scholarly journals Early and Rapid Diagnosis with Multislice CT Reduces Lethality in Trauma Patients Requiring Intensive Care: Findings of a Prospective Study

2013 ◽  
Vol 2013 ◽  
pp. 1-8
Author(s):  
Peter Hilbert ◽  
Karsten zur Nieden ◽  
Ingmar Kaden ◽  
Gunther O. Hofmann ◽  
Ralph Stuttmann
Keyword(s):  
Intensive Care ◽  
Injury Severity ◽  
Multislice Ct ◽  
Reference Population ◽  
Diagnostic Methods ◽  
Trauma Patients ◽  
Trauma Room ◽  
Diagnostic Approaches ◽  
Group 2 ◽  
A Prospective Study

Objective. The objective of this study was to investigate if short diagnostic times by MSCT have an influence on lethal outcomes. Methods. In three different patient populations, hospital mortality was examined. Group 1: retrospective data derived from conventional diagnostic methods in the trauma room between 2002 and 2003; group 2: data from the same centre taken prospectively between 2004 and 2010 after modification of the trauma room algorithm; group 3: a reference population from the TraumaRegister DGU (TR-DGU) from 2004 to 2010. Injury severity was determined using the ISS and lethality was predicted on the basis of the RISC. Results. At the singular centre, data from 943 polytraumatised patients requiring intensive care between 2002 and 2010 were examined. With the new trauma room algorithm, lethality was likewise significantly lower (9.1% versus 15%; P<0.05) compared to the population from 2002 to 2003, with a comparable ISS (28.5 versus 30.2). The ISS (28.5) was comparable with the TR-DGU (24.9) population and lethality was significantly lower. Conclusion. Early diagnostic approaches using MSCT during the first minutes of trauma room treatment, as an integral part of a stringently timed, highly structured concept, have been found to reduce lethality as compared to the TR-DGU and our own retrospective historical data. This trial is registered with DRKS00005055; TR-DGU-Projekt-ID: 2009-005.

Is There a Benefit to Multidisciplinary Rounds in an Open Trauma Intensive Care Unit regarding Ventilator-Associated Pneumonia?

2009 ◽  
Vol 75 (12) ◽  
pp. 1171-1174 ◽  
Author(s):  
Johnson Van ◽  
Alicia Mangram ◽  
Christopher Mitchell ◽  
Manuel Lorenzo ◽  
Dot Howard ◽  
...  
Keyword(s):  
Intensive Care ◽  
Injury Severity ◽  
Case Manager ◽  
Trauma Patients ◽  
Ventilator Associated Pneumonia ◽  
Surgical Resident ◽  
Nurse Case Manager ◽  
Multidisciplinary Rounds ◽  
Group 2 ◽  
Group 1

Multidisciplinary rounds (MDRs) have been instituted for patient care since June 2005. Before June 2005, all care was provided by individual practitioners. MDRs include the surgical intensivist, surgical resident, patient's nurse, case manager, pharmacist, chaplain, nutritionist, and respiratory therapist. Our study examined the effect of MDRs on ventilator-associated pneumonia in trauma patients in open intensive care units (ICUs). Group 1 included patients from June 2003 to May 2005 before the implementation of MDRs, and Group 2 included patients after the institution of MDRs from June 2005 to May 2007. In Group 1, there were 83 ventilator-associated pneumonias (VAPs) during 2414 ventilator days. In Group 2, there were 49 VAPs during 2094 ventilator days. The ratio of VAPs per thousand ventilator days decreased from 34.4 to 23.4 between the two groups ( P = 0.04). When comparing trauma patients in our open ICU with similar mean Injury Severity Score and mean Abbreviated Injury Score for chest and for head and neck, implementing MDRs significantly decreased our incidence of VAP.

scholarly journals 186 Acute Kidney Injury in Skeletal Trauma Admissions to Intensive Care: An Under-Estimated Complication

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
O Brown ◽  
T Crisp ◽  
M Flatman ◽  
C Hing
Keyword(s):  
Acute Kidney Injury ◽  
Intensive Care ◽  
Injury Severity ◽  
Penetrating Trauma ◽  
Kidney Injury ◽  
Long Bone ◽  
Trauma Patients ◽  
Skeletal Trauma ◽  
Body Regions ◽  
Intensive Care Stay

Abstract Introduction Acute kidney injury (AKI) is associated with prolonged admission and 3.5 times increased mortality for trauma patients requiring intensive care (ICU) treatment. Blunt trauma confers greater risk of AKI than penetrating trauma, potentially related to long bone fracture. The relationship between skeletal trauma and AKI in ICU has not previously been investigated. Method Retrospective data was analysed from 202 consecutive adult patients admitted to ICU with skeletal trauma from 01/06/2018 to 01/06/2019. AKI was defined by creatinine rise &gt;1.5 times baseline. Results AKI was found in 70/202 (34.65%) patients aged 16-99 years, 138 males and 64 females. Mean limb Abbreviated Injury Scale (AIS) was significantly higher in AKI (AIS= 2.57 (SD 0.53) versus non-AKI AIS=2.38 (SD 0.61), p = 0.027). Other body regions and total Injury Severity Score (ISS) were non-significant. AKI was associated with a significantly worse Glasgow Outcome Score (AKI 3.28 (SD 1.52) versus 4.02 (SD 1.08) p &lt; 0.001), increased intensive care stay (AKI 7.03 (SD 8.30) days versus non-AKI 3.8 (SD 4.1) days p &lt; 0.001) and increased 30-day mortality (AKI 18/70 (25.71%) versus non-AKI 10/132 (7.58%) p &lt; 0.001) Conclusions Skeletal trauma patients have a high incidence of AKI, which was significantly correlated with severity of skeletal limb trauma but not overall ISS.

Trauma Intensive Care Unit ‘Bouncebacks': Identifying Risk Factors for Unexpected Return Admission to the Intensive Care Unit

2014 ◽  
Vol 80 (8) ◽  
pp. 778-782 ◽  
Author(s):  
A. Britton Christmas ◽  
Elizabeth Freeman ◽  
Angela Chisolm ◽  
Peter E. Fischer ◽  
Gaurav Sachdev ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Brain Injuries ◽  
Injury Severity ◽  
Hospital Costs ◽  
Retrospective Chart Review ◽  
Trauma Patients ◽  
Respiratory Compromise ◽  
Patient Demographics ◽  
Hygiene Practices

Return transfer (RT) to the intensive care unit (ICU) negatively impacts patient outcomes, length of stay (LOS), and hospital costs. This study assesses the most common events necessitating RT in trauma patients. We performed a retrospective chart review of ICU RT from 2004 to 2008. Patient demographics, injuries and injury severity, reason for transfer, LOS, interventions, and outcomes data were collected. Overall, 158 patients required readmission to the ICU. Respiratory insufficiency/ failure (48%) was the most common reason for RT followed by cardiac (16%) and neurological (13%) events. The most commonly associated injuries were traumatic brain injuries (TBIs) (32%), rib fractures (30%), and pulmonary contusions (20%). Initial ICU LOS was 6.6 ± 8 days (range, 1 to 44 days) with 4.4 ± 7.8 ventilator days. Mean floor time before ICU RT was 5.7 ± 6.3 days (range, 0 to 33 days). Forty-nine patients (31%) required intubation and mechanical ventilation on RT. ICU RT incurred an additional ICU LOS of 8 ± 8.5 days (range, 1 to 40 days) and 5.2 ± 7.5 ventilator days. Mortality after a single RT was 10 per cent (n = 16). RT to the ICU most often occurs as a result of respiratory compromise, and patients with TBI are particularly vulnerable. Trauma pulmonary hygiene practices should be evaluated to determine strategies that could decrease RT.

Fever and Leukocytosis in Critically Ill Trauma Patients: It is Not the Blood

2009 ◽  
Vol 75 (5) ◽  
pp. 405-410 ◽  
Author(s):  
Jeffrey A. Claridge ◽  
Joseph F. Golob ◽  
Adam M. A. Fadlalla ◽  
Mark A. Malangoni ◽  
Jeffrey Blatnik ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Injury Severity ◽  
Leukocyte Count ◽  
Cohort Analysis ◽  
Clinical Signs ◽  
Blood Cultures ◽  
Daily Temperature ◽  
Trauma Patients

The diagnosis of bacteremia in critically ill patients is classically based on fever and/or leukocytosis. The objectives of this study were to determine 1) if our intensive care unit obtains blood cultures based on fever and/or leukocytosis over the initial 14 days of hospitalization after trauma; and 2) the efficacy of this diagnostic workup. An 18-month retrospective cohort analysis was performed on consecutively admitted trauma patients. Data collected included demographics, injuries, and the first 14 days maximal daily temperature, leukocyte count, and results of blood and catheter tip cultures. Fever was defined as a maximum daily temperature of 38.5°C or greater and leukocytosis as a leukocyte count 12,000/mm3 or greater of blood. Five hundred ten patients were evaluated for a total of 3,839 patient-days. The mean age and injury severity score were 49 ± 1 years and 19 ± 1, respectively. Four hundred twenty-five blood culture episodes were obtained and 25 (6%) bacteremias were identified in 23 patients (5%). A significant association was found between obtaining blood cultures in patients with fever (relative risk [RR], 7.7), leukocytosis (RR, 1.3), and fever + leukocytosis (RR, 3.2). However, no significant association was found between these clinical signs and the diagnosis of bacteremia. In fact, fever alone was inversely associated with bacteremia. Our intensive care unit follows the common “fever workup” practice and obtains blood cultures based on the presence of fever and leukocytosis. However, fever and leukocytosis were not associated with bacteremia, suggesting inefficiency and that other factors are more important after trauma.

Reduction in Inadequate Empiric Antibiotic Therapy for Ventilator-Associated Pneumonia: Impact of a Unit-Specific Treatment Pathway

2008 ◽  
Vol 74 (6) ◽  
pp. 516-523 ◽  
Author(s):  
Louis J. Magnotti ◽  
Thomas J. Schroeppel ◽  
Timothy C. Fabian ◽  
L. Paige Clement ◽  
Joseph M. Swanson ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Antibiotic Therapy ◽  
Injury Severity ◽  
Specific Treatment ◽  
Empiric Antibiotic Therapy ◽  
Trauma Patients ◽  
Ventilator Associated Pneumonia ◽  
Empiric Antibiotic ◽  
Specific Pathway

Empiric antibiotic therapy is routinely initiated for patients with presumed ventilator-associated pneumonia (VAP). Reported mortality rates for inadequate empiric antibiotic therapy (IEAT) for VAP range from 45 to 91 per cent. The purpose of this study was to determine the effect of a unit-specific pathway for the empiric management of VAP on reducing IEAT episodes and improving outcomes in trauma patients. Patients admitted with VAP over 36-months were identified and stratified by gender, age, severity of shock, and injury severity. Outcomes included number of IEAT episodes, ventilator days, intensive care unit days, hospital days, and mortality. Three hundred and ninety-three patients with 668 VAP episodes were identified. There were 144 (22%) IEAT episodes: significantly reduced compared with our previous study (39%) ( P < 0.001). Patients were classified by number of IEAT episodes: 0 (n = 271), 1 (n = 98) and ≥ 2 (n = 24). Mortality was 12 per cent, 13 per cent, and 38 per cent ( P < 0.001), respectively. Multivariable logistic regression identified multiple IEAT episodes as an independent predictor of mortality (odds ratio = 4.7; 95% confidence interval: 1.684–13.162). Multiple IEAT episodes were also associated with prolonged mechanical ventilation and intensive care unit stay ( P < 0.001). Trauma patients with multiple IEAT episodes for VAP have increased morbidity and mortality. Adherence to a unit-specific pathway for the empiric management of VAP reduces multiple IEAT episodes. By limiting IEAT episodes, resource utilization and hospital mortality are significantly decreased.

A Central Venous Line Protocol Decreases Bloodstream Infections and Length of Stay in a Trauma Intensive Care Unit Population

2009 ◽  
Vol 75 (12) ◽  
pp. 1166-1170 ◽  
Author(s):  
TherÈSe M. Duane ◽  
Holly Brown ◽  
C. Todd Borchers ◽  
Luke G. Wolfe ◽  
Ajai K. Malhotra ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Bloodstream Infections ◽  
Central Venous Line ◽  
Trauma Patients ◽  
Central Venous ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

We evaluated the benefit of a central venous line (CVL) protocol on bloodstream infections (BSIs) and outcome in a trauma intensive care unit (ICU) population. We prospectively compared three groups: Group 1 (January 2003 to June 2004) preprotocol; Group 2 (July 2004 to June 2005) after the start of the protocol that included minimizing CVL use and strict universal precautions; and Group 3 (July 2005 to December 2006) after the addition of a line supply cart and nursing checklist. There were 1622 trauma patients admitted to the trauma ICU during the study period of whom 542 had a CVL. Group 3 had a higher Injury Severity Score (ISS) compared with both Groups 2 and 1 (28.3 ± 13.0 vs 23.5 ± 11.7 vs 22.8 ± 12.0, P = 0.0002) but had a lower BSI rate/1000 line days (Group 1:16.5; Group 2:15.0; Group 3: 7.7). Adjusting for ISS group, three had shorter ICU length of stay (LOS) compared with Group 1 (12.11 ± 1.46 vs 18.16 ± 1.51, P = 0.01). Logistic regression showed ISS ( P = 0.04; OR, 1.025; CI, 1.001-1.050) and a lack of CVL protocol ( P = 0.01; OR, 0.31; CI, 0.13-0.76) to be independent predictors of BSI. CVL protocols decrease both BSI and LOS in trauma patients. Strict enforcement by a nurse preserves the integrity of the protocol.

Ten Years of Mechanical Complications of Central Venous Catheterization in Trauma Patients

2012 ◽  
Vol 78 (5) ◽  
pp. 545-549 ◽  
Author(s):  
Crystal Ives ◽  
Donald Moe ◽  
Kenji Inaba ◽  
Bernardino Castelo Branco ◽  
Lydia Lam ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Injury Severity ◽  
Central Venous Catheterization ◽  
Unit Length ◽  
P Value ◽  
Trauma Patients ◽  
Central Venous ◽  
Mechanical Complications ◽  
Venous Catheterization

The study purpose was to determine the incidence of mechanical complications (MC) associated with central venous catheterization (CVC) and to evaluate their impact on outcomes. This was a retrospective review of trauma morbidity and mortality records at a Level I trauma center (1999 to 2009). Demographics and outcomes were extracted for all trauma patients with CVC. Patients developing MC were compared with those who did not. Four thousand eight hundred eighteen lines were placed in 2935 patients. Of these, 1.5 per cent (n = 73) had MC. A total of 64.4 per cent (n = 47) were pneumothoraces followed by arterial cannulation at 8.2 per cent (n = 6) and thrombosis at 6.8 per cent (n = 5). The rate of MC by access site was: subclavian 1.8 per cent (n = 52), internal jugular 1.2 per cent (n = 10), and femoral 0.3 per cent (n = 3) (P value for trend = 0.001). Change in management was required in 31.5 per cent (n = 23). Number of lines ( P < 0.001), Injury Severity Score ( P < 0.001), body mass index less than 20 kg/m2 ( P = 0.036), and chest Abbreviated Injury Score greater than3 ( P = 0.034) were significant predictors of MC. Patients with MC had a longer intensive care unit length of stay (18.8 ± 25.7 vs 11.4 ± 13.3; adjusted odds ratio, 5.75; 95% confidence interval, 2.24–9.25; P = 0.001). Incidence of MC was 1.5 per cent. Complications were clinically significant in 31.5 per cent and resulted in longer intensive care unit stays.

scholarly journals Lack of Prioritization Causes Extended Time to Assessment of Severely Injured Trauma Patients in a Resource-Scarce Emergency Department

2019 ◽  
Vol 34 (s1) ◽  
pp. s144-s145
Author(s):  
Maria Lampi ◽  
John Tabu ◽  
Johan Junker ◽  
Andreas Wladis
Keyword(s):  
Emergency Department ◽  
Injury Severity ◽  
Prehospital Care ◽  
Medical Intervention ◽  
Trauma Patients ◽  
Triage System ◽  
Post Test ◽  
Care Systems ◽  
Sub Saharan ◽  
A Prospective Study

Introduction:The time between injury and medical intervention is crucial in trauma care. Triage is essential to ensure prioritization and timely assessment of injured patients.Aim:To investigate how the lack of triage system impacts timely intervention in a sub-Saharan hospital emergency department, and to investigate potential benefits of triage towards efficient management of trauma patients.Methods:A prospective study including adult trauma patients admitted to the emergency department at Moi Teaching and Referral Hospital in Eldoret, Kenya, was conducted. Mode of arrival, vital parameters, time before physician’s assessment, and mortality were registered. Retrospectively, Injury Severity Score (ISS) was calculated, and patients were categorized according to the Rapid Emergency Triage and Treatment System (RETTS).Results:A total of 571 patients were analyzed, revealing a mean ISS of 12.2 (SD 7.7) and a mean length of stay of 11.6 (SD 18.3) days. 70% of the patients arrived by taxi, private car, or police car; only 17.6% were transported by ambulance. RETTS categorization was compared with ISS using a Kruskal-Wallis test with Dunn’s multiple comparisons post-test. A higher average ISS was found in the red category compared to other categories (H(df) = 24.47(4), p < 0.001). A Spearman correlation test between ISS and time to assessment revealed an r value of −0.041 (p = 0.43).Discussion:The results clearly illustrate a lack of correct prioritization of patients in relation to the need for timely assessment. Since there was no difference in time to assessment regardless of ISS, the need for a triage system is apparent. Currently, the implementation and evaluation of a validated triage tool at the emergency department are underway. Moreover, the finding that less than 18% of trauma patients are transported to the emergency department by ambulance illustrates the need to develop prehospital care systems.

Identification of Sarcopenia in Elderly Trauma Patients: The Value of Clinical Competency and Experience

2021 ◽  
pp. 000313482098285
Author(s):  
Daisy M. Proksch ◽  
Katherine M. Kelley ◽  
Sasha White ◽  
Jessica R. Burgess
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Functional Status ◽  
Injury Severity ◽  
Psoas Muscle ◽  
Control Group ◽  
Trauma Patients ◽  
Medical Providers ◽  
Phone Calls ◽  
Elderly Trauma Patients

Introduction There is currently no standard definition of sarcopenia, which has often been associated with frailty. A commonly cited surrogate measure of sarcopenia is psoas muscle size. The purpose of this prospective study is to assess medical providers’ capabilities to identify frail elderly trauma patients and consequent impact on outcomes after intensive care unit admission. Methods Trauma intensive care unit patients over the age of 50 were enrolled. A preadmission functional status questionnaire was completed on admission. Attendings, residents, and nurses, blinded to their patient’s sarcopenic status, completed surveys regarding 6-month prognosis. Chart review included cross-sectional psoas area measurements on computerized tomography scan. Finally, patients received phone calls 3 and 6 months after admission to determine overall health and functional status. Results Seventy-six participants had an average age of 70 years and a corrected psoas area of 383 ± 101 mm2/m2. Injury Severity Score distribution (17.2 ± 8.9) was similar for both groups. Patients also had similar preinjury activities of daily living. Both groups had similar hospital courses. While sarcopenic patients were less likely to be predicted to survive to 6 months (60% vs. 76%, P = 0.017), their actual 6-month mortality was similar (22% vs. 21%, P = 0.915). Conclusion Despite similar objective measures of preadmission health and trauma injury severity, medical providers were able to recognize frail patients and predicted they would have worse outcomes. Interestingly, sarcopenic patients had similar outcomes to the control group. Additional studies are needed to further delineate factors influencing provider insight into functional reserves of elderly trauma patients.

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