Risk Factors Associated with Mortality in Severe Chest Trauma Patients Admitted to the ICU

Prolonged time to recovery and its predictors among trauma patients admitted to the intensive care units in comprehensive specialized hospitals in Northwest Ethiopia: a multicenter retrospective follow-up study, 2022

Introduction

A prolonged time to recovery in the intensive care units has adverse effects on both the patients and the healthcare providers. However, there is limited evidence in African countries, including Ethiopia. Therefore, this study aimed to assess the time to recovery and its predictors among trauma patients admitted to intensive care units.

Methods

An institutional-based retrospective follow-up study was conducted on trauma patients hospitalized in intensive care units between 9 January 2019 and 8 January 2022. The charts of 450 patients were chosen using a simple random sampling technique. Data collection was conducted using smartphones and tablets. The data were then exported into STATA version 16 for analysis. The log-rank test and the Kaplan-Meier survival curve were fitted for analysis. An adjusted hazard ratio with 95% confidence intervals was reported to declare the strength of association between time to recovery and predictors in the multivariable Weibull regression analysis.

Results

The overall incidence density rate of recovery was 6.53 per 100 person-day observations, with a median time to recovery of 10 days. Significant predictors of time to recovery included being on mechanical ventilation (AHR = 0.47, 95% CI: 0.34, 0.64), having a Glasgow Coma Scale (GCS) score between 9-12 and 13-15 (AHR = 1.58, 95% CI: 1.01, 2.47, and AHR = 1.66, 95% CI: 1.09, 2.53, respectively), experiencing polytrauma (AHR = 0.55, 95% CI: 0.39, 0.78), and having complications (AHR = 0.43, 95% CI: 0.31, 0.59).

Conclusion and recommendations

The incidence rate of recovery for trauma patients is lower than the national standard, and the median time to recovery is longer. Being on mechanical ventilation, mild and moderate GCS scores, polytrauma, and the presence of complications were significantly associated with prolonged time to recovery. Therefore, special attention has to be given to trauma patients who had polytrauma, complications, received mechanical ventilation, and had a lower GCS score.

Mortality of traumatic chest injury and its predictors across sub-saharan Africa: systematic review and meta-analysis, 2024

INTRODUCTION

Globally, chest trauma remain as a prominent contributor to both morbidity and mortality. Notably, patients experiencing blunt chest trauma exhibit a higher mortality rate (11.65%) compared to those with penetrating chest trauma (5.63%).

AIM

This systematic review and meta-analysis aimed to assess the mortality rate and its determinants in cases of traumatic chest injuries.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist guided the data synthesis process. Multiple advanced search methods, encompassing databases such as PubMed, Africa Index Medicus, Scopus, Embase, Science Direct, HINARI, and Google Scholar, were employed. The elimination of duplicate studies occurred using EndNote version X9. Quality assessment utilized the Newcastle-Ottawa Scale, and data extraction adhered to the Joanna Briggs Institute (JBI) format. Evaluation of publication bias was conducted via Egger's regression test and funnel plot, with additional sensitivity analysis. All studies included in this meta-analysis were observational, ultimately addressing the query, what is the pooled mortality rate of traumatic chest injury and its predictors in sub-Saharan Africa?

RESULTS

Among the 845 identified original articles, 21 published original studies were included in the pooled mortality analysis for patients with chest trauma. The determined mortality rate was nine (95% CI: 6.35-11.65). Predictors contributing to mortality included age over 50 (AOR 3.5; 95% CI: 1.19-10.35), a time interval of 2-6 h between injury and admission (AOR 3.9; 95% CI: 2.04-7.51), injuries associated with the head and neck (AOR 6.28; 95% CI: 3.00-13.15), spinal injuries (AOR 7.86; 95% CI: 3.02-19.51), comorbidities (AOR 5.24; 95% CI: 2.93-9.40), any associated injuries (AOR 7.9; 95% CI: 3.12-18.45), cardiac injuries (AOR 5.02; 95% CI: 2.62-9.68), the need for ICU care (AOR 13.7; 95% CI: 9.59-19.66), and an Injury Severity Score (AOR 3.5; 95% CI: 10.6-11.60).

CONCLUSION

The aggregated mortality rate for traumatic chest injuries tends to be higher in sub-Saharan Africa. Factors such as age over 50 years, delayed admission (2-6 h), injuries associated with the head, neck, or spine, comorbidities, associated injuries, cardiac injuries, ICU admission, and increased Injury Severity Score were identified as positive predictors. Targeted intervention areas encompass the health sector, infrastructure, municipality, transportation zones, and the broader community.

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.

Risk factors that predict mortality in patients with blunt chest wall trauma: an updated systematic review and meta-analysis

BACKGROUND

Over the last 10 years, research has highlighted emerging potential risk factors for poor outcomes following blunt chest wall trauma. The aim was to update a previous systematic review and meta-analysis of the risk factors for mortality in blunt chest wall trauma patients.

METHODS

A systematic review of English and non-English articles using MEDLINE, Embase and Cochrane Library from January 2010 to March 2022 was completed. Broad search terms and inclusion criteria were used. All observational studies were included if they investigated estimates of association between a risk factor and mortality for blunt chest wall trauma patients. Where sufficient data were available, ORs with 95% CIs were calculated using a Mantel-Haenszel method. Heterogeneity was assessed using the I² statistic.

RESULTS

73 studies were identified which were of variable quality (including 29 from original review). Identified risk factors for mortality following blunt chest wall trauma were: age 65 years or more (OR: 2.11; 95% CI 1.85 to 2.41), three or more rib fractures (OR: 1.96; 95% CI 1.69 to 2.26) and presence of pre-existing disease (OR: 2.86; 95% CI 1.34 to 6.09). Other new risk factors identified were: increasing Injury Severity Score, need for mechanical ventilation, extremes of body mass index and smoking status. Meta-analysis was not possible for these variables due to insufficient studies and high levels of heterogeneity.

CONCLUSIONS

The results of this updated review suggest that despite a change in demographics of trauma patients and subsequent emerging evidence over the last 10 years, the main risk factors for mortality in patients sustaining blunt chest wall trauma remained largely unchanged. A number of new risk factors however have been reported that need consideration when updating current risk prediction models used in the ED.

PROSPERO REGISTRATION NUMBER

CRD42021242063. Date registered: 29 March 2021. https://www.crd.york.ac.uk/PROSPERO/%23recordDetails.