Background: National guidelines recommend that prehospital and emergency department (ED) criteria identify patients who might benefit from trauma center triage and highest-level trauma team activation. However, some patients who are seemingly "stable" in the field and do not meet the standard criteria for trauma activation still die.
Objectives: The purpose of this study was to identify these at-risk patients to potentially improve triage algorithms.
Methods: Patients enrolled in the National Trauma Data Bank (2007-2012) were included. All adult blunt trauma patients that were stable in the field and upon arrival to the ED (defined as a Glasgow Coma Scale score of 13-15, a heart rate ≤120 beats/min, systolic blood pressure ≥90 mm Hg, and diastolic blood pressure ≤200 mm Hg) and did not meet the standard criteria for the highest-level trauma team activation as defined by the American College of Surgeons were included. Demographic, clinical, and injury data including comorbidities, ED vitals, and outcome were collected. Regression models were used to identify independent risk factors for mortality.
Results: A total of 1,003,350 patients were stable in both the field and ED. Of these 11,010 (1.1%) died, including 1785 (0.2%) who died within 24 hours of hospital admission. The mortality in patients ≥60 years of age was 2.6%, and in patients ≥60 years of age with either a cerebrovascular accident (CVA) or congestive heart failure (CHF) was 5.4%. Age ≥60 years was a significant independent predictor of early mortality (odds ratio [OR] 4.53, p < 0.001). CHF (OR 1.88, p < 0.001) and a history of stroke (OR 1.52, p < 0.001) were also significant independent predictors of mortality.
Conclusions: Despite apparent evidence of both prehospital stability and stability upon arrival to the ED, patients ≥60 years of age and with a history of CHF or CVA have a significantly increased risk of early mortality after blunt trauma. These patients are at risk for subsequent clinical deterioration and should be considered for early transfer to a trauma center with highest-level activation.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.jemermed.2018.02.001 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Early Dynamics of Portal Pressure Gradient After TIPS Insertion Predict Mortality.
Aliment Pharmacol Ther
January 2025
Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital, Friedrich-Schiller-University, Jena, Germany.
Background: Transjugular intrahepatic portosystemic shunt (TIPS) placement leads to a reduction in portal pressure and an improvement in survival in patients with recurrent and refractory ascites and variceal haemorrhage. Prediction of post-TIPS survival is primarily determined by factors identified before the TIPS procedure, as data collected during or after TIPS implantation are limited. The aim of the study was to evaluate the influence of early hemodynamic changes after TIPS placement on survival, in order to refine post TIPS management.
View Article and Find Full Text PDFBackground: The Modified Nutritional Risk in Critically Ill (mNUTRIC) score has been proposed as a tool to identify hospitalized patients at risk for malnutrition who may benefit from early enteral nutrition (EN) therapy.
Objective: Our goal was to determine if mNUTRIC scores could predict, at time of intensive care unit admission, which mechanically ventilated trauma patients were at risk for malnutrition and might benefit from early EN, as indicated by reduced mortality.
Methods: We conducted a retrospective chart review of all adult trauma patients requiring mechanical ventilation for at least 48 hours between 01/21/2012 and 12/31/2016, reviewing inpatient medical records, demographic data, disease markers, injury severity, and comorbidities.
Coagulation indices and fibrinogen degradation products as predictive biomarkers for tumor-node-metastasis staging and metastasis in gastric cancer.
World J Gastrointest Oncol
January 2025
Clinical Laboratory, Tongji Hospital of Tongji University, Shanghai 200000, China.
Background: Gastric cancer (GC) is a prevalent malignancy with a substantial health burden and high mortality rate, despite advances in prevention, early detection, and treatment. Compared with the global average, Asia, notably China, reports disproportionately high GC incidences. The disease often progresses asymptomatically in the early stages, leading to delayed diagnosis and compromised outcomes.
View Article and Find Full Text PDFBackground: Cardiovascular diseases are the primary cause of nonobstetric morbidity and mortality in pregnant women worldwide. Pakistan's high maternal and neonatal mortality rates underscore the need for effective screening protocols to detect cardiovascular diseases during pregnancy.
Objectives: The objective of this study was to assess the prevalence and factors associated with structural heart disease among pregnant women without active cardiorespiratory symptoms (no symptoms or symptoms attributed to pregnancy) attending routine antenatal appointments.
Systemic Sirolimus Therapy Is Associated With Reduced Intervention Frequency in Pulmonary Vein Stenosis.
JACC Adv
December 2024
Division of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA.
Background: Early clinical outcomes data for adjunctive systemic sirolimus therapy (SST) for moderate to severe pediatric pulmonary vein stenosis (PVS) are promising but limited.
Objectives: The authors aimed to characterize a cohort of patients treated with SST to determine if SST was associated with a reduction in frequency of PVS interventions.
Methods: Medical records of 45 patients with PVS treated with SST for ≥1 month from 2015 to 2022 were retrospectively reviewed.
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!