1
|
Gupta J, Kshirsagar S, Naik S, Pande A. Comparative Evaluation of Mortality Predictors in Trauma Patients: A Prospective Single-center Observational Study Assessing Injury Severity Score Revised Trauma Score Trauma and Injury Severity Score and Acute Physiology and Chronic Health Evaluation II Scores. Indian J Crit Care Med 2024; 28:475-482. [PMID: 38738209 PMCID: PMC11080098 DOI: 10.5005/jp-journals-10071-24664] [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] [Received: 01/01/2024] [Accepted: 02/03/2024] [Indexed: 05/14/2024] Open
Abstract
Aim This prospective cohort study aimed to compare the predictive accuracy of outcome (survival/death) among trauma patients using various prognostic scores. Methods Over 3 months, 240 trauma patients in a tertiary care hospital were assessed for demographic details, trauma characteristics, vital signs, Glasgow coma scale, arterial blood gas values, and lab markers. Injury severity score (ISS), revised trauma score (RTS), trauma and injury severity score (TRISS), and acute physiology and chronic health evaluation II (APACHE II) were applied at admission, 24 hours, and 48 hours post-admission. Results Road traffic accidents (55.83%) were the primary cause of trauma, followed by falls (33.75%) and violence (10.41%). The all-cause mortality rate was 23.33%, with 34.16% requiring ICU admission. Head injuries (65.83%) were both the most frequent injury site and cause of mortality. Conclusion Analysis indicated that APACHE II outperformed other scores in predicting outcomes, with ISS following closely. The study concludes that trauma severity correlates with ICU admission and mortality, emphasizing APACHE II as a superior predictor, particularly for traumatic brain injuries leading to ICU admission and mortality. Clinical significance This study contributes to the existing body of knowledge by addressing the gap in comparing prognostic abilities among scoring systems for trauma patients. The unexpected superiority of APACHE II suggests its potential as a valuable tool in predicting outcomes in this specific patient population. How to cite this article Gupta J, Kshirsagar S, Naik S, Pande A. Comparative Evaluation of Mortality Predictors in Trauma Patients: A Prospective Single-center Observational Study Assessing Injury Severity Score Revised Trauma Score Trauma and Injury Severity Score and Acute Physiology and Chronic Health Evaluation II Scores. Indian J Crit Care Med 2024;28(5):475-482.
Collapse
Affiliation(s)
- Janhvi Gupta
- Department of Anaesthesiology, B. J. Govt. Medical College and Sassoon General Hospitals, Pune, Maharashtra, India
| | - Sujit Kshirsagar
- Department of Anaesthesiology, B. J. Govt. Medical College and Sassoon General Hospitals, Pune, Maharashtra, India
| | - Sanyogita Naik
- Department of Anaesthesiology, B. J. Govt. Medical College and Sassoon General Hospitals, Pune, Maharashtra, India
| | - Anandkumar Pande
- Department of Anaesthesiology, B. J. Govt. Medical College and Sassoon General Hospitals, Pune, Maharashtra, India
| |
Collapse
|
2
|
Yazıcı H, Uğurlu O, Aygül Y, Yıldırım M, Deniz Uçar A. The effect of well-known burn-related features on machine learning algorithms in burn patients' mortality prediction. ULUS TRAVMA ACIL CER 2023; 29:1130-1137. [PMID: 37791433 PMCID: PMC10644077 DOI: 10.14744/tjtes.2023.79968] [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: 05/25/2023] [Revised: 05/26/2023] [Accepted: 08/14/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND Burns is one of the most common traumas worldwide. Severely injured burn patients have an increased risk for mortality and morbidity. This study aimed to evaluate well-known risk factors for burn mortality and comparison of six machine learn-ing (ML) Algorithms' predictive performances. METHODS The medical records of patients who had burn injuries treated at Izmir Bozyaka Training and Research Hospital's Burn Treatment Center were examined retrospectively. Patients' demographics such as age and gender, total burned surface area (TBSA), Inhalation injury (II), full-thickness burns (FTBSA), and burn types (BT) were recorded and used as input features in ML models. Pa-tients were analyzed under two groups: Survivors and Non-Survivors. Six ML algorithms, including k-Nearest Neighbor, Decision Tree, Random Forest, Support Vector Machine, Multi-Layer Perceptron, and AdaBoost (AB), were used for predicting mortality. Several different input feature combinations were evaluated for each algorithm. RESULTS The number of eligible patients was 363. All six parameters (TBSA, Gender, FTBSA, II, Age, BT) that were included in ML algorithms showed a significant difference (p<0.001). The results show that AB algorithm using all input features had the best predic-tion performance with an accuracy of 90% and an area under the curve of 92%. CONCLUSION ML algorithms showed strong predictive performance in burn mortality. The development of an ML algorithm with the right input features could be useful in the clinical practice. Further investigations are needed on this topic.
Collapse
Affiliation(s)
- Hilmi Yazıcı
- Department of General Surgery, Marmara University, Pendik Training and Research Hospital, İstanbul-Türkiye
| | - Onur Uğurlu
- Faculty of Engineering and Architecture, Izmir Bakircay University, İzmir-Türkiye
| | - Yeşim Aygül
- Department of Mathematics, Ege University, İzmir-Türkiye
| | - Mehmet Yıldırım
- Department of General Surgery, University of Health Sciences, Izmir Bozyaka Training and Research Hospital, İzmir-Türkiye
| | - Ahmet Deniz Uçar
- Department of General Surgery, University of Health Sciences, Izmir Bozyaka Training and Research Hospital, İzmir-Türkiye
| |
Collapse
|
3
|
Alao DO, Cevik AA, Abu-Zidan FM. Trauma deaths of hospitalized patients in Abu Dhabi Emirate: a retrospective descriptive study. World J Emerg Surg 2023; 18:31. [PMID: 37118764 PMCID: PMC10148441 DOI: 10.1186/s13017-023-00501-y] [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: 04/04/2023] [Accepted: 04/19/2023] [Indexed: 04/30/2023] Open
Abstract
AIM To study the epidemiology and pattern of trauma-related deaths of hospitalized patients in Abu Dhabi Emirate, United Arab Emirates, in order to improve trauma management and injury prevention. METHODS The Abu Dhabi Trauma Registry prospectively collects data of all hospitalized trauma patients from seven major trauma centres in Abu Dhabi Emirate. We studied all patients who died on arrival or after admission to these hospitals from January 2014 to December 2019. RESULTS There were 453 deaths constituting 13.5% of all trauma deaths in the Abu Dhabi Emirate. The median (IQR) age of the patients was 33 (25-45) years, and 82% were males. 85% of the deaths occurred in the emergency department (ED) and the intensive care unit (ICU). Motor vehicle collision (63.8%) was the leading cause of death. 45.5% of the patients had head injury. Two of the seven hospitals admitted around 50% of all patients but accounted for only 25.8% of the total deaths (p < 0.001). Those who died in the ward (7%) were significantly older, median (IQR) age: of 65.5 (31.75-82.25) years, (p < 0.001), 34.4% of them were females (p = 0.09). The median (IQR) GCS of those who died in the ward was 15 (5.75-15) compared with 3 (3-3) for those who died in ED and ICU (P < 0.001). CONCLUSIONS Death from trauma predominantly affects young males with motor traffic collision as the leading cause. Over 85% of in-hospital deaths occur in the ICU and ED, mainly from head injuries. Injury prevention of traffic collisions through enforcement of law and improved hospital care in the ED and ICU will reduce trauma death.
Collapse
Affiliation(s)
- David O Alao
- Department of Internal Medicine, Section of Emergency Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.
- The Department of Emergency Medicine, Tawam Hospital, Al-Ain, United Arab Emirates.
| | - Arif Alper Cevik
- Department of Internal Medicine, Section of Emergency Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
- The Department of Emergency Medicine, Tawam Hospital, Al-Ain, United Arab Emirates
| | - Fikri M Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| |
Collapse
|
4
|
Hosseini M, Shayan L, Yadollahi M, Karajizadeh M. Characteristics of Traumatic Patients Referring to the Emergency Department and their Association with Mortality and Incidence of Surgery Performance. Bull Emerg Trauma 2023; 11:132-137. [PMID: 37525653 PMCID: PMC10387339 DOI: 10.30476/beat.2023.97729.1413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/22/2023] [Accepted: 05/30/2023] [Indexed: 08/02/2023] Open
Abstract
Objective To identify the distinctive features of acutely injured patients who were presented to the emergency department (ED) and their association with mortality and surgical intervention outcomes. Methods This cross-sectional study was conducted on all trauma patients resuscitated in the ED of Shahid Rajaee (Emtiaz) Trauma Hospital (Shiraz, Iran) from May 2018 to June 2019. Demographic information, the mechanism of trauma, trauma type, injured body regions, criteria of abbreviated injury scale (AIS) score, injury severity score (ISS), and surgical intervention were all taken into consideration. The items related to the mortality and surgical performance outcomes among the patients were analyzed. Results Of all 1281 cases, 82.9% were men, and the mean age of the patients was 37.9±19.1 years. The most common mechanism of injury was a car accident, and the thorax was the most prevalent injured area of the body. The majority of the patients had moderate blunt trauma. The mechanism of trauma, ISS, and the severity of head trauma were all significantly correlated with operation interventions. Moreover, age, the mechanism and type of trauma, ISS, and the necessity for the surgery were significantly associated with death occurrence. Additionally, head, thorax, and abdomen trauma were significantly related to a high mortality rate. Conclusion Age, trauma mechanism and type, ISS, and the necessity for surgery were significantly associated with the mortality rate of injured patients. The severity of the trauma, particularly head injuries and the mechanism of damage were important determinants in concern for surgery the necessity.
Collapse
Affiliation(s)
- Maryam Hosseini
- Truama Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Leila Shayan
- Truama Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahnaz Yadollahi
- Truama Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrdad Karajizadeh
- Truama Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
5
|
Yazıcı H, Uçar AD, Namdaroglu O, Yıldırım M. Mortality prediction models for severe burn patients: Which one is the best? ULUS TRAVMA ACIL CER 2022; 28:790-795. [PMID: 35652868 PMCID: PMC10443002 DOI: 10.14744/tjtes.2021.29540] [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: 01/28/2021] [Accepted: 03/13/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND For prediction of mortality and clinical course, various scoring systems had been developed. We choose four well known burn specific scoring systems and a general scoring system that using in Intensive Care Units. The primary outcome of this study was evaluate the predictive performances of this models and define the optimal one for our patient population. METHODS Variables analyzed were age, gender, burn type, total burned surface area (TBSA), total partial thickness burn area, total full thickness burn area, inhalation injuries, mechanical ventilation supports, blood products usage, total scores of Abbreviated Burn Severity Index (ABSI), revised Baux, Belgian Outcome in Burn Injury, Fatality by Longevity, Acute Physiology and Chronic Health Eval-uation II (APACHE II) score, Measured Extent of burn and Sex (FLAMES) and APACHE II, and their relations with mortality. RESULTS In our study, a statistically significant relationship was found with mortality between age, TBSA, full thickness burn percent-age, inhalation injury, burn type, and it was similar to literature. Female gender was found to be a significant risk factor for mortality. CONCLUSION We compared several burn mortality scoring systems and their predictional mortality rates. ABSI scores of patients for estimated mortality rates were similar to our mortality rate. Consequently, it was thought that ABSI was included all mortality-re-lated parameters.
Collapse
Affiliation(s)
- Hilmi Yazıcı
- Department of Burn Treatment Center, University of Health Sciences İzmir Bozyaka Training and Research Hospital, İzmir-Turkey
| | - Ahmet Deniz Uçar
- Department of Burn Treatment Center, University of Health Sciences İzmir Bozyaka Training and Research Hospital, İzmir-Turkey
| | - Ozan Namdaroglu
- Department of Burn Treatment Center, University of Health Sciences İzmir Bozyaka Training and Research Hospital, İzmir-Turkey
| | - Mehmet Yıldırım
- Department of Burn Treatment Center, University of Health Sciences İzmir Bozyaka Training and Research Hospital, İzmir-Turkey
| |
Collapse
|
6
|
Yasin YJ, Alao DO, Grivna M, Abu-Zidan FM. Impact of the COVID-19 Pandemic on road traffic collision injury patterns and severity in Al-Ain City, United Arab Emirates. World J Emerg Surg 2021; 16:57. [PMID: 34798873 PMCID: PMC8602977 DOI: 10.1186/s13017-021-00401-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/02/2021] [Indexed: 11/14/2022] Open
Abstract
Background The COVID-19 Pandemic lockdowns restricted human and traffic mobility impacting the patterns and severity of road traffic collisions (RTCs). We aimed to study the effects of the COVID-19 Pandemic on incidence, patterns, severity of the injury, and outcomes of hospitalized RTCs trauma patients in Al-Ain City, United Arab Emirates. Methods We compared the data of two cohorts of patients which were collected over two periods; the Pandemic period (28 March 2020 to 27 March 2021) and the pre-pandemic period (28 March 2019 to 27 March 2020). All RTCs trauma patients who were hospitalized in the two major trauma centers (Al-Ain and Tawam Hospitals) of Al-Ain City were studied. Results Overall, the incidence of hospitalized RTC trauma patients significantly reduced by 33.5% during the Pandemic compared with the pre-pandemic period. The mechanism of injury was significantly different between the two periods (p < 0.0001, Fisher’s Exact test). MVCs were less during the Pandemic (60.5% compared with 72%), while motorcycle injuries were more (23.3% compared with 11.2%). The mortality of hospitalized RTC patients was significantly higher during the Pandemic (4.4% compared with 2.3%, p = 0.045, Fisher’s Exact test). Logistic regression showed that the significant factors that predicted mortality were the low GCS (p < 0.0001), admission to the ICU (p < 0.0001), and the high ISS (p = 0.045). COVID-19 Pandemic had a very strong trend (p = 0.058) for increased mortality. Conclusions Our study has shown that the numbers of hospitalized RTC trauma patients reduced by 33.5% during the COVID-19 Pandemic compared with the pre-pandemic period in our setting. This was attributed to the reduced motor vehicle, pedestrian and bicycle injuries while motorcycle injuries increased. Mortality was significantly higher during the Pandemic, which was attributed to increased ISS and reduced GCS.
Collapse
Affiliation(s)
- Yasin J Yasin
- Institute of Public Health, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates.,Department of Environmental Health and Behavioral Sciences, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - David O Alao
- Department of Internal Medicine, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates.,Emergency Department, Tawam Hospital, Al-Ain, United Arab Emirates
| | - Michal Grivna
- Institute of Public Health, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates.,Department of Public Health and Preventive Medicine, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates.
| |
Collapse
|
7
|
Mortality analysis of hospitalized trauma patients in the intensive care unit. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.780138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
8
|
Factors affecting mortality in trauma patients hospitalized in the intensive care unit. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.812409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
|
9
|
Yadollahi M, Rahmanian N, Jamali K. Analysis of Risk Factors with Hospital Mortality in Pedestrian Injured Patients; A Dataset Analysis of a Level-I Trauma Center in Southern Iran. Bull Emerg Trauma 2018; 6:349-354. [PMID: 30402525 PMCID: PMC6215079 DOI: 10.29252/beat-060413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: To determine the indicators predicting the hospital mortality in pedestrian injured patients admitted to a level I trauma center in Southern Iran. Methods: This case control study was conducted in a Level-I trauma hospital in Shiraz. We selected all survived pedestrians who were admitted in the hospital with duration of admission more than 24 hours in one year from March 2016 to February 2017 as control group and compared with all non-survived pedestrian patients who expired in the hospital according to clinical from March 2012 to February 2017. Multiple logistic regression was performed to identify factors of hospital effect on pedestrian mortality and results expressed by Odds Ratios and their confidence intervals (CI) of 95%. Results: A total of 424 survived pedestrian injured patients were compare to 117 non-survived one. Their mean of survived and non-survived patients were 43.79 ± 19.37 and 56.76 ± 18.55 years respectively of which 361 (66.7%) and 180 (33.3%) were men and women, respectively. We found that the gender does not have any relation with hospital mortality (p=0.275). Followed by, age is in relevance with mortality. Glasgow Coma Scale(GCS), Injury Severity Score (ISS), blood urea nitrogen (BUN), platelet (PLT), potassium (K) and hemoglobin (Hb) are significant factor which are associated with mortality. According to logistic analysis GCS ≤8 (p<0.001), low hemoglobin level <9 (p=0.030), BUN >24 (p<0.001), thrombocytopenia <150,000 (p<0.001), and hypokalemia <3.5 (p=0.01) were independently associated with hospital mortality. Among them, GCS≤8 was 72.237 times more likely to be associated with hospital mortality (OR =72.24, CI95% =23.19- 225.05). Conclusion: The results suggest that GCS score, ISS, hemoglobin level, platelet count, BUN and potassium level might be independent factors associated with hospital mortality in pedestrian injured patients.
Collapse
Affiliation(s)
- Mahnaz Yadollahi
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Narges Rahmanian
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kazem Jamali
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
10
|
Zhou YT, Tong DM, Wang SD, Ye S, Xu BW, Yang CX. Acute spontaneous intracerebral hemorrhage and traumatic brain injury are the most common causes of critical illness in the ICU and have high early mortality. BMC Neurol 2018; 18:127. [PMID: 30149796 PMCID: PMC6112133 DOI: 10.1186/s12883-018-1127-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 08/15/2018] [Indexed: 11/19/2022] Open
Abstract
Background Critical care covers multiple disciplines. However, the causes of critical illness in the ICU, particularly the most common causes, remain unclear. We aimed to investigate the incidence and the most common causes of critical illness and the corresponding early mortality rates in ICU patients. Methods A retrospective cohort study was performed to examine critically ill patients (aged over 15 years) in the general ICU in Shuyang County in northern China (1/2014–12/2015). The incidences and causes of critical illnesses and their corresponding early mortality rates in the ICU were determined by an expert panel. Results During the 2-year study period, 1,211,138 person-years (PY) and 1645 critically ill patients (mean age, 61.8 years) were documented. The median Glasgow Coma Scale (GCS) score was 6 (range, 3–15). The mean acute physiology and chronic health evaluation II (APACHE II) score was 21.2 ± 6.8. The median length of the ICU stay was 4 days (range, 1–29 days). The most common causes of critical illness in the ICU were spontaneous intracerebral hemorrhage (SICH) (26%, 17.6/100,000 PY) and traumatic brain injury (TBI) (16.8%, 11.4/100,000 PY). During the first 7 days in the ICU, SICH was the most common cause of death (42.2%, 7.4/10,000 PY), followed by TBI (36.6%, 4.2/100,000 PY). Based on a logistic analysis, older patients had a significantly higher risk of death from TBI (risk ratio [RR], 1.7; 95% CI, 1.034–2.635), heart failure/cardiovascular crisis (RR, 0.2; 95% CI, 0.083–0.484), cerebral infarction (RR, 0.15; 95% CI, 0.050–0.486), or respiratory failure (RR, 0.35; 95% CI, 0.185–0.784) than younger patients. However, the risk of death from SICH in the two groups was similar. Conclusions The most common causes of critical illness in the ICU were SICH and TBI, and both critical illnesses showed a higher risk of death during the first 7 days in the ICU.
Collapse
Affiliation(s)
- Ye-Ting Zhou
- Department of Surgery, Affiliated Shuyang Hospital, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Dao-Ming Tong
- Department of Neurology, Affiliated Shuyang Hospital, Xuzhou Medical University, Xuzhou, Jiangsu, China.
| | - Shao-Dan Wang
- Department of Intensive Care Medicine, Affiliated Shuyang Hospital, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Song Ye
- Department of Surgery, Affiliated Shuyang Hospital, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Ben-Wen Xu
- Department of Surgery, Affiliated Shuyang Hospital, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Chen-Xi Yang
- Department of Surgery, Affiliated Shuyang Hospital, Xuzhou Medical University, Xuzhou, Jiangsu, China
| |
Collapse
|
11
|
da Costa LGV, Carmona MJC, Malbouisson LM, Rizoli S, Rocha-Filho JA, Cardoso RG, Auler-Junior JOC. Independent early predictors of mortality in polytrauma patients: a prospective, observational, longitudinal study. Clinics (Sao Paulo) 2017; 72:461-468. [PMID: 28954004 PMCID: PMC5577616 DOI: 10.6061/clinics/2017(08)02] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 03/14/2017] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES: Trauma is an important public health issue and associated with substantial socioeconomic impacts and major adverse clinical outcomes. No single study has previously investigated the predictors of mortality across all stages of care (pre-hospital, emergency room, surgical center and intensive care unit) in a general trauma population. This study was designed to identify early predictors of mortality in severely injured polytrauma patients across all stages of care to provide a better understanding of the physiologic changes and mechanisms by which to improve care in this population. METHODS: A longitudinal, prospective, observational study was conducted between 2010 and 2013 in São Paulo, Brazil. Patients submitted to high-energy trauma were included. Exclusion criteria were as follows: injury severity score <16, <18 years old or insufficient data. Clinical and laboratory data were collected at four time points: pre-hospital, emergency room, and 3 and 24 hours after hospital admission. The primary outcome assessed was mortality within 30 days. Data were analyzed using tests of association as appropriate, nonparametric analysis of variance and generalized estimating equation analysis (p<0.05). ClinicalTrials.gov: NCT01669577. RESULTS: Two hundred patients were included. Independent early predictors of mortality were as follows: arterial hemoglobin oxygen saturation (p<0.001), diastolic blood pressure (p<0.001), lactate level (p<0.001), Glasgow Coma Scale score (p<0.001), infused crystalloid volume (p<0.015) and presence of traumatic brain injury (p<0.001). CONCLUSION: Our results suggest that arterial hemoglobin oxygen saturation, diastolic blood pressure, lactate level, Glasgow Coma Scale, infused crystalloid volume and presence of traumatic brain injury are independent early mortality predictors.
Collapse
Affiliation(s)
- Luiz Guilherme V. da Costa
- Divisao de Anestesiologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Grupo de Resgate e Atendimento as Urgencias (GRAU), Secretaria de Estado da Saude, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Maria José C. Carmona
- Divisao de Anestesiologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Luiz M. Malbouisson
- Divisao de Anestesiologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Sandro Rizoli
- University of Toronto Trauma and Acute Care Service, St Michael’s Hospital, Toronto, Canada
| | - Joel Avancini Rocha-Filho
- Divisao de Anestesiologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Ricardo Galesso Cardoso
- Grupo de Resgate e Atendimento as Urgencias (GRAU), Secretaria de Estado da Saude, Sao Paulo, SP, BR
| | - José Otávio C. Auler-Junior
- Divisao de Anestesiologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| |
Collapse
|
12
|
Khajavikhan J, Vasigh A, Khani A, Jaafarpour M, Kokhazade T. Outcome and Predicting Factor Following Severe Traumatic Brain Injury: A Retrospective Cross-Sectional Study. J Clin Diagn Res 2016; 10:PC16-9. [PMID: 27042518 DOI: 10.7860/jcdr/2016/16390.7294] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 11/05/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Severe traumatic brain injury (TBI) is a major and challenging problem in critical care medicine. AIM To assess the outcome and predicting factor following severe TBI. MATERIALS AND METHODS This is a retrospective and cross-sectional study. Data were collected from two sections; one section consisting of a questionnaire answered by the patients and other section from the patient records. The instruments used included the Glasgow Outcome Scale (GOS), SF-36 and the Hospital Anxiety and Depression Scale (HAD). RESULTS The mortality rate of the patients was 46.2%. The quality of life (QOL) of the patients in most dimension were impaired and (58%) of patients had unfavourable QOL. About (37.5%) of patients with anxiety and (27.5%) had a depression. A significant correlation was found between age, GCS arrival, length of ICU stay, mechanical ventilation, VAP & ARDS and pupil reactivity with QOL, GOS, HAD-A and HAD-D (p<0.05, p< 0.001). GCS arrival a predicate factor for QOL and GOS (p <0.001, OR: 1.75, 1.94 respectively); length of ICU stay a predicate factor for QOL and GOS (p <0.05, OR : 1.11, 1.28 respectively); mechanical ventilation a predicate factor for GOS (p <0.001, OR : 1.78); ventilation associated pneumonia (VAP) & acute respiratory distress syndrome (ARDS) and pupil reactivity a predicate factor for GOS (p <0.05, OR : 1.36; p<0.001, OR: 1.94 respectively). The GCS arrival and ICU stay a predicate factor for HAD-A (p<0.05, OR: 1.73, 1.38 respectively). CONCLUSION With respect to results advanced in pre hospital, medical and surgical care for the decrease in mortality rates of Head trauma (HT), the use of trauma triage tools and strict enforcement of traffic rules are necessary.
Collapse
Affiliation(s)
- Javaher Khajavikhan
- Anaesthesiologist, Department of Anesthesiology, Medicine Faculty, Ilam University of Medical Science , Ilam, IR-Iran
| | - Aminolah Vasigh
- Anaesthesiologist, Department of Anesthesiology, Medicine Faculty, Ilam University of Medical Science , Ilam, IR-Iran
| | - Ali Khani
- MSc of Nursing, Department of Nursing, Nursing and Midwifery Faculty, Ilam University of Medical Science , Ilam, IR-Iran
| | - Molouk Jaafarpour
- MSc of Midwifery, Department of Midwifery, Nursing and Midwifery Faculty, Ilam University of Medical Science , Ilam, IR-Iran
| | - Taleb Kokhazade
- MSc of Nursing, Department of Nursing, Nursing and Midwifery Faculty, Ilam University of Medical Science , Ilam, IR-Iran
| |
Collapse
|
13
|
Karimi H, Momeni M, Motevalian A, Bahar M, Boddouhi N, Alinejad F. The burn registry program in Iran - First report. ANNALS OF BURNS AND FIRE DISASTERS 2014; 27:154-159. [PMID: 26170796 PMCID: PMC4441305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Indexed: 06/04/2023]
Abstract
Burn injury is still a major problem in Iran, resulting in many reports which are usually dispersed, uncoordinated and probably unreliable. We created a burn registry comprised of a data entry program with 222 variables for each admitted burn patient. This program was established in August 2010 at the Iran University of Medical Sciences, Motahari Burn Hospital. We had 14,277 burn patients from August 2010 to August 2011, 877 of whom were admitted to the hospital. Of the patients, 65.9% were male and 34.1% were female. The age was 28.85 years (SD = 19.77). The most prevalent cause of burn was flame 78.5% (pipe propane gas 57.2; kerosene 19.9%). The mean total body surface area (TBSA) involvement was 23%. A total of 77.8% of patients were discharged with partial recovery, while mortality was 8.9%. The mean hospital stay was 14.63 days (SD =11.07). The program is designed to help understand the scope of burn injury in Iran, providing information on patients, etiology, and course of treatment. It also highlights differences between various parts of the country in terms of the causes and frequency of burn injuries. Moreover, the burn registry provides a basis for further research and surveys for treatment and preventive programs. Our results showed that, although Emergency Medical Services (EMS) staff are highly capable and well-trained, their coverage seems to be less than 50% and needs to be increased. Marriage status was shown to have no influence on the occurrence of burns, and among our patients, 57.0 % were poorly educated.
Collapse
Affiliation(s)
- H. Karimi
- Faculty of Medicine, Burn Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - M. Momeni
- Faculty of Medicine, Burn Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - A. Motevalian
- Faculty of Health, Burn Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - M.A. Bahar
- Faculty of Medicine, Burn Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - N. Boddouhi
- Faculty of Medicine, Burn Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - F. Alinejad
- Department of Infectious Diseases, Burn Research Center, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
14
|
Tumwine JK. Non-communicable diseases are reaching epidemic proportions: evidence from low and middle income countries. Afr Health Sci 2013; 13:i-iv. [PMID: 24250333 DOI: 10.4314/ahs.v13i3.94044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- James K Tumwine
- African Health Sciences, Makerere University, College of Health Sciences
| |
Collapse
|