Distribution of Laboratory Parameters in Trauma Population

Massive Trauma and Resuscitation Strategies

Massive trauma remains the leading cause of mortality among people aged younger than 45 years. In this review, we discuss the initial care and diagnosis of trauma patients followed by a comparison of resuscitation strategies. We discuss various strategies including use of whole blood and component therapy, examine viscoelastic techniques for management of coagulopathy, and consider the benefits and limitations of the resuscitation strategies and consider a series of questions that will be important for researchers to answer to provide the best and most cost-effective therapy for severely injured patients.

Association of Serum Biomarkers with the Mortality of Trauma Victims in a Level -1 Trauma Care Centre of Eastern India

OBJECTIVE

To determine correlation of important biochemical laboratory investigations in different trauma patients and their degree of injury severity and overall mortality association.

METHODS

In this hospital based retrospective observational study, 238 trauma patients were divided into two groups. Group I with injury severity score (ISS)<16 and group II with ISS>16. Haemoglobin (Hb), international normalized ratio, serum creatinine, blood urea nitogen (BUN), serum electrolyte, serum uric acid and liver function parameters were recorded and statistically analyzed.

RESULTS

Group II had statistically significant (p<0.0001) elevated levels for referral pulse rate, creatinine, BUN, liver enzymes and decreased level in Hb% and potassium level compared to Group I. Strong positive correlation only exists between BUN and severity score, moderate positive correlation exists between creatinine, aspartate transaminase, and alanine transaminase, alkaline phosphatase and severity score and negative correlation between potassium and severity score. In this study, higher odds of high BUN and creatinine and lower potassium to normal values are associated with bad outcome such as higher mortality in the population of high ISS (>16).

CONCLUSION

The study establishes the absolute need of doing three laboratory parameters (serum creatinine, serum blood urea nitrogen and serum potassium) instead of doing laboratory tests battery at the time of trauma victims admission and predicting survival among injured patients in trauma population from Indian settings.

A retrospective register study comparing fibrinogen treated trauma patients with an injury severity score matched control group

BACKGROUND

Fibrinogen concentrate (FC) is frequently used to treat bleeding trauma patients, although the clinical effects are not well known. In this study we describe demographic and clinical outcome data in a cohort of trauma patients receiving FC, compared to a matched control group, who did not receive FC.

METHODS

This retrospective, single-center, observational study included adult trauma patients admitted to a level 1-trauma center in Sweden between January 2013 and June 2015. The study population consisted of patients to whom FC was administrated within 24 h (n = 138, "Fib+"). Patients with Injury Severity Score (ISS) > 49 and/or deceased within 1 h from arrival were excluded (n = 30). Controls (n = 108) were matched for age, gender and ISS ("Fib-"). Primary outcome was mortality (24 h-/30 days-/1 year-), and secondary outcomes were blood transfusions, thromboembolic events and organ failure.

RESULTS

The Fib+ group, despite having similar ISS as Fib-, had higher prevalence of penetrating trauma and lower Glasgow Coma Scale (GCS), indicating more severe injuries. Patients receiving FC had a higher mortality after 24 h/ 30 days/ 1 year compared to controls (Fib-). However, in a propensity score matched model, the differences in mortality between Fib+ and Fib- were no longer significant. Blood transfusions were more common in the Fib+ group, but no difference was observed in thromboembolic events or organ failure. In both groups, low as well as high P-fibrinogen levels at arrival were associated with increased mortality, with the lowest mortality observed at P-fibrinogen values of 2-3 g/l.

CONCLUSIONS

Despite equal ISS, patients receiving FC had a higher mortality compared to the control group, presumably associated to the fact that these patients were bleeding and physiologically deranged on arrival. When applying a propensity score matching approach, the difference in mortality between the groups was no longer significant. No differences were observed between the groups regarding thromboembolic events or organ failure, despite higher transfusion volumes in patients receiving FC.

Public health crisis of road traffic accidents in India: Risk factor assessment and recommendations on prevention on the behalf of the Academy of Family Physicians of India

Roads are considered a sign of development bringing colossal benefits to community as socioeconomic and logistic facilitator. Yet, growth of road network has brought road crashes leading to civic pain from premature deaths of productive age group. In 2017, 16 citizens were killed and 53 injured every hour on Indian roads as per officially reported data, while a fair number go unreported. This is unacceptably high when compared with international standards. Risk correlates of road traffic injuries (RTIs) need to be redefined so as to form a continuum with other confounding factors that impact to take lives on road. Risk factors impacting RTIs vary from human components to the roles and responsibilities of healthcare stakeholders. We should have made roads safer for all citizens because a large percentage of population – children, pedestrians, cyclists, motorcyclists, and the elderly – are most vulnerable. A taskforce was set up by the Academy of Family Physicians of India to scientifically analyze the literature available to assess risks and put forward appropriate recommendations.