA, USA
| | - Duraiyah Thangathurai
- Department of Anesthesiology, 5116University of Southern California, Los Angeles, CA, USA
| | - Catherine M Kuza
- Department of Anesthesiology, 5116University of Southern California, Los Angeles, CA, USA
| | - Lourdes Swentek
- Department of Surgery, 8788University of California, Irvine, Orange, CA, USA
| | - Jeffry Nahmias
- Department of Surgery, 8788University of California, Irvine, Orange, CA, USA
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Lentsck MH, Paris MDC, Sangaleti CT, Pelazza BB, Soares LG, Baratieri T, Pitilin EDB, Moreira RC. PREVALÊNCIA E FATORES ASSOCIADOS À DOENÇA CRÍTICA CRÔNICA EM HOSPITALIZADOS POR TRAUMA EM TERAPIA INTENSIVA. TEXTO & CONTEXTO ENFERMAGEM 2022. [DOI: 10.1590/1980-265x-tce-2022-0246pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
RESUMO Objetivo identificar a prevalência de doença crítica crônica e fatores associados em pacientes hospitalizados por trauma em Unidade de Terapia Intensiva. Método estudo de caso-controle, com dados de prontuários de adultos hospitalizados por trauma em uma Unidade de Terapia Intensiva, entre 2013 e 2019. Os dados foram coletados do livro de admissão de pacientes, do prontuário eletrônico e das fichas do Serviço de Controle de Infecção Hospitalar. A variável dependente foi a ocorrência de doença crítica crônica e as variáveis independentes relacionavam-se às características sociodemográficas, comorbidades, trauma, atendimento pré-hospitalar, índices prognósticos, procedimentos e complicações. Realizou-se análise de regressão logística múltipla, que estimou o Ods Ratio (OR) e respectivos intervalos de confiança (IC). Resultados a doença crítica crônica ocorreu em 150 pacientes (24,2%), dos 619 estudados. Os fatores associados à DCC foram disfunção orgânica (OR=1,09) e complicações gastrointestinais (OR=2,71). Os pacientes com doença crítica crônica, além de demandarem por procedimentos cirúrgicos, desenvolveram disfunções orgânicas em diferentes sistemas, apresentando altas pontuações nos índices de prognósticos, ou seja, um pior prognóstico, além de desenvolverem complicações. Conclusão a identificação das complicações gastrointestinais e o aumento da disfunção orgânica como fatores associados ao paciente crítico crônico tornam-se úteis para compor perfil clínico de pacientes e para planejar a assistência intensiva ao traumatizado, contribuindo, assim, para a prevenção e o manejo desses pacientes pelo enfermeiro.
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Rosen JE, Bulger EM, Cuschieri J. Respiratory events after intensive care unit discharge in trauma patients: Epidemiology, outcomes, and risk factors. J Trauma Acute Care Surg 2022; 92:28-37. [PMID: 34284468 PMCID: PMC8692327 DOI: 10.1097/ta.0000000000003362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Respiratory complications are associated with significant morbidity and mortality in trauma patients. The care transition from the intensive care unit (ICU) to the acute care ward is a vulnerable time for injured patients. There is a lack of knowledge about the epidemiology of respiratory events and their outcomes during this transition. METHODS Retrospective cohort study in a single Level I trauma center of injured patients 18 years and older initially admitted to the ICU from 2015 to 2019 who survived initial transfer to the acute care ward. The primary outcome was occurrence of a respiratory event, defined as escalation in oxygen therapy beyond nasal cannula or facemask for three or more consecutive hours. Secondary outcomes included unplanned intubation for a primary pulmonary cause, adjudicated via manual chart review, as well as in-hospital mortality and length of stay. Multivariable logistic regression was used to examine patient characteristics associated with posttransfer respiratory events. RESULTS There were 6,561 patients that met the inclusion criteria with a mean age of 52.3 years and median Injury Severity Score of 18 (interquartile range, 13-26). Two hundred and sixty-two patients (4.0%) experienced a respiratory event. Respiratory events occurred early after transfer (median, 2 days, interquartile range, 1-5 days), and were associated with high mortality (16% vs. 1.8%, p < 0.001), and ICU readmission rates (52.6% vs. 4.7%, p < 0.001). Increasing age, male sex, severe chest injury, and comorbidities, including preexisting alcohol use disorder, congestive heart failure, and chronic obstructive pulmonary disease, were associated with increased odds of a respiratory event. Fifty-eight patients experienced an unplanned intubation for a primary pulmonary cause, which was associated with an in-hospital mortality of 39.7%. CONCLUSION Respiratory events after transfer to the acute care ward occur close to the time of transfer and are associated with high mortality. Interventions targeted at this critical time are warranted to improve patient outcomes. LEVEL OF EVIDENCE Prognostic and Epidemiological study, level III.
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Affiliation(s)
- Joshua E Rosen
- From the Surgical Outcomes Research Center, Department of Surgery (J.E.R.), University of Washington; Department of Surgery (J.E.R., E.M.B.), Harborview Medical Center, Seattle, Washington; and Department of Surgery (J.C.), University of California San Francisco, San Francisco, California
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Lentsck MH, Paris MDC, Sangaleti CT, Pelazza BB, Soares LG, Baratieri T, Pitilin EDB, Moreira RC. PREVALENCE AND FACTORS ASSOCIATED WITH CHRONIC CRITICAL DISEASE IN HOSPITALIZED FOR TRAUMA IN INTENSIVE CARE. TEXTO & CONTEXTO ENFERMAGEM 2022. [DOI: 10.1590/1980-265x-tce-2022-0246en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
ABSTRACT Objective to identify the prevalence of chronic critical disease and associated factors in patients hospitalized for trauma in the Intensive Care Unit. Method case-control study, with data from medical records of adults hospitalized for trauma in an Intensive Care Unit, between 2013 and 2019. Data were collected from the patient admission book, the electroni cmedical records and the records of the Hospital Infection Control Service. The dependent variable was the occurrence of chronic critical disease, and the independent variables were related to sociodemographic characteristics, comorbidities, trauma, pre-hospital care, prognostic indices, procedures and complications. Multiple logistic regression analysis was performed, which estimated the Ods Ratio (OR) and respective confidence intervals (CI). Results chronic critical disease occurred in 150 patients (24.2%), of the 619 patients studied. The factors associated with CCD were organic dysfunction (OR=1.09) and gastrointestinal complications (OR=2.71). Patients with chronic critical disease, in addition to proseeding for surgical procedures, developed organic dysfunctions in different systems, presenting high scores in prognostic indexes, i.e., a worse prognosis, in addition to developing complications. Conclusion the identification of gastrointestinal complications and the increase in organic dysfunction as factors associated with chronic critical patients become useful to compose the clinical profile of patients and to plan intensive care for the traumatized patients, thus contributing to the prevention and management of these patients by nurses.
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Lee KC, Lin TC, Chiang HF, Horng GJ, Hsu CC, Wu NC, Su HC, Chen KT. Predicting outcomes after trauma: Prognostic model development based on admission features through machine learning. Medicine (Baltimore) 2021; 100:e27753. [PMID: 34889225 PMCID: PMC8663914 DOI: 10.1097/md.0000000000027753] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 10/27/2021] [Indexed: 01/05/2023] Open
Abstract
In an overcrowded emergency department (ED), trauma surgeons and emergency physicians need an accurate prognostic predictor for critical decision-making involving patients with severe trauma. We aimed to develope a machine learning-based early prognostic model based on admission features and initial ED management.We only recruited patients with severe trauma (defined as an injury severity score >15) as the study cohort and excluded children (defined as patients <16 years old) from a 4-years database (Chi-Mei Medical Center, from January 2015, to December 2018) recording the clinical features of all admitted trauma patients. We considered only patient features that could be determined within the first 2 hours after arrival to the ED. These variables included Glasgow Coma Scale (GCS) score; heart rate; respiratory rate; mean arterial pressure (MAP); prehospital cardiac arrest; abbreviated injury scales (AIS) of head and neck, thorax, and abdomen; and ED interventions (tracheal intubation/tracheostomy, blood product transfusion, thoracostomy, and cardiopulmonary resuscitation). The endpoint for prognostic analyses was mortality within 7 days of admission.We divided the study cohort into the early death group (149 patients who died within 7 days of admission) and non-early death group (2083 patients who survived at >7 days of admission). The extreme Gradient Boosting (XGBoost) machine learning model provided mortality prediction with higher accuracy (94.0%), higher sensitivity (98.0%), moderate specificity (54.8%), higher positive predict value (PPV) (95.4%), and moderate negative predictive value (NPV) (74.2%).We developed a machine learning-based prognostic model that showed high accuracy, high sensitivity, and high PPV for predicting the mortality of patients with severe trauma.
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Affiliation(s)
- Kuo-Chang Lee
- Emergency Department, Chi-Mei Medical Center, Tainan, Taiwan
| | - Tzu-Chieh Lin
- Department of Computer Science and Information Engineering, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Hsiu-Fen Chiang
- Department of Computer Science and Information Engineering, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Gwo-Jiun Horng
- Department of Computer Science and Information Engineering, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Chien-Chin Hsu
- Emergency Department, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Biotechnology, Southern Tainan University of Technology, Tainan, Taiwan
| | - Nan-Chun Wu
- Division of Traumatology, Department of Surgery, Chi-Mei Medical Center, Tainan, Taiwan
| | - Hsiu-Chen Su
- Division of Traumatology, Department of Surgery, Chi-Mei Medical Center, Tainan, Taiwan
| | - Kuo-Tai Chen
- Emergency Department, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Santarelli S, Morgan ME, Vernon T, Bradburn E, Perea LL. Unplanned Readmissions to the Intensive Care Unit Among Geriatric Trauma Patients. Am Surg 2021; 88:866-872. [PMID: 34645332 DOI: 10.1177/00031348211048842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Unplanned readmission/bounceback to the intensive care unit (ICUBB) is a prevalent issue in the medical community. The geriatric population is incompletely studied in regard to ICUBB. We sought to determine if ICUBB in older patients was associated with higher risk of mortality. We hypothesized that, of those who were older, those with ICUBB would have higher mortality compared to those with no ICUBB. Further, we hypothesized that of those with ICUBB, older age would lead to higher mortality. METHODS The Pennsylvania Trauma Outcome Study database was retrospectively queried from 2003 to 2018 for all trauma patients of age ≥40 years. Those with advance directives were excluded. Adjusted analysis in the form of logistic regressions controlling for demographic and injury covariates and clustering by facility were used to assess the adjusted impact of ICUBB and age on mortality. RESULTS 363,778 patients were aged ≥40 years. When comparing mortalities between the age 40 and 49 years group and those in older groups, a dramatic increase in mortality was observed between those in each respective age category with ICUBB vs non-ICUBB. This trend was most prominent in those in the 90+ years age group (ICUBB: AOR: 34.78, P < .001; non-ICUBB: AOR: 9.08, P < .001). A second model only including patients who had ICUBB found that patients of age ≥65 years had significantly higher odds of mortality (AOR: 4.10, P < .001) when compared to their younger counterparts (age <65 years). DISCUSSION An ICUBB seems to exacerbate mortality rates as age increases. This profound increase in mortality calls for strategies to be developed, especially in the older population, to attempt to mitigate the factors leading to ICUBB.
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Affiliation(s)
- Shana Santarelli
- 6556Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Madison E Morgan
- 6556Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Tawnya Vernon
- Research Institute, 209639Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | - Eric Bradburn
- Department of Surgery, Division of Trauma and Acute Care Surgery, 209639Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | - Lindsey L Perea
- Department of Surgery, Division of Trauma and Acute Care Surgery, 209639Penn Medicine Lancaster General Health, Lancaster, PA, USA
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Tully N, Terry M, Dhanasekara S, Tucker A, Ronaghan C, Richmond R. Dynamic Cushioning: Obesity and Trauma Patients Undergoing Exploratory Laparotomy. J Surg Res 2021; 270:68-73. [PMID: 34638095 DOI: 10.1016/j.jss.2021.07.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/29/2021] [Accepted: 07/22/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Traumatic injuries account for 10% of all mortalities in the United States. Annually the global estimated population of overweight and obese individuals rises in number. It is well established in the literature that obesity is associated with worse outcomes in trauma patients. While body mass index, or BMI is not an independent predictor of increased morbidity or mortality after trauma laparotomy, we hypothesized that it may place patients at increased risk of postoperative complications and have lasting significant negative effects on quality of life in a manner disproportionate to normal-weight patients. METHODS The trauma registry of an academic level 1 trauma hospital was queried for laparotomies following either blunt or penetrating traumatic injury from 2015 to 2019. Individual patient charts were reviewed. Patients were divided into three groups, according to Body Mass Index (BMI) cut-offs as normal weight (BMI < 25 kg/m2), overweight; BMI 25-29.9 kg/m2), and obese (BMI ≥ 30 kg/m2). Demographics, intraoperative management and outcomes were compared between groups, after which complications were regressed based on BMI to evaluate the impact BMI had on each. RESULTS Records of 197 trauma patients who underwent exploratory laparotomies were analyzed. There was no significant difference in demographics or injury severity score (ISS) between groups. BMI had a direct positive association with intensive care unit length of stay (r = 0.239 [0.103, 0.367]), P < 0.001), hospital length of stay (r = 0.197 [0.059, 0.328], P = 0.005) and return to OR (OR = 1.057, [1.010, 1.109], P = 0.017). There was no significant relationship between BMI and in-hospital or 90-d mortality. CONCLUSIONS Our findings show that with increasing BMI, postoperative complications increase following laparotomy for trauma. As rates of obesity increase, trauma surgeons must be prepared to anticipate plans of care from patient presentation to well beyond discharge to cope with more complex postoperative and post-hospital clinical courses.
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Affiliation(s)
- Natalie Tully
- Department of Surgery, Texas Tech University Health Sciences Center, School of Medicine, Lubbock, Texas.
| | - Michelle Terry
- Department of Surgery, Texas Tech University Health Sciences Center, School of Medicine, Lubbock, Texas
| | - Samudani Dhanasekara
- Department of Surgery, Texas Tech University Health Sciences Center, School of Medicine, Lubbock, Texas
| | - Amber Tucker
- University Medical Center Trauma and Burn Service, Lubbock, Texas
| | - Catherine Ronaghan
- Department of Surgery, Texas Tech University Health Sciences Center, School of Medicine, Lubbock, Texas
| | - Robyn Richmond
- Department of Surgery, Texas Tech University Health Sciences Center, School of Medicine, Lubbock, Texas
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Komori A, Iriyama H, Kainoh T, Aoki M, Naito T, Abe T. The impact of infection complications after trauma differs according to trauma severity. Sci Rep 2021; 11:13803. [PMID: 34226621 PMCID: PMC8257796 DOI: 10.1038/s41598-021-93314-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/23/2021] [Indexed: 11/27/2022] Open
Abstract
The impact of infection on the prognosis of trauma patients according to severity remains unclear. We assessed the impact of infection complications on in-hospital mortality among patients with trauma according to severity. This retrospective cohort study used a nationwide registry of trauma patients. Patients aged ≥ 18 years with blunt or penetrating trauma who were admitted to intensive care units or general wards between 2004 and 2017 were included. We compared the baseline characteristics and outcomes between patients with and without infection and conducted a multivariable logistic regression analysis to investigate the impact of infection on in-hospital mortality according to trauma severity, which was classified as mild [Injury Severity Score (ISS) < 15], moderate (ISS 15–29), or severe (ISS ≥ 30). Among the 150,948 patients in this study, 10,338 (6.8%) developed infections. Patients with infection had greater in-hospital mortality than patients without infection [1085 (10.5%) vs. 2898 (2.1%), p < 0.01]. After adjusting for clinical characteristics, in-hospital mortality differed between trauma patients with and without infection according to trauma severity [17.1% (95% CI 15.2–18.9%) vs. 2.9% (95% CI 2.7–3.1%), p < 0.01, in patients with mild trauma; 14.8% (95% CI 13.3–16.3%) vs. 8.4% (95% CI 7.9–8.8%), p < 0.01, in patients with moderate trauma; and 13.5% (95% CI 11.2–15.7%) vs. 13.7% (95% CI 12.4–14.9%), p = 0.86, in patients with severe trauma]. In conclusion, the effect of infection complications in patients with trauma on in-hospital mortality differs by trauma severity.
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Affiliation(s)
- Akira Komori
- Department of Emergency and Critical Care Medicine, Tsukuba Memorial Hospital, Tsukuba, Japan.,Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Hiroki Iriyama
- Department of Emergency and Critical Care Medicine, Tsukuba Memorial Hospital, Tsukuba, Japan.,Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Takako Kainoh
- Department of Emergency and Critical Care Medicine, Tsukuba Memorial Hospital, Tsukuba, Japan
| | - Makoto Aoki
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan.,Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Toshio Naito
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Toshikazu Abe
- Department of Emergency and Critical Care Medicine, Tsukuba Memorial Hospital, Tsukuba, Japan. .,Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
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Farhat A, Grigorian A, Farhat A, Chin TL, Donnelly M, Dolich M, Kuza CM, Lekawa M, Nahmias J. Injury and Mortality Profiles in Level II and III Trauma Centers. Am Surg 2021; 88:58-64. [PMID: 33775161 DOI: 10.1177/0003134820966290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND While the benefit of admission to trauma centers compared to non-trauma centers is well-documented and differences in outcomes between Level-I and Level-II trauma centers are well-studied, data on the differences in outcomes between Level-II trauma centers (L2TCs) and Level-III trauma centers (L3TCs) are scarce. OBJECTIVES We sought to compare mortality risk between patients admitted to L2TCs and L3TCs, hypothesizing no difference in mortality risk for patients treated at L3TCs compared to L2TCs. METHODS A retrospective analysis of the 2016 Trauma Quality Improvement Program (TQIP) database was performed. Patients aged 18+ years were divided into 2 groups, those treated at American College of Surgeons (ACS) verified L2TCs and L3TCs. RESULTS From 74,486 patients included in this study, 74,187 (99.6%) were treated at L2TCs and 299 (.4%) at L3TCs. Both groups had similar median injury severity scores (ISSs) (10 vs 10, P < .001); however, L2TCs had a higher mean ISS (14.6 vs 11.9). There was a higher mortality rate for L2TC patients (6.0% vs 1.7%, P = .002) but no difference in associated risk of mortality between the 2 groups (OR .46, CI .14-1.50, P = .199) after adjusting predictors of mortality. L2TC patients had a longer median length of stay (5.0 vs 3.5 days, P < .001). There was no difference in other outcomes including myocardial infarction (MI) and cerebrovascular accident (CVA) (P > .05). DISCUSSION Patients treated at L2TCs had a longer LOS compared to L3TCs. However, after controlling for covariates, there was no difference in associated mortality risk between L2TC and L3TC patients.
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Affiliation(s)
- Ali Farhat
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Areg Grigorian
- Department of Surgery, University of California, Irvine, CA, USA
| | - Ahmed Farhat
- Department of Surgery, University of California, Irvine, CA, USA
| | - Theresa L Chin
- Department of Surgery, University of California, Irvine, CA, USA
| | - Megan Donnelly
- Department of Surgery, University of California, Irvine, CA, USA
| | - Matthew Dolich
- Department of Surgery, University of California, Irvine, CA, USA
| | - Catherine M Kuza
- Department of Anesthesiology, 5116University of Southern California, Los Angeles, CA, USA
| | - Michael Lekawa
- Department of Surgery, University of California, Irvine, CA, USA
| | - Jeffry Nahmias
- Department of Surgery, University of California, Irvine, CA, USA
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Jakobsen RK, Bonde A, Sillesen M. Assessment of post-trauma complications in eight million trauma cases over a decade in the USA. Trauma Surg Acute Care Open 2021; 6:e000667. [PMID: 33869787 PMCID: PMC8009234 DOI: 10.1136/tsaco-2020-000667] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/11/2021] [Accepted: 03/08/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Trauma is associated with a significant risk of post-trauma complications (PTCs). These include thromboembolic events, strokes, infections, and failure of organ systems (eg, kidney failure). Although care of the trauma patient has evolved during the last decade, whether this has resulted in a reduction in specific PTCs is unknown. We hypothesize that the incidence of PTCs has been decreasing during a 10-year period from 2007 to 2017. METHODS This is a descriptive study of trauma patients originating from level 1, 2, 3, and 4 trauma centers in the USA, obtained via the Trauma Quality Improvement Program (TQIP) database from 2007 to 2017. PTCs documented throughout the time frame were extracted along with demographic variables. Multiple regression modeling was used to associate admission year with PTCs, while controlling for age, gender, Glasgow Coma Scale score, and Injury Severity Score. RESULTS Data from 8 720 026 trauma patients were extracted from the TQIP database. A total of 366 768 patients experienced one or more PTCs. There was a general decrease in the incidence of PTCs during the study period, with the overall incidence dropping from 7.0% in 2007 to 2.8% in 2017. Multiple regression identified a slight decrease in incidence in all PTCs, although deep surgical site infection (SSI), deep venous thrombosis (DVT), and stroke incidences increased when controlled for confounders. DISCUSSION Overall the incidence of PTCs dropped during the 10-year study period, although deep SSI, DVT, stroke, and cardiac arrest increased during the study period. Better risk prediction tools, enabling a precision medicine approach, are warranted to identify at-risk patients. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Rasmus Kirial Jakobsen
- Department of Surgical Gastroenterology and Transplantation C-TX, Rigshospitalet, Kobenhavn, Denmark
- Center for Surgical Translational and Artificial Intelligence Research (CSTAR), Copenhagen, Denmark
| | - Alexander Bonde
- Department of Surgical Gastroenterology and Transplantation C-TX, Rigshospitalet, Kobenhavn, Denmark
- Center for Surgical Translational and Artificial Intelligence Research (CSTAR), Copenhagen, Denmark
| | - Martin Sillesen
- Department of Surgical Gastroenterology and Transplantation C-TX, Rigshospitalet, Kobenhavn, Denmark
- Center for Surgical Translational and Artificial Intelligence Research (CSTAR), Copenhagen, Denmark
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Spinopelvic Dissociation: A Systematic Review and Meta-analysis. J Am Acad Orthop Surg 2021; 29:e198-e207. [PMID: 32453011 DOI: 10.5435/jaaos-d-19-00293] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 04/15/2020] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Spinopelvic dissociation is a rare type of injury which occurs in approximately 2.9% of pelvic disruptions and correlates with high-energy trauma.The purpose of this study was to systematically evaluate the incidence, demographics, treatment, clinical outcome, and complication rate associated with these injuries. METHODS A literature review on Medline, PubMed, and Google was performed. Overall, 216 abstracts were reviewed in English, German, and French, of which 50 articles were included. RESULTS Within the 50 studies, 19 publications were case reports and 16 were case series with low-level evidence. Overall, 379 patients with spinopelvic dissociation were identified at a mean age of 31.6 ± 11.6 years and an injury severity score of 23.1 ± 3.8 between 1969 and 2018. Most cases were related to fall from heights (55.7%), followed by road accidents (28.5%). Two hundred fifty-eight patients (68.1%) showed neurologic impairment at initial presentation, which improved in 65.1% after surgery. The treatment of choice was surgery in 93.1% of cases with triangular fixation in 68.8%. Regardless of the technique, the healing/fusion rate was 100% with a complication rate of 29.9% (n = 96/321). CONCLUSION Spinopelvic dissociation is a rare type of injury with limited data in the literature. Based on our review, it is possible that a streamlined, evidence-based algorithm may improve care for these difficult patients. LEVEL OF EVIDENCE II. STUDY DESIGN Systematic Review.
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A statistically rigorous deep neural network approach to predict mortality in trauma patients admitted to the intensive care unit. J Trauma Acute Care Surg 2020; 89:736-742. [PMID: 32773672 DOI: 10.1097/ta.0000000000002888] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Trauma patients admitted to critical care are at high risk of mortality because of their injuries. Our aim was to develop a machine learning-based model to predict mortality using Fahad-Liaqat-Ahmad Intensive Machine (FLAIM) framework. We hypothesized machine learning could be applied to critically ill patients and would outperform currently used mortality scores. METHODS The current Deep-FLAIM model evaluates the statistically significant risk factors and then supply these risk factors to deep neural network to predict mortality in trauma patients admitted to the intensive care unit (ICU). We analyzed adult patients (≥18 years) admitted to the trauma ICU in the publicly available database Medical Information Mart for Intensive Care III version 1.4. The first phase selection of risk factor was done using Cox-regression univariate and multivariate analyses. In the second phase, we applied deep neural network and other traditional machine learning models like Linear Discriminant Analysis, Gaussian Naïve Bayes, Decision Tree Model, and k-nearest neighbor models. RESULTS We identified a total of 3,041 trauma patients admitted to the trauma surgery ICU. We observed that several clinical and laboratory-based variables were statistically significant for both univariate and multivariate analyses while others were not. With most significant being serum anion gap (hazard ratio [HR], 2.46; 95% confidence interval [CI], 1.94-3.11), sodium (HR, 2.11; 95% CI, 1.61-2.77), and chloride (HR, 2.11; 95% CI, 1.69-2.64) abnormalities on laboratories, while clinical variables included the diagnosis of sepsis (HR, 2.03; 95% CI, 1.23-3.37), Quick Sequential Organ Failure Assessment score (HR, 1.52; 95% CI, 1.32-3.76). And Systemic Inflammatory Response Syndrome criteria (HR. 1.41; 95% CI, 1.24-1.26). After we used these clinically significant variables and applied various machine learning models to the data, we found out that our proposed DNN outperformed all the other methods with test set accuracy of 92.25%, sensitivity of 79.13%, and specificity of 94.16%; positive predictive value, 66.42%; negative predictive value, 96.87%; and area under the curve of the receiver-operator curve of 0.91 (1.45-1.29). CONCLUSION Our novel Deep-FLAIM model outperformed all other machine learning models. The model is easy to implement, user friendly and with high accuracy. LEVEL OF EVIDENCE Prognostic study, level II.
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Zolin SJ, Bhangu JK, Young BT, Posillico SE, Ladhani HA, Claridge JA, Ho VP. Critical Care Documentation for the Dying Trauma Patient: Are We Recognizing Our Own Efforts? Am Surg 2020; 87:1488-1495. [PMID: 33356466 DOI: 10.1177/0003134820972989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Missed documentation for critical care time (CCT) for dying patients may represent a missed opportunity for physicians to account for intensive care unit (ICU) services, including end-of-life care. We hypothesized that CCT would be poorly documented for dying trauma patients. METHODS Adult trauma ICU patients who died between December 2014 and December 2017 were analyzed retrospectively. Critical care time was not calculated for patients with comfort care code status. Critical care time on the day prior to death and day of death was collected. Logistic regression was used to determine factors associated with documented CCT. RESULTS Of 147 patients, 43% had no CCT on day prior to death and 55% had no CCT on day of death. 82% had a family meeting within 1 day of death. Family meetings were independently associated with documented CCT (OR 3.69, P = .008); palliative care consultation was associated with decreased documented CCT (OR .24, P < .001). CONCLUSIONS Critical care time is not documented in half of eligible trauma patients who are near death. Conscious (time spent in family meetings and injury acuity) and unconscious factors (anticipated poor outcomes) likely affect documentation.
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Affiliation(s)
- Samuel J Zolin
- Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Department of Surgery, 2559MetroHealth Medical Center, Cleveland, OH, USA.,Department of General Surgery, Digestive Disease Institute, 2569Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Jasmin K Bhangu
- Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Department of Surgery, 2559MetroHealth Medical Center, Cleveland, OH, USA
| | - Brian T Young
- Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Department of Surgery, 2559MetroHealth Medical Center, Cleveland, OH, USA
| | - Sarah E Posillico
- Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Department of Surgery, 2559MetroHealth Medical Center, Cleveland, OH, USA
| | - Husayn A Ladhani
- Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Department of Surgery, 2559MetroHealth Medical Center, Cleveland, OH, USA
| | - Jeffrey A Claridge
- Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Department of Surgery, 2559MetroHealth Medical Center, Cleveland, OH, USA
| | - Vanessa P Ho
- Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Department of Surgery, 2559MetroHealth Medical Center, Cleveland, OH, USA.,Department of Population and Quantitative Health Sciences, 12304Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Papadimitriou-Olivgeris M, Panteli E, Koutsileou K, Boulovana M, Zotou A, Marangos M, Fligou F. Predictors of mortality of trauma patients admitted to the ICU: a retrospective observational study☆. Braz J Anesthesiol 2020; 71:23-30. [PMID: 33712248 PMCID: PMC9523669 DOI: 10.1016/j.bjane.2020.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 06/27/2020] [Indexed: 11/24/2022] Open
Abstract
Background and objectives Worldwide, trauma is one of the leading causes of morbidity and mortality. The aim of the present study is to identify the predictors of mortality of trauma patients requiring Intensive Care Unit (ICU) admission. Methods This retrospective study was conducted in the ICU of our institution in Greece during a six-year period (2010–215). Results Among 326 patients, trauma was caused by road traffic accidents in .5%, followed by falls (21.1%) and violence (7.4%). Thirty-day mortality was 27.3%. Multivariate analysis showed that higher New Injury Severity Score (NISS), severe head/neck injury, acute kidney injury, septic shock and hemorrhagic shock were significantly associated with mortality while higher Revised Injury Severity Classification, version II (RISC II) and the administration of enteral nutrition were associated with survival. NISS showed the higher accuracy in predicting 30-day mortality followed by RISC II, while scores based only in physiological variables had lower predictive ability. Conclusions Increased mortality was strongly associated with the severity of the injury upon admission. Traumatic brain injury, septic shock and acute kidney injury have also been found among the strongest predictors of mortality. NISS can be considered as a statistically superior score in predicting mortality of severely injured patients.
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Affiliation(s)
- Matthaios Papadimitriou-Olivgeris
- University of Patras, School of Medicine, Department of Anaesthesiology and Intensive Care Medicine, Patras, Greece; University Hospital of Lausanne, Department of Infectious Diseases, Lausanne, Switzerland; University of Patras, School of Medicine, Division of Infectious Diseases, Patras, Greece.
| | - Eleftheria Panteli
- University of Patras, School of Medicine, Department of Anaesthesiology and Intensive Care Medicine, Patras, Greece
| | - Kyriaki Koutsileou
- University of Patras, School of Medicine, Department of Anaesthesiology and Intensive Care Medicine, Patras, Greece
| | - Maria Boulovana
- University of Patras, School of Medicine, Department of Anaesthesiology and Intensive Care Medicine, Patras, Greece
| | - Anastasia Zotou
- University of Patras, School of Medicine, Department of Anaesthesiology and Intensive Care Medicine, Patras, Greece
| | - Markos Marangos
- University of Patras, School of Medicine, Division of Infectious Diseases, Patras, Greece
| | - Fotini Fligou
- University of Patras, School of Medicine, Department of Anaesthesiology and Intensive Care Medicine, Patras, Greece
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Peterson MJ, Woerhle T, Harry M, Heger AMC, Gerchman-Smith M, Vogel L, Hughes C, McCarty C. Family satisfaction in a neuro trauma ICU. Nurs Crit Care 2020; 27:334-340. [PMID: 33345370 DOI: 10.1111/nicc.12583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 12/04/2020] [Accepted: 12/08/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this quality improvement initiative was to evaluate satisfaction of family members of patients in a neuro trauma ICU (NTICU). METHODS Adult patients (age 18+) admitted to the NTICU for at least 24 hours between June 2017 and November 2018 were identified. Near or at the time of discharge from the NTICU, the health unit coordinator or registered nurse identified the family member who was either the next-of-kin, surrogate decision-maker, or person who had been most frequently present at the patient's bedside. This person was provided a packet containing a letter of consent and the Critical Care Family Satisfaction Survey (CCFSS). RESULTS Surveys were completed by 78 family members, the majority of whom were the wife of the patient (n = 35, 44%), 60 years and older (n = 48, 60.8%). Fifty-seven percent of patients (n = 45) were in the ICU less than 3 days and 59% (n = 47) of medical events were injury-related. Total CCFSS scores ranged from 69 to 100 (median 95). The item with the largest number of dissatisfied responses was "Noise level in the critical care unit" (n = 4, 5.3% not satisfied). Open-ended question comments were primarily positive (n = 60, 66%), with 32% (n = 29) representing areas for improvement. CONCLUSIONS Results of this satisfaction survey have been disseminated to leadership and have been taken into consideration in the planning of a new hospital building currently being built, including ICU patient rooms that allow for more privacy and reduced noise, and more comfortable family rooms. RELEVANCE TO CLINICAL PRACTICE Family members are a very useful source of feedback for ICU care. Several concerns identified by family members in this study are likely to be relevant to other sites. These included: communication between health care providers and family about patient status, noise in the ICU, peaceful waiting areas for family, and slow transfers.
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Affiliation(s)
| | - Theo Woerhle
- Essentia Institute of Rural Health, Duluth, Minnesota, USA
| | - Melissa Harry
- Essentia Institute of Rural Health, Duluth, Minnesota, USA
| | | | | | - Linda Vogel
- Essentia Health St. Mary's Medical Center, Duluth, Minnesota, USA
| | - Carolyn Hughes
- Essentia Health St. Mary's Medical Center, Duluth, Minnesota, USA
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Almarhabi M, Cornish J, Lee G. The effectiveness of educational interventions on trauma intensive care unit nurses' competence: A systematic review and meta-analysis. Intensive Crit Care Nurs 2020; 64:102931. [PMID: 32950377 DOI: 10.1016/j.iccn.2020.102931] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/02/2020] [Accepted: 08/11/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To examine the current evidence on the effect of education on intensive care unit nurses' knowledge and skills competence in caring for adult major trauma patients. METHODOLOGY A systematic review and meta-analysis was conducted to identify relevant studies through a comprehensive search, following strict eligibility criteria. Five databases were searched: MEDLINE, PubMed, CINAHL, Cochrane and Web of Science. A subsequent hand search was performed. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument tool was used to assess methodological quality. RESULTS Five eligible quantitative studies were identified and appraised. The overall results demonstrated that educational interventions have positive effects in improving intensive care nurses' knowledge and practice in managing major trauma patients. Meta-analysis was applied to three homogenous studies relating to knowledge outcome. Results demonstrated significant improvements immediately post-intervention and at one-to three-month follow-up [MD (mean difference) = 29.12, 95%CI (confidence interval) 10.29-47.95; P < 0.00001], and [MD = 23.70, 95%CI 8.84-38.56; P < 0.00001], respectively. A slight decrease in the knowledge and practice scores was noted from one- to three-month follow-up. CONCLUSION This review demonstrated the significant effects of trauma education on improving intensive care nurses' knowledge and practices. Further research should develop valid competencies and policies to drive nurses' practice and potentially improve the safety and quality of care.
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Affiliation(s)
- Maha Almarhabi
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK; Faculty of Nursing, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Jocelyn Cornish
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK
| | - Geraldine Lee
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK
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Hong ZJ, Firek M, Zachary B, Mörs K, Schindler C, Marzi I, Yu JC, Coimbra R. The effect of age and sex on outcomes following isolated moderate to severe traumatic brain injury. Eur J Trauma Emerg Surg 2020; 48:871-880. [PMID: 32929551 DOI: 10.1007/s00068-020-01491-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/04/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The impact of female sex on traumatic brain injury (TBI) outcomes remains controversial. The combined impact of age and sex on TBI outcomes must be clarified. We hypothesized that females have better outcomes than males in the premenopausal age group. METHODS Data from the 2007-2016 National Trauma Data Bank of the Committee on Trauma-American College of Surgeons were used. Of a total of 686,549 patients with moderate to severe TBI (AIS ≥ 3), 251,491 were female. Comparison analyses of clinical characteristics and outcomes between females and males were conducted at different age groups: < 45 years, 45-55, and > 55 years. Logistic regressions were performed to assess the impact of age and female sex on mortality and complications. RESULTS Mortality rate between females and males aged < 45 and 45-55 years was similar, but significantly reduced in the > 55 years group. After multivariate logistic regression analysis controlling for multiple confounding factors, we found that females aged > 55 years had markedly decreased risk of mortality (AOR: 0.857, 95% CI 0.835-0.879, p < 0.001) and complications. CONCLUSION Female patients in the postmenopausal stage have better outcomes following TBI than males, but pre- and perimenopausal females do not, suggesting that female sexual hormones may not provide a significant protective effect on clinical outcomes following isolated moderate to severe TBI.
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Affiliation(s)
- Zhi-Jie Hong
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System Medical Center, 26520 Cactus Ave., CPC Building, Suite 102-5, Riverside, Moreno Valley, CA, 92555, USA.,Division of Traumatology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.,Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Matthew Firek
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System Medical Center, 26520 Cactus Ave., CPC Building, Suite 102-5, Riverside, Moreno Valley, CA, 92555, USA
| | - Bishoy Zachary
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System Medical Center, 26520 Cactus Ave., CPC Building, Suite 102-5, Riverside, Moreno Valley, CA, 92555, USA
| | - Katharina Mörs
- Department of Trauma, Hand and Reconstructive Surgery, University of Frankfurt, Frankfurt, Germany
| | - Cora Schindler
- Department of Trauma, Hand and Reconstructive Surgery, University of Frankfurt, Frankfurt, Germany
| | - Ingo Marzi
- Department of Trauma, Hand and Reconstructive Surgery, University of Frankfurt, Frankfurt, Germany
| | - Jyh-Cherng Yu
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Raul Coimbra
- Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System Medical Center, 26520 Cactus Ave., CPC Building, Suite 102-5, Riverside, Moreno Valley, CA, 92555, USA. .,Department of Surgery, Loma Linda University School of Medicine, Loma Linda, CA, USA.
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Chiang YT, Lin TH, Hu RH, Lee PC, Shih HC. Predicting factors for major trauma patient mortality analyzed from trauma registry system. Asian J Surg 2020; 44:262-268. [PMID: 32859471 DOI: 10.1016/j.asjsur.2020.06.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/18/2020] [Accepted: 06/28/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE We investigated the predictors of mortality in major trauma patients using a trauma registry system database. METHODS Data were obtained from the trauma registry of a level I trauma center for all patients aged ≥18 years admitted to an intensive care unit (ICU) between January 1, 2006 and December 31, 2013. Models were adjusted for patient demographics, injury mechanism, preexisting comorbidity, Glasgow coma scale (GCS), injury severity score (ISS), emergency department (ED) and ICU procedures, surgical procedures, and complications. Multivariate logistic regression analysis was used to determine predictors of mortality and odds ratios of its associated factors. RESULTS In total, 1561 patients met the inclusion criteria. The overall mortality rate was 13.4%. After controlling for all variables in a logistic regression model, the factors associated with increased mortality risk (P < 0.05) were age ≥ 45 years; ISS > 24; GCS score < 8 and 8-12; fall accident; preexisting comorbidity of renal insufficiency; ED cardiopulmonary resuscitation (CPR) procedures; ICU blood transfusion; and cardiovascular, respiratory, digestive system and infection complications. CONCLUSION Our data showed some predictors of patient mortality after major trauma, most of which were determined during the trauma event. Only those treatment complications may be improved when performing the treatment procedures.
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Affiliation(s)
- Yueh-Tzu Chiang
- Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taiwan, ROC; Department of Orthopedics, KuangTien General Hospital, Taiwan, ROC.
| | - Tzu-Hsin Lin
- Department of Traumatology, National Taiwan University Hospital, And College of Medicine, National Taiwan University, Taiwan, ROC.
| | - Rey-Heng Hu
- Department of Traumatology, National Taiwan University Hospital, And College of Medicine, National Taiwan University, Taiwan, ROC
| | - Po-Chu Lee
- Department of Traumatology, National Taiwan University Hospital, And College of Medicine, National Taiwan University, Taiwan, ROC
| | - Hsin-Chin Shih
- Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taiwan, ROC
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Abstract
OBJECTIVE Early differential diagnosis of an infection in a trauma patient is likely to have a significant influence on the prognosis. In the present study, we evaluated the early differential value of plasma presepsin, procalcitonin (PCT), C-reactive protein (CRP), and white blood cells (WBCs) on infection in trauma patients. METHODS Trauma patients were divided into noninfected (n = 89) and infected trauma groups (n = 68); healthy adult volunteers (n = 60) and patients having sterile surgery (n = 60) were enrolled as the controls. Plasma presepsin, PCT, CRP, and WBC counts were measured and the injury severity score (ISS) was calculated. RESULTS Plasma presepsin levels within the first 3 d of admission were only significantly increased in the infected trauma group, but not in the noninfected trauma and sterile groups. This indicated that presepsin might have an ability to differentiate the infection in trauma patients; however, plasma PCT, CRP, and WBCs were significantly increased in both the infected and noninfected trauma patients. Binary logistic regression analysis showed that only increased plasma presepsin, PCT, and ISS were significantly associated with an increased likelihood of infection in trauma patients. Both presepsin and PCT were valuable for diagnosing infection; presepsin had a higher area under the curve than PCT. CONCLUSION Presepsin might be a superior biomarker for early differentiation of infection in trauma patients; however, trauma stress elevates PCT, CRP, and WBCs even in the absence of infection; therefore, caution is advised when using these indicators to diagnose infection.
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Naess HL, Vikane E, Wehling EI, Skouen JS, Bell RF, Johnsen LG. Effect of Early Interdisciplinary Rehabilitation for Trauma Patients: A Systematic Review. Arch Rehabil Res Clin Transl 2020; 2:100070. [PMID: 33543097 PMCID: PMC7853396 DOI: 10.1016/j.arrct.2020.100070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Objective To perform a systematic review to assess the current scientific evidence concerning the effect of EIR for trauma patients with or without an associated traumatic brain injury. Data Source We performed a systematic search of several electronic (Ovid MEDLINE, Embase, Cochrane Library Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health, and SveMed+) and 2 clinical trial registers (clinicaltrials.gov and International Clinical Trials Registry Platform). In addition, we handsearched reference lists from relevant studies. Data Extraction Two review authors independently identified studies that were eligible for inclusion. The primary outcome measures were functional-related outcomes and return to work. The secondary outcome measures were length of stay in hospital, number of days on respirator, complication rate, physical and mental health measures, quality of life, and socioeconomic costs. Data Synthesis Four studies with a total number of 409 subjects, all with traumatic brain–associated injuries, were included in this review. The included trials varied considerably in study design, inclusion and exclusion criteria, and had small numbers of participants. All studies were judged to have at least 1 high risk of bias. We found the quality of evidence, for both our primary and secondary outcomes, low. Conclusions No studies that matched our inclusion criteria for EIR for trauma patients without traumatic brain injuries could be found. For traumatic brain injuries, there are a limited number of studies demonstrating that EIR has a positive effect on functional outcomes and socioeconomic costs. This review highlights the need for further research in trauma care regarding early phase interdisciplinary rehabilitation.
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Affiliation(s)
- Hanne Langseth Naess
- Regional Trauma Center, Haukeland University Hospital, Bergen, Norway.,Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway
| | - Eirik Vikane
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway
| | - Eike Ines Wehling
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway.,Department of Biological and Medicine Psychology, University of Bergen, Bergen, Norway
| | - Jan Sture Skouen
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Rae Frances Bell
- Regional Centre of Excellence in Palliative Care, Haukeland University Hospital, Bergen, Norway
| | - Lars Gunnar Johnsen
- Department of Neuromedicine and Movement Science, University of Trondheim, Trondheim, Norway.,Norwegian National Advisory Unit on Trauma, Oslo, Norway
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48
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Abstract
PURPOSE Cigarettes have been demonstrated to be toxic to the pulmonary connective tissue by impairing the lung's ability to clear debris, resulting in infection and acute respiratory distress syndrome (ARDS). Approximately 8% of adolescents are smokers. We hypothesized that adolescent trauma patients who smoke have a higher rate of ARDS and pneumonia when compared to non-smokers. METHODS The Trauma Quality Improvement Program (2014-2016) was queried for adolescent trauma patients aged 13-17 years. Adolescent smokers were 1:2 propensity-score-matched to non-smokers based on age, comorbidities, and injury type. Data were analyzed using chi square for categorical data and Mann-Whitney U test for continuous data. RESULTS From 32,610 adolescent patients, 997 (3.1%) were smokers. After matching, 459 smokers were compared to 918 non-smokers. There were no differences in matched characteristics. Compared to non-smokers, smokers had an increased rate of pneumonia (3.1% vs. 1.1%, p = 0.01) but not ARDS (0.2% vs. 0%, p = 0.16). Compared to the non-smoking group, the smokers had a longer median total hospital length-of-stay (3 vs. 2 days, p = 0.01) and no difference in overall mortality (1.5% vs. 2.4%, p = 0.29). CONCLUSION Smoking is associated with an increased rate of pneumonia in adolescent trauma patients. Future research should target smoking cessation and/or interventions to mitigate the deleterious effects of smoking in this population.
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49
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Roussas A, Masjedi A, Hanna K, Zeeshan M, Kulvatunyou N, Gries L, Tang A, Joseph B. Number and Type of Complications Associated With Failure to Rescue in Trauma Patients. J Surg Res 2020; 254:41-48. [PMID: 32408029 DOI: 10.1016/j.jss.2020.04.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 03/28/2020] [Accepted: 04/15/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Failure to rescue (FTR) is becoming a ubiquitous metric of quality care. The aim of our study is to determine the type and number of complications associated with FTR after trauma. METHODS We reviewed the Trauma Quality Improvement Program including patients who developed complications after admission. Patients were divided as the following: "FTR" if the patient died or "rescued" if the patient did not die. Logistic regression was used to ascertain the effect of the type and number of complications on FTR. RESULTS A total of 25,754 patients were included with 972 identified as FTR. Logistic regression identified sepsis (odds ratio [OR] = 6.61 [4.72-9.27]), pneumonia (OR = 2.79 [2.15-3.64]), acute respiratory distress syndrome (OR = 4.6 [3.17-6.69]), and cardiovascular complications (OR = 24.22 [19.39-30.26]) as predictors of FTR. The odds ratio of FTR increased by 8.8 for every single increase in the number of complications. CONCLUSIONS Specific types of complications increase the odds of FTR. The overall complication burden will also increase the odds of FTR linearly. LEVEL OF EVIDENCE Level III Prognostic.
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Affiliation(s)
- Adam Roussas
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Aaron Masjedi
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Kamil Hanna
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Muhammad Zeeshan
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Narong Kulvatunyou
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Lynn Gries
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Andrew Tang
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona
| | - Bellal Joseph
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona.
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50
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Tiruneh A, Siman-Tov M, Radomislensky I, Peleg K. Inequality in in-hospital mortality due to road traffic accident between ethnic populations in specified groups living in the same country. Isr J Health Policy Res 2020; 9:17. [PMID: 32312315 PMCID: PMC7171802 DOI: 10.1186/s13584-020-0363-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 01/29/2020] [Indexed: 11/10/2022] Open
Abstract
Background Road traffic accidents (RTA) are not equally distributed between ethnic groups, disproportionately affecting minorities. In Israel, Arabs are at higher risk of involvement in RTA relative to their proportion in the population. This study aims to compare the risk of in-hospital mortality from RTA between Arabs and Jews in Israel and to identify the factors associated with mortality in each population group. Methods This study is based on the Israeli National Trauma Registry of patients hospitalized due to road traffic injuries (Injury Severity Score 16+) between 2008 and 2017. Demographic, injury and hospitalization characteristics, evacuation means and in-hospital mortality were analyzed. Hierarchical multivariate logistic regression with random intercept for the treating hospital was performed to estimate the risk of mortality. Results Of the 11,523 hospitalizations reported, 29% were Arabs, which is higher than their proportion in the Israeli population (21%). When comparing Arabs with Jews they were younger (ages 0–24 years - 61% vs 30%), injured as a car driver (28% vs 20%) or passenger (21% vs 15%) and less likely to be a motor cyclist (8.8% vs. 19.2%). In addition, Arabs were more likely to suffer from critical injuries (51% vs 44%) and head injuries (71% vs 66%). Although Arabs were less likely to be evacuated by ambulance (68% vs 80%), they were more likely to be evacuated by a private vehicle or an emergency medical helicopter. Transfers between hospitals were greater among Arabs (14% vs 22%), as were hospital admissions “outside official work hours” (70% vs 78%) and hospital resource utilization. After accounting for demographic, injury, and hospitalization characteristics the risk of in-hospital mortality was significantly higher among Arabs compared to Jews (OR: 1.63, 95% CI: 1.14–2.32). The significantly higher mortality among Arabs was apparent in the sub-group of patients who were critically injured and in those who arrived at the hospital “outside official work hours”. Conclusions This study suggests the need for developing appropriate interventions focusing on the Arab community in general, and according to the analysis of risk groups and areas of injury in particular, including rapid access to emergency medical services and definitive care.
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Affiliation(s)
- Abebe Tiruneh
- Israel National Center for Trauma and Emergency Medicine, Gertner Institute for Epidemiology and Health Policy Research, Tel-Hashomer, Ramat Gan, Israel
| | - Maya Siman-Tov
- Israel National Center for Trauma and Emergency Medicine, Gertner Institute for Epidemiology and Health Policy Research, Tel-Hashomer, Ramat Gan, Israel
| | - Irina Radomislensky
- Israel National Center for Trauma and Emergency Medicine, Gertner Institute for Epidemiology and Health Policy Research, Tel-Hashomer, Ramat Gan, Israel
| | | | - Kobi Peleg
- Israel National Center for Trauma and Emergency Medicine, Gertner Institute for Epidemiology and Health Policy Research, Tel-Hashomer, Ramat Gan, Israel. .,Department of Disaster Management, School of Public Health, Tel Aviv University, Tel Aviv, Israel.
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