scholarly journals Complications of Trauma Patients Admitted to the ICU in Level I Academic Trauma Centers in the United States

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Stefania Mondello ◽  
Amy Cantrell ◽  
Domenico Italiano ◽  
Vincenzo Fodale ◽  
Patrizia Mondello ◽  
...  
Keyword(s):  
The United States ◽  
Population Based ◽  
Trauma Patients ◽  
Cns Injury ◽  
Modifiable Factors ◽  
Potential Risk Factors ◽  
Male Patients ◽  
Level I ◽  
Complications And Mortality ◽  
The Relationship

Background. The aims of this study were to evaluate the complications that occur after trauma and the characteristics of individuals who develop complications, to identify potential risk factors that increase their incidence, and finally to investigate the relationship between complications and mortality.Methods. We did a population-based retrospective study of trauma patients admitted to ICUs of a level I trauma center. Logistic regression analyses were performed to determine independent predictors for complications.Results. Of the 11,064 patients studied, 3,451 trauma patients developed complications (31.2%). Complications occurred significantly more in younger male patients. Length of stay was correlated with the number of complications(R=0.435,P<0.0001). The overall death rate did not differ between patients with or without complications. The adjusted odds ratio (OR) of developing complication for patients over age 75 versus young adults was 0.7(P<0.0001). Among males, traumatic central nervous system (CNS) injury was an important predictor for complications (adjusted OR 1.24).Conclusions. Complications after trauma were found to be associated with age, gender, and traumatic CNS injury. Although these are not modifiable factors, they may identify subjects at high risk for the development of complications, allowing for preemptive strategies for prevention.

Racial and Sex Disparities in Trauma Outcomes Based on Geographical Region

2020 ◽  
pp. 000313482096006
Author(s):  
William Q. Duong ◽  
Areg Grigorian ◽  
Cyrus Farzaneh ◽  
Jeffry Nahmias ◽  
Theresa Chin ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
Trauma Patients ◽  
Improvement Program ◽  
Trauma Outcomes ◽  
Risk Of Death ◽  
Hospital Access ◽  
Risk Of Mortality ◽  
Sex Disparities ◽  
Male Patients

Objectives Disparities in outcomes among trauma patients have been shown to be associated with race and sex. The purpose of this study was to analyze racial and sex mortality disparities in different regions of the United States, hypothesizing that the risk of mortality among black and Asian trauma patients, compared to white trauma patients, will be similar within all regions in the United States. Methods The Trauma Quality Improvement Program (2010-2016) was queried for adult trauma patients, separating by U.S. Census regions. Multivariable logistic regression analyses were performed for each region, controlling for known predictors of morbidity and mortality in trauma. Results Most trauma patients were treated in the South (n = 522 388, 40.7%). After risk adjustment, black trauma patients had a higher associated risk of death in all regions, except the Northeast, compared to white trauma patients. The highest associated risk of death for blacks (vs. whites) was in the Midwest (odds ratio [OR] 1.30, P < .001). Asian trauma patients only had a higher associated risk of death in the West (OR 1.39, P < .001). Male trauma patients, compared to women, had an increased associated risk of mortality in all four regions. Discussion This study found major differences in outcomes among different races within different regions of the United States. There was also both an increased rate and associated risk of mortality for male patients in all regions. Future prospective studies are needed to identify what regional differences in trauma systems including population density, transport times, hospital access, and other trauma resources explain these findings.

Does Gender Matter: A Multi-Institutional Analysis of Viscoelastic Profiles for 1565 Trauma Patients With Severe Hemorrhage

2021 ◽  
pp. 000313482110335
Author(s):  
Alison Smith ◽  
Juan Duchesne ◽  
Matthew Marturano ◽  
Shaun Lawicki ◽  
Kevin Sexton ◽  
...  
Keyword(s):  
Alpha Angle ◽  
Reaction Times ◽  
Maximum Amplitude ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Survival Difference ◽  
Severe Hemorrhage ◽  
Male Patients ◽  
Level I ◽  
Clot Formation Time

Background Viscoelastic tests including thromboelastography (TEG) and rotational thromboelastometry (ROTEM) are being used in patients with severe hemorrhage at trauma centers to guide resuscitation. Several recent studies demonstrated hypercoagulability in female trauma patients that was associated with a survival advantage. The objective of our study was to elucidate the effects of gender differences in TEG/ROTEM values on survival in trauma patients with severe hemorrhage. Methods A retrospective review of consecutive adult patients receiving massive transfusion protocol (MTP) at 7 Level I trauma centers was performed from 2013 to 2018. Data were stratified by gender and then further examined by TEG or ROTEM parameters. Results were analyzed using univariate and multi-variate analyses. Results A total of 1565 patients were included with 70.9% male gender (n = 1110/1565). Female trauma patients were older than male patients (43.5 ± .9 vs 41.1 ± .6 years, P = .01). On TEG, females had longer reaction times (6.1 ± .9 min vs 4.8 ± .2 min, P = .03), increased alpha angle (68.6 ± .8 vs 65.7 ± .4, P < .001), and higher maximum amplitude (59.8 ± .8 vs 56.3 ± .4, P < .001). On ROTEM, females had significantly longer clot time (99.2 ± 13.7 vs 75.1 ± 2.6 sec, P = .09) and clot formation time (153.6 ± 10.6 sec vs 106.9 ± 3.8 sec, P < .001). When comparing by gender, no difference for in-hospital mortality was found for patients in the TEG or ROTEM group ( P > .05). Multivariate analysis showed no survival difference for female patients (OR 1.11, 95% CI .83-1.50, P = .48). Conclusions Although a difference between male and females was found on TEG/ROTEM for certain clotting parameters, no difference in mortality was observed. Prospective multi-institutional studies are needed.

Management and Outcomes of Traumatic Colon Injury in Civilian and Military Patients

2011 ◽  
Vol 77 (12) ◽  
pp. 1685-1691 ◽  
Author(s):  
Chitra N. Sambasivan ◽  
Samantha J. Underwood ◽  
Reed B. Kuehn ◽  
S. D. Cho ◽  
Laszlo N. Kiraly ◽  
...  
Keyword(s):  
United States ◽  
Injury Severity ◽  
Primary Repair ◽  
Patient Characteristics ◽  
The United States ◽  
Trauma Patients ◽  
Colon Injury ◽  
Initial Management ◽  
Civilian Trauma ◽  
Level I

Divergent injury patterns may indicate the need for differing strategies in combat and civilian trauma patients. This study aims to compare outcomes of colon injury management in these two populations. Parallel retrospective reviews were conducted comparing warfighters (n = 59) injured downrange and subsequently transferred to the United States with civilians (n = 30) treated at a United States Level I trauma center. Patient characteristics, mechanisms of injury, treatment course, and complications were compared. The civilian (CP) and military (MP) populations did not differ in Injury Severity Score (MP 20 vs CP 26; P = 0.41). The MP experienced primarily blast injuries (51%) as opposed to blunt trauma (70%; P < 0.01) in the CP. The site of colon injury did not differ between groups ( P = 0.15). Initial management was via primary repair (53%) and resection and anastomosis (27%) in the CP versus colostomy creation (47%) and stapled ends (32%) in the MP ( P < 0.001). Ultimately, the CP and MP experienced equivalent continuity rates (90%). Overall complications (MP 68% vs CP 53%; P = 0.18) and mortality (MP 3% vs CP 3%; P = 0.99) did not differ between the two groups. The CP and MP experience different mechanisms and initial management of colon injury. Ultimately, continuity is restored in the majority of both populations.

Trauma Patients’ Attitudes toward Organ Donation at an Urban Level I Trauma Center

2018 ◽  
Vol 84 (9) ◽  
pp. 1493-1497
Author(s):  
John D. Cull ◽  
Katarina Ivkovic ◽  
Benjamin Manning ◽  
Edie Y. Chan
Keyword(s):  
United States ◽  
Organ Donation ◽  
Trauma Center ◽  
Family Members ◽  
Organ Donor ◽  
The United States ◽  
Trauma Patients ◽  
Willingness To Donate ◽  
Patient Responses ◽  
Level I

Many health-care workers (HCWs) surveyed at a trauma center believed their patients distrusted the organ allocation system. This study compares urban trauma patients’ (TPs) attitudes toward organ donation with attitudes from the 2012 National Survey of Organ Donation Attitudes (NSODA). TPs presenting to the trauma clinic between September 2014 and August 2015 were surveyed. Patient responses were compared with the 2012 NSODA. One hundred and thirty-three TPs (95.0%) responded to the survey. Compared with the 2012 NSODA, groups were similar with regard to a patient's desire for OD after death (Trauma: 62.4% [Confidence interval [CI]: 53.6–70.7] vs NSODA: 59.3% [CI: 56.6–61.8]) and the belief that doctors are less likely to save their life if they are an organ donor (24.8% [CI: 17.7–33.0] vs 19.6% [CI: 18.3–21.0]). Approximately, 30 per cent of patients believed discrimination prevented minority patients from receiving transplants (27.1 [CI: 19.7–35.5] vs 30.3 [CI: 28.8–31.9]). TPs were less likely than the NSODA group to donate a family members’ organs, if they did not know the family members’ wishes (56.4% [CI: 47.5–65.0] vs 75.6% [CI: 68.7–71.8]); TPs were less likely to believe the United States transplant system uses a fair approach to distribute organs (47.4% [38.7–56.2] vs 64.6% [CI: 63.0–66.2]). Adjusting for race, both groups were similar in their willingness to donate a family members’ organs; black TPs were less likely to believe the United States transplant system, which follows a fair approach in distributing organs (43.0% [CI: 32.4–54.2] vs 63.7% [59.7–67.6]). Despite HCWs perceptions, TPs had a positive view of OD. Educating HCWs on patient attitudes toward OD may decrease institutional barriers to OD.

scholarly journals Moderate to severe leukocytosis with vasopressor use is associated with increased mortality in trauma patients

2020 ◽  
pp. 175114372097531
Author(s):  
Bima J Hasjim ◽  
Areg Grigorian ◽  
Stephen Stopenski ◽  
Lourdes Swentek ◽  
Beatrice Sun ◽  
...  
Keyword(s):  
Trauma Center ◽  
Time Course ◽  
Mortality Rates ◽  
Future Research ◽  
Multivariable Logistic Regression Analysis ◽  
Trauma Patients ◽  
Level I ◽  
Wbc Count ◽  
Vasopressor Use ◽  
Complications And Mortality

Background Leukocytosis is a rise in white blood cell (WBC) count and clinical outcomes of moderate to severe leukocytosis in trauma patients have not been described. We hypothesized that trauma patients with severe leukocytosis (SL; ≥40.0 × 109 leukocytes/L) have higher rates of in-hospital complications and mortality than those with moderate leukocytosis (ML; 25.0–39 × 109 leukocytes/L). Methods We performed a retrospective analysis (2010-2017) on trauma patients developing ML or SL at a single Level-I trauma center. A multivariable logistic regression analysis for risk factors were performed. Results From 15,807 trauma admissions, 332 (2.1%) had ML or SL. Of these, 308 (92.8%) were ML and 24 (7.2%) were SL. Patients with ML and SL reached their peak WBC count in 1 and 10 days after admission respectively (p < 0.001). SL patients suffered higher rates of in-hospital complications (p < 0.05) and mortality compared to those without ML or SL (14.5% vs. 3.3%, p < 0.001). Between ML and SL, mortality rates rose with leukocytosis severity (13.3% vs. 29.2%, p = 0.03). Among all patients with ML or SL, vasopressor use was the strongest independent risk factor for mortality (OR 12.61, p < 0.001). Conclusion Clinicians should be weary of the increased mortality rates and in-hospital complications in SL patients. Among patients with ML or SL, vasopressor use, rather than SL, was the strongest predictor of mortality. Patients with ML had a quicker time course to peak leukocytosis compared to SL, suggesting these two entities to be distinct in etiology and outcome, warranting future research.

scholarly journals Does Mode of Transport Confer a Mortality Benefit in Trauma Patients? Characteristics and Outcomes at an Ontario Lead Trauma Hospital

CJEM ◽  
2016 ◽  
Vol 18 (5) ◽  
pp. 363-369 ◽  
Author(s):  
Ian M. Buchanan ◽  
Angela Coates ◽  
Niv Sne
Keyword(s):  
Injury Severity ◽  
Trauma Centre ◽  
Trauma Patients ◽  
Mortality Benefit ◽  
Rotor Wing ◽  
Observational Cohort ◽  
Level I ◽  
Mode Of Transport ◽  
Evidence Based Guidelines ◽  
The Relationship

AbstractObjectivesEvidence-based guidelines regarding the optimal mode of transport for trauma patients from scene to trauma centre are lacking. The purpose of this study was to investigate the relationship between trauma patient outcomes and mode of transport at a single Ontario Level I Trauma Centre, and specifically to investigate if the mode of transport confers a mortality benefit.MethodsA historical, observational cohort study was undertaken to compare rotor-wing and ground transported patients. Captured data included demographics, injury severity, temporal and mortality variables. TRISS-L analysis was performed to examine mortality outcomes.Results387 rotor-wing transport and 2,759 ground transport patients were analyzed over an 18-year period. Rotor-wing patients were younger, had a higher Injury Severity Score, and had longer prehospital transport times. Mechanism of injury was similarly distributed between groups. After controlling for heterogeneity with TRISS-L analysis, the mortality of rotor-wing patients was found to be lower than predicted mortality, whereas the converse was found with ground patients.ConclusionRotor-wing and ground transported trauma patients represent heterogeneous populations. Accounting for these differences, rotor-wing patients were found to outperform their predicted mortality, whereas ground patients underperformed predictions.

scholarly journals The Predictive Effect of Health Examination in the Incidence of Diabetes Mellitus in Chinese Adults: A Population-Based Cohort Study

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Xiaomin Fu ◽  
Yingmin Jia ◽  
Jing Liu ◽  
Qinghua Lei ◽  
Lele Li ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Cox Regression ◽  
Population Based ◽  
Health Examination ◽  
The Public ◽  
Kaplan Meier ◽  
Potential Risk Factors ◽  
The Relationship ◽  
Predictive Effect

Background. The incidence of diabetes mellitus (DM) was increasing in recent years, and it is important to screen those nondiabetic populations through health examination to detect the potential risk factors for DM. We aimed to find the predictive effect of health examination on DM. Methods. We used the public database from Rich Healthcare Group of China to evaluate the potential predictive effect of health examination in the onset of DM. The colinear regression was used for estimating the relationship between the dynamics of the health examination index and the incident year of DM. The time-dependent ROC was used to calculate the best cutoff in predicting DM in the follow-up year. The Kaplan-Meier method and Cox regression were used to evaluate the HR of related health examination. Results. A total of 211,833 participant medical records were included in our study, with 4,172 participants diagnosing as DM in the following years (among 2-7 years). All the initial health examination was significantly different in participants’ final diagnosing as DM to those without DM. We found a negative correlation between the incidence of years of DM and the average initial FPG ( r = − 0.1862 , P < 0.001 ). Moreover, the initial FPG had a strong predictive effect in predicting the future incidence of DM ( AUC = 0.961 ), and the cutoff was 5.21 mmol/L. Participants with a higher initial FPG (>5.21 mmol/L) had a 2.73-fold chance to develop as DM in follow-up ( 95 % CI = 2.65 – 2.81 , P < 0.001 ). Conclusion. Initial FPG had a good predictive effect for detecting DM. The FPG should be controlled less than 5.21 mmol/L.

Attachment and Hope as a Framework for Improving Depression Outcomes for Trauma Patients

2020 ◽  
Vol 51 (2) ◽  
pp. 94-114
Author(s):  
John Blake ◽  
Monica Leppma ◽  
George Mamboleo ◽  
Jonathan Nauser ◽  
Heidi O'Toole ◽  
...  
Keyword(s):  
Intensive Care ◽  
Trauma Patients ◽  
Secure Attachment ◽  
Anxious Attachment ◽  
Psychological Variables ◽  
Avoidant Attachment ◽  
Discharge Status ◽  
Level I ◽  
Quantitative Descriptive ◽  
The Relationship

PurposeTest hope as mediator of relationships between attachment and depressive symptoms for trauma patients, and evaluate relationships among psychological variables (i.e., attachment, hope, and depression) and medical variables (i.e., patient admission disposition, length of intensive care unit (ICU) stay, discharge status, intubation, and days on ventilator).DesignQuantitative descriptive design using multiple regression and correlational techniques.Participants106 participants were recruited from among admitted patients at a nationally verified university Level I trauma center.ResultsHope was a significant mediator of the relationship between attachment and depression. Admission to the ICU instead of less intensive care was associated with lower secure attachment and elevated avoidant attachment. Longer ICU stays were related to lower secure attachment, elevated anxious attachment, low hope, and elevated depression. Discharge to a facility (rather than home) was associated with elevated anxious attachment and elevated depression. Intubation and days on a ventilator were associated with elevated anxious attachment. Secure attachment, anxious attachment, and hope were related to depression.Conclusionscreening trauma patients for personality and psychological characteristics that hamper recovery may improve outcomes. Hope-enhancing interventions may decrease attachment-predicted depression and improve recovery for trauma patients.

scholarly journals Effect of polyfluoroalkyl chemicals on the occurrence of urge urinary incontinence: a population-based study

2021 ◽  
Vol 13 ◽  
pp. 175628722110297
Author(s):  
Shu Cui ◽  
Xinghua Zhao ◽  
Xiaohan Chu ◽  
Shengwei Zhang ◽  
Qingyang Gu ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Group Analysis ◽  
Urge Urinary Incontinence ◽  
The United States ◽  
Population Based ◽  
Indoor Dust ◽  
Population Based Study ◽  
Health And Nutrition ◽  
History Of ◽  
The Relationship

Background: The artificial fluorinated group of compounds polyfluoroalkyl chemicals (PFCs) has been applied extensively in daily life for decades, and is present in food, drinking water, and indoor dust. The nephrotoxicity of PFCs has been widely studied for its characteristics of being mainly excreted through passing urine and affecting urodynamics. This work aimed to investigate the relationship between PFCs and the occurrence of urge urinary incontinence (UUI) in the United States (US) population. Methods: There were 3157 eligible female participants retrieved from the National Health and Nutrition Examination Survey (NHANES) between 2007 and 2014. A logistic regression model was used to examine the relationship between UUI and eight kinds of PFCs. The dose–response relationship was investigated through restricted cubic spline analysis in this retrospective study. Results: Of the 3157 eligible female participants, 913 self-reported a history of UUI. Total PFCs, perfluorohexane sulfonic acid (PFHS), 2-(N-methyl-perfluorooctane sulfonamido) acetate (MPAH), and perfluorononanoic acid (PFNA) correlated positively with the occurrence of UUI after adjusting for age, race, education, vigorous recreational activities, hypertension, diabetes, body mass index (BMI), creatinine, and estimated glomerular filtration rate (eGFR). Based on the results of sub-group analysis, the increasing tertiles contained odds ratios [OR; 95% confidence intervals (CI)] of 1.25 (95% CI, 1.03–1.51, p = 0.026) and 1.56 (95% CI, 1.29–1.89, p < 0.001) for total PFCs compared with the lowest tertile. The OR for PFHS, MPAH, and PFNA were 1.75, 1.71, and 1.41 respectively, in the highest tertile. Conclusion: This study investigated the relationship between PFCs and UUI in female and found total PFCs, PFHS, MPAH, and PFNA were positively correlated with the risk of UUI. The results will contribute to developing individualized treatment for female patients suffering UUI.

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