Epidemiology, prognostic factors, and outcome of trauma patients admitted in a Brazilian intensive care unit

Mortality Due to Acute Respiratory Distress Syndrome in Latin America

OBJECTIVES

Mortality due to acute respiratory distress syndrome (ARDS) is a major global health problem. Knowledge of epidemiological data on ARDS is crucial to design management, treatment strategies, and optimize resources. There is ample data regarding mortality of ARDS from high-income countries; in this review, we evaluated mortality due to ARDS in Latin America.

DATA SOURCES

We searched in PubMed, Cochrane Central Register of Controlled Trials, Web of Science, and Latin American and Caribbean Health Science Literature databases from 1967 to March 2023.

STUDY SELECTION

We searched prospective or retrospective observational studies and randomized controlled trials conducted in Latin American countries reporting ARDS mortality.

DATA EXTRACTION

Three pairs of independent reviewers checked all studies for eligibility based on their titles and abstracts. We performed meta-analysis of proportions using a random-effects model. We performed sensitivity analyses including studies with low risk of bias and with diagnosis using the Berlin definition. Subgroup analysis comparing different study designs, time of publication (up to 2000 and from 2001 to present), and studies in which the diagnosis of ARDS was made using Pa o2 /F io2 less than or equal to 200 and regional variations. Subsequently, we performed meta-regression analyses. Finally, we graded the certainty of the evidence (Grading of Recommendations Assessment, Development, and Evaluation).

DATA SYNTHESIS

Of 3315 articles identified, 32 were included (3627 patients). Mortality was 52% in the pooled group (low certainty of evidence). In the sensitivity analysis (according to the Berlin definition), mortality was 46% (moderate certainty of evidence). In the subgroup analysis mortality was 53% (randomized controlled trials), 51% (observational studies), 66% (studies published up to 2000), 50% (studies after 2000), 44% (studies with Pa o2 /F io2 ≤ 200), 56% (studies from Argentina/Brazil), and 40% (others countries). No variables were associated with mortality in the meta-regression.

CONCLUSIONS

ARDS mortality in Latin America remains high, as in other regions. These results should constitute the basis for action planning to improve the prognosis of patients with ARDS (PROSPERO [CRD42022354035]).

Effective factors of severity of traffic accident traumas based on the Haddon matrix: a systematic review and meta-analysis

Objective

This study aims to investigate the factors affecting the severity of trauma caused by traffic accidents based on martrix Haddon; a systematic review and meta-analysis.

Methods

In this study searched five international databases in this study, including Medline/PubMed, ProQuest, Scopus, Web of Knowledge, and Google Scholar, for published articles by the end of 2022. Data were entered into the statistical program and analyses were performed using STATA 17.0 software. Odds ratio (OR) values were computed for severity accidents.

Results

Results of study showed that among the risk factors related to the host, not using helmet increased the risk of injury severity by 3.44 times compared to people who have used helmets (OR Not using helmet/Using helmet = 3.44, 95% CI: 2.27-5.00, P=0.001, I2=0.00%). Also, crossing over a centre divider has a protective role for the risk of injury severity compared to undertaking (OR crossing over a centre divider/undertaking=0.39, 95% CI: 0.20-0.75, P=0.01, I2=25.79%). in terms of the type of accident, accident of car-car reduces the risk of injury severity by 23% compared to accident of car-pedestrian (OR accident of car-car/accident of car-pedestrian=0.77, 95% CI: 0.61-0.96, P=0.02, I2=0.00%).

Conclusions

It is necessary to pay attention to the intersection of human, vehicle and environmental risks and their contribution and how they interact. Based on the Haddon matrix approach, special strategies can be designed to prevent road damage. Safety standards for vehicles should also be addressed through stricter legal requirements and inspections.

Effects of the COVID-19 pandemic on trauma-related emergency medical service in older people: a retrospective cohort study

INTRODUCTION

The ever-increasing human life expectancy has currently resulted in a noticeable rise in the world's older population. Addressing the healthcare needs of the older people has become a significant concern for many countries. Moreover, the older people are particularly vulnerable to traumatic events. This study aimed to examine the impact of the COVID-19 pandemic on prehospital care provided by Emergency Medical Services (EMS) for trauma-related cases among the older people in Iran.

METHODS

This retrospective cohort study involved analyzing the medical records of 1,111 older people aged above 60 who experienced traumatic injuries and received pre-hospital emergency services from March 2018 to March 2022. In order to collect the data, the checklist made by the researcher was used and data analysis in SPSS16 was done using the Chi-square test and Fisher's exact test.

RESULTS

The age group of 60-74 received the highest number of services both before and after the COVID-19 pandemic. The older men experienced more traumatic events compared to women throughout the study period. The majority of the traumatic events occurred between 8 a.m. and 12 p.m. both before and after the COVID-19 pandemic.

CONCLUSIONS

The high prevalence rate of geriatric traumas can be primarily attributed to their physical problems and no control over movements caused by old age, as well as unsafe living conditions. To address these issues, it is suggested that facilities be provided to assist with mobility problems. Moreover, constructing suitable pedestrian bridges and regularly checking neighborhoods and surroundings to identify potential risk factors should be prioritized. Once these risk factors are identified, efforts can be made to adjust and eliminate them, thereby minimizing traumatic events and enhancing a safe and friendly environment for the older people.

Variables associated to intensive care unit (ICU)-mortality among patients admitted to surgical intensive care unit in Ethiopia: a retrospective observational study

BACKGROUND

The present study aimed to assess variables associated to ICU-mortality among patients admitted to surgical intensive care unit in Ethiopia.

METHODS

A Hospital-based retrospective follow-up study was conducted on all patients who were admitted to the surgical intensive care unit. Data were extracted from patients' charts with a pretested data extraction tool, entered into Epi-data 4.6.0, and analyzed with STATA- 14. Bivariate and multivariate Cox proportional hazards regression models were fitted.

RESULTS

Of the total study participants (388), 148 (38.1%) patients admitted to the surgical intensive care unit died during the follow-up period with a median survival time of 11 days. Potassium level < 3.5 mmol/L (adjusted hazard ratio ( AHR): 3.46, 95% CI (1.83 6.55), potassium level > 5.0 mmol/L (AHR:2.41, 95% CI (1.29-4.51), hypoxia (AHR:1.66, 95% CI (1.10-2.48), Glasgow Coma Scale (GCS) score < 9 (AHR: 4.06, 95% CI (1.51-10.89), mechanical ventilation (AHR:12, 95%CI (3-45), absence of thromboprophylaxis (AHR:10.8,95% CI (6.04-19.29), absence of enteral feeding (AHR:3.56, 95% CI (2.20-5.78) were variables associated with ICU-mortality among patients admitted to surgical intensive care unit.

CONCLUSIONS

The overall ICU-mortality of patients admitted to our surgical intensive care unit was higher compared to patients admitted to similar intensive care unit in developed countries. The variables associated to ICU-mortality among patients admitted to surgical intensive care unit were abnormal serum potassium level, lower GCS score, mechanical support, hypoxia, absence of thromboprophylaxis, and enteral feeding.

Incidence and predictors of mortality among adult trauma patients admitted to the intensive care units of comprehensive specialized hospitals in Northwest Ethiopia

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.

Epidemiological and clinical characteristics predictive of ICU mortality of patients with traumatic brain injury treated at a trauma referral hospital - a cohort study

BACKGROUND

Traumatic brain injury (TBI) has substantial physical, psychological, social and economic impacts, with high rates of morbidity and mortality. Considering its high incidence, the aim of this study was to identify epidemiological and clinical characteristics that predict mortality in patients hospitalized for TBI in intensive care units (ICUs).

METHODS

A retrospective cohort study was carried out with patients over 18 years old with TBI admitted to an ICU of a Brazilian trauma referral hospital between January 2012 and August 2019. TBI was compared with other traumas in terms of clinical characteristics of ICU admission and outcome. Univariate and multivariate analyses were used to estimate the odds ratio for mortality.

RESULTS

Of the 4816 patients included, 1114 had TBI, with a predominance of males (85.1%). Compared with patients with other traumas, patients with TBI had a lower mean age (45.3 ± 19.1 versus 57.1 ± 24.1 years, p < 0.001), higher median APACHE II (19 versus 15, p < 0.001) and SOFA (6 versus 3, p < 0.001) scores, lower median Glasgow Coma Scale (GCS) score (10 versus 15, p < 0.001), higher median length of stay (7 days versus 4 days, p < 0.001) and higher mortality (27.6% versus 13.3%, p < 0.001). In the multivariate analysis, the predictors of mortality were older age (OR: 1.008 [1.002-1.015], p = 0.016), higher APACHE II score (OR: 1.180 [1.155-1.204], p < 0.001), lower GCS score for the first 24 h (OR: 0.730 [0.700-0.760], p < 0.001), greater number of brain injuries and presence of associated chest trauma (OR: 1.727 [1.192-2.501], p < 0.001).

CONCLUSION

Patients admitted to the ICU for TBI were younger and had worse prognostic scores, longer hospital stays and higher mortality than those admitted to the ICU for other traumas. The independent predictors of mortality were older age, high APACHE II score, low GCS score, number of brain injuries and association with chest trauma.

Survival status and predictors of mortality among patients admitted to surgical intensive care units of Addis Ababa governmental hospitals, Ethiopia: A multicenter retrospective cohort study

Introduction

Critical care is a serious global healthcare burden. Although a high number of surgical patients are being admitted to the surgical intensive care unit (SICU), the mortality remained high, particularly in low and middle-income countries. However, there is limited data in Ethiopia. Therefore, this study aimed to investigate the survival status and predictors of mortality in surgical patients admitted to the SICUs of Addis Ababa governmental hospitals, Ethiopia.

Methods

A multicenter retrospective cohort study was conducted on 410 surgical patients admitted to the SICUs of three government hospitals in Addis Ababa selected using a simple random sampling from February 2017 to February 2020. The data were entered into Epidata version 4.6 and imported to STATA/MP version 16 for further analysis. Bi-variable and multivariable Cox regression models were fitted in the analysis to determine the predictor variables. A hazard ratio (HR) with a 95% confidence interval (CI) was computed, and variables with a p-value <0.05 were considered statistically significant.

Results

From a sample of 410 patients, 378 were included for final analysis and followed for a median follow-up of 5 days. The overall mortality among surgical patients in the SICU was 44.97% with an incidence rate of 5.9 cases per 100 person-day observation. Trauma (AHR = 1.83, 95% CI: 1.19-2.08), Glasgow coma score (GCS) <9 (AHR = 2.06, 95% CI: 1.28-3.31), readmission to the SICU (AHR = 3.52, 95% CI: 2.18-5.68), mechanical ventilation (AHR = 2.52, 95% CI: 1.23-5.15), and creatinine level (AHR = 1.09, 95% CI: 1.01-1.18) were found to be significantly associated with mortality in the SICU.

Conclusion

The mortality of surgical patients in the SICU was high. Trauma, GCS <9 upon admission, readmission to the SICU, mechanical ventilation, and increased in the creatinine level on admission to the SICU were the identified predictors of mortality in the SICU.

Epidemiological pattern of trauma patients based on the mechanisms of trauma: trends of a regional trauma center in Midwest of Iran

INTRODUCTION

Trauma is one of the important issues in public health because it is responsible for 90% of mortality in Low and Middle-Income Countries (LIMCs). The present study aimed to determine the epidemiological pattern of trauma patients in a regional trauma center in the Midwest of Iran from 2014 to 2020.

METHODS

This study was a retrospective study that was performed on 29,804 trauma patients admitted to Be'sat Hospital in Hamadan from January 2014 to December 2020. Data was collected using Health Information Management (HIM) Center of the Be'sat Hospital. For investigating the relationship of the characteristics of trauma patients and the mechanisms of trauma, Multiple Multinomial Logistic Regression (MMNLR) model was used. All statistical analyses were performed using the IBM SPSS Statistics version 24.

RESULTS

The mean age of all patients was 35.4 (SD = 21.9) years. Most of them were men (71.7%). The most common mechanism of trauma was road traffic accidents (RTAs) (39.6%) followed by falls (30.2%), other (19.7%), violence (6.2%), and burn (4.4%). 1.5% of the trauma patients expired. The results of multiple multinomial logistic regression indicated that significant affected factor on odds referring because of RTAs compared to other mechanism were: season and hospital length of stay (LOS); in falls and violence: age, sex, season, and LOS; and in burn: age, sex, season, evening time, and LOS (p < 0.05).

CONCLUSION

Based on the investigation of 29,804 trauma patients, in Iran as a developing country, RTAs and falls were two common mechanisms of trauma. It seems that as a short-term plan, it is possible to focus on road safety, to improve the quality of vehicles, to hold training courses for drivers. Also, as a long-term goal, considering that the elderly population in Iran is increasing, it is necessary to pay attention to fall reduction programs.

The magnitude of mortality and its determinants in Ethiopian adult intensive care units: A systematic review and meta-analysis

Introduction

Despite mortality in intensive care units being a global burden, it is higher in low-resource countries, including Ethiopia. A sufficient number of evidence is not yet established regarding mortality in the intensive care unit and its determinants. This study intended to determine the prevalence of ICU mortality and its determinants in Ethiopia.

Methods

PubMed, Google Scholar, The Cochrane Library, HINARI, and African Journals Online (AJOL) databases were systematically explored for potentially eligible studies on mortality prevalence and determinants reported by studies done in Ethiopia. Using a Microsoft Excel spreadsheet, two reviewers independently screen, select, review, and extract data for further analysis using STATA/MP version 17. A meta-analysis using a random-effects model was performed to calculate the pooled prevalence and odds ratio with a 95% confidence interval. In addition, using study region and sample size, subgroup analysis was also performed.

Results

9799 potential articles were found after removing duplicates and screening for eligibility, 14 were reviewed. Ethiopia's pooled national prevalence of adult intensive care unit mortality was 39.70% (95% CI: 33.66, 45.74). Mechanical ventilation, length of staying more than two weeks, GCS below 9, and acute respiratory distress syndrome were major predictors of mortality in intensive care units of Ethiopia.

Conclusion

Mortality in adult ICU is high in Ethiopia. We strongly recommend that all health care professionals and other stakeholders should act to decrease the high mortality among critically ill patients in Ethiopia.

Tracheobronchial Surgery in Emerging Countries

Tracheobronchial surgery is widely performed in emerging countries mainly as a consequence of the high number of airway-related complications and poor management in intensive care units. This has led to great expertise in the surgical management of postintubation tracheal stenosis, and opportunity for advancing scientific knowledge. Nonetheless, tracheal stenosis has a severe impact on a patient's quality of life, is a major burden to the health system, and should be prevented. Incorporation of innovative techniques, technologies, and prospective databases should prompt earlier diagnosis and lead to fewer complications.

PREVALÊNCIA E FATORES ASSOCIADOS À DOENÇA CRÍTICA CRÔNICA EM HOSPITALIZADOS POR TRAUMA EM TERAPIA INTENSIVA

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.

PREVALENCE AND FACTORS ASSOCIATED WITH CHRONIC CRITICAL DISEASE IN HOSPITALIZED FOR TRAUMA IN INTENSIVE CARE

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.

Which criteria is a better predictor of ICU admission in trauma patients? An artificial neural network approach

PURPOSE

One of the most critical concerns in the intensive care unit (ICU) section is identifying the best criteria for entering patients to this part. This study aimed to predict the best compatible criteria for entering trauma patients in the ICU section.

METHOD

The present study was a historical cohort study. The data were collected from 2448 trauma patients referring to Shahid Rajaee Hospital between January 2015 and January 2017 in Shiraz, Iran. The artificial neural network (ANN) models with cross-validation and logistic regression (LR) with a backward method was used for data analysis. The final analysis was performed on a total of 958 patients who were transferred to the ICU section.

RESULTS

Based on the present results, the motor component of the GCS score at each cutoff point had the highest importance. The results also showed better performance for the AUC and accuracy rate for ANN compared with LR.

CONCLUSION

The most critical indicators in predicting the optimal use of ICU services in this study were the Motor component of the GCS. Results revealed that the ANN had a better performance than the LR in predicting the main outcomes of the traumatic patients in both the accuracy and AUC index. Trauma section surgeons and ICU specialists will benefit from this study's results and can assist them in making decisions to predict the patient outcomes before entering the ICU.

Predicting factors and incidence of preventable trauma induced mortality

Introduction

Trauma is one of the most common causes of morbidity and mortality worldwide. Since the definition of preventable death has been described many studies like current one were conducted to evaluate this issue.

Methods

This cohort retrospective study investigated archived medical files of trauma victims from 2017 to 2020 in a referral single-center trauma hospital. Registered demographic data, vital signs, Glasgow coma scale (GCS), timing of trauma and death, executed interventions, type and mechanism of trauma in addition to time errors, clinical mismanagements, and missed injuries were extracted. Injury severity score, revised trauma score, and probability of survival based on TRISS method for each case were calculated. Eventually preventable and non-preventable death were defined and compared.

Results

Finally from the all 413 trauma deaths 246(54.9 %) files were enrolled. Dead persons were from 18 to 95 years. Of all 189(76.8 %) were males. Analysis manifested 135(54.9 %) of all deaths were potentially preventable and the rest 49.1 % was non-preventable for expiration(p = 0.001). Data showed that from all variables systolic blood pressure ≥80 mmHg, respiratory rate >19 per minute, GCS>8, higher RTS, road traffic accidents and control of external bleeding were contributed to prediction of preventable trauma related mortality.

Conclusion

This study implied on that frequency of trauma related preventable death was regionally high and associating factors that could influence the number of these mortalities included systolic blood pressure, respiratory rate, GCS, revised trauma score, mechanism of trauma, and external bleeding of trauma patients.

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Preventable trauma related mortality is achieved to 55 % in this study while World Health Organization considered 20 % averagely.

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Time errors, missing injuries, and clinical management errors were not generally attributed to preventable trauma death.

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SBP>80, RR>19, GCS>8, road-traffic accident, and adequate control of external bleeding could rescue patients from death.

The risk to future pregnancies of transfusing Rh(D)-negative females of childbearing potential with Rh(D)-positive red blood cells during trauma resuscitation is dependent on their age at transfusion

BACKGROUND

A risk assessment model for predicting the risk of haemolytic disease of the fetus and newborn (HDFN) in future pregnancies following the transfusion of Rh(D)-positive red blood cell (RBC)-containing products to females of childbearing potential (FCP) was developed, accounting for the age that the FCP is transfused in various countries.

METHODS

The HDFN risk prediction model included the following inputs: risk of FCP death in trauma, Rh(D) alloimmunization rate following Rh(D)-positive RBC transfusion, expected number of live births following resuscitation, probability of carrying an Rh(D)-positive fetus, the probability of HDFN in an Rh(D)-positive fetus carried by an alloimmunized mother. The model was implemented in Microsoft R Open, and one million FCPs of each age between 18 and 49 years old were simulated. Published data from eight countries, including the United States, were utilized to generate country-specific HDFN risk estimates.

RESULTS

The risk predictions showed similar characteristics for each country in that the overall risk of having a pregnancy affected by HDFN was higher if the FCP was younger when she received her Rh(D)-positive transfusion than if she was older. In the United States, the overall risk of HDFN if the FCP was transfused at age 18 was 3·4% (mild: 1·20%, moderate: 0·45%; severe: 1·15%; IUFD: 0·57%); the risk was approximately 0% if the FCP was 43 years or older at the time of transfusion.

CONCLUSION

This model can be used to predict HDFN outcomes when establishing transfusion policies as it relates to the administration of Rh(D)-positive products for massively bleeding FCPs.