Background: Survivors of trauma are at increased risk of dying after discharge. Studies have found that age, head injury, injury severity, falls and co-morbidities predict long-term mortality. The objective of our study was to build a nomogram predictor of 1-year and 3-year mortality for major blunt trauma adult survivors of the index hospitalization.
Methods: Using data from the Singapore National Trauma Registry, 2011-2013, we analyzed adults aged 18 and over, admitted after blunt injury, with an injury severity score (ISS) of 12 or more, who survived the index hospitalization, linked to death registry data. The study population was randomly divided 60/40 into separate construction and validation datasets, with the model built in the construction dataset, then tested in the validation dataset. Multivariable logistic regression was used to analyze 1-year and 3-year mortality.
Results: Of the 3414 blunt trauma survivors, 247 (7.2%) died within 1 year, and 551 (16.1%) died within 3 years of injury. Age (OR 1.06, 95% CI 1.05-1.07, p < 0.001), male gender (OR 1.53, 95% CI 1.12-2.10, p < 0.01), low fall from 0.5 m or less (OR 3.48, 95% CI 2.06-5.87, p < 0.001), Charlson comorbidity index of 2 or more (OR 2.26, 95% CI 1.38-3.70, p < 0.01), diabetes (OR 1.31, 95% CI 1.68-2.52, p = 0.04), cancer (OR 1.76, 95% CI 0.94-3.32, p = 0.08), head and neck AIS 3 or more (OR 1.79, 95% CI 1.13-2.84, p = 0.01), length of hospitalization of 30 days or more (OR 1.99, 95% CI 1.02-3.86, p = 0.04) were predictors of 1-year mortality. This model had a c-statistic of 0.85. Similar factors were found significant for the model predictor of 3-year mortality, which had a c-statistic of 0.83. Both models were validated on the second dataset, with an overall accuracy of 0.94 and 0.84 for 1-year and 3-year mortality respectively.
Conclusions: Adult survivors of major blunt trauma can be risk-stratified at discharge for long-term support.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5907285 | PMC |
| http://dx.doi.org/10.1186/s13049-018-0497-y | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Detection of Costal Cartilage Fractures on CT Images With Computer-aided Detection System for Rib Fractures.
In Vivo
December 2024
Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan.
Background/aim: Costal cartilage fractures are associated with poor prognosis in patients with blunt chest trauma. A Computer-Aided Detection (CAD) system for detecting rib fractures has been used in practice, but it is unclear whether this system recognizes costal cartilage fractures. This study investigated whether the CAD system for rib fracture can detect costal cartilage fractures.
View Article and Find Full Text PDFRegional anesthesia modalities in blunt thoracic trauma: A systematic review and Bayesian network meta-analysis.
Am J Emerg Med
December 2024
Department of Anesthesia and Intensive care, University of Pisa, Pisa, Italy.
Background: Various regional anesthesia techniques have been studied for blunt chest wall trauma over the past decades, but their impact on patient outcomes remains unclear. This systematic review and Bayesian network meta-analysis aimed to identify the most effective regional anesthesia techniques for different outcomes in blunt thoracic trauma patients.
Methods: We searched Medline, EMBASE, Scopus, and Cochrane databases for randomized controlled trials comparing regional anesthesia techniques (thoracic epidural, erector spinae plane block, serratus anterior plane block, intercostal block, paravertebral block, intrapleural block, retrolaminar block) and standard intravenous analgesia.
Implementation of a Modified Pain, Inspiration, Cough Protocol in Patients With Traumatic Rib Fractures.
J Surg Res
December 2024
Department of Surgery, Northwell, New Hyde Park, New York; Department of Surgery at Zucker School of Medicine, Manhasset, New York.
Introduction: Patients with blunt chest wall injuries and rib fractures are known to have high rates of atelectasis, pneumonia, pulmonary contusion, and can develop acute respiratory distress syndrome. This can lead to ventilator requirement and dependence, deconditioning secondary to uncontrolled pain, and increased hospital length of stay (LOS). Many studies in the literature have developed triage algorithms in patients with rib fractures to guide disposition and management, and several institutions have gone on to describe their institution-specific management protocols to decrease complications related to traumatic rib fractures.
View Article and Find Full Text PDFStereotactic navigation for traumatic parafalcine subdural hematoma evacuation: illustrative cases.
J Neurosurg Case Lessons
December 2024
Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana.
Background: Parafalcine subdural hematomas (pSDHs) are a subtype of subdural hematoma (SDH) that occur most frequently in older patients after blunt trauma. The literature primarily describes two clinical courses for patients with pSDH: those who are neurologically intact with stable examinations and imaging and those with focal deficits, with or without hematoma progression. Surgical management is undoubtedly required for the latter group; however, there are no evidence-based guidelines specifically for pSDH.
View Article and Find Full Text PDFAre interventional radiology techniques ideal for nonpenetrating splenic injury management: Robust statistical analysis of the Trauma Quality Program database.
PLoS One
December 2024
Department of Family Health and Preventive Medicine, Stony Brook University Renaissance School of Medicine, Stony Brook, New York, United States of America.
Background: Splenic artery embolization (SAE) is increasingly favored for adult blunt splenic injury management. We compared SAE to other splenic injury management strategies using robust statistical techniques.
Materials And Methods: Univariate analyses of demographics and outcomes were performed for four patient groups: observation, SAE, splenic surgery, splenic surgery + SAE in the American College of Surgeons Trauma Quality Program (TQIP) database.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!