The Impact of Non-trauma Factors on Trauma Patient Mortality and Hospital Resource Utilization: Population-Based Retrospective Review.

IF 1 4区医学 Q3 SURGERY

American Surgeon Pub Date : 2024-11-12 DOI:10.1177/00031348241300368

Mariel Javier, Ilko Luque, Jaclyn Kliewer, Nicole Yordan Lopez, David Ritchie, Beatriz Cobo Dominguez, Orlando Morejon

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引用次数: 0

Abstract

Background: The death of trauma patients with low injury severity scores (ISS) may not be fully explained by the severity of their injuries. Our objective was to evaluate preexisting conditions (PECs) that may contribute to the mortality rate of and hospital resources consumed by patients with low ISS.

Methods: Trauma patients with ISS <9 were selected from the National Trauma Database Bank [NTDB] [2019-21]. Bivariate and multivariate analysis identified the risk factors associated with mortality, adjusting for secondary PECs, mechanism of injury, AIS body region, vital signs, and blood transfusion. A t test was used to compare PEC status with intensive care unit (ICU) and hospital length of stay (LOS) for significant differences (P < .05).

Results: 1,689,392 patients suffered mild injuries [59.1% male, mean age 45.2, 8579 expired (0.5%)]. Mortality was associated with the presence of several risk factors, especially advanced directive [OR = 9.13, P < .001], cirrhosis [OR = 8.55, P < .001], disseminated cancer [OR = 8.53, P < .001], congestive heart failure (CHF) [OR = 6.62, P < .001], chronic renal failure (CRF) [OR = 6.16, P < .001], chemotherapy for cancer [OR = 5.64, P < .001], peripheral arterial disease (PAD) [OR = 5.32, P < .001], myocardial infarction (MI) [OR = 4.96, P < .001], dementia [OR = 4.62, P < .001], and functionally dependent health [OR = 4.57, P < .001]. In addition, there was a relationship between the presence of several PECs and increased ICU and hospital LOS, especially cirrhosis, CRF, CHF, and PAD.

Discussion: Nontraumatic factors and preexisting conditions are associated with increased mortality and hospital resource consumption in trauma patients with a low ISS. They should be considered during clinical decision-making for these patients, who may otherwise masquerade as part of a low-risk population.

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非创伤因素对创伤患者死亡率和医院资源利用率的影响：基于人群的回顾性研究。

背景：受伤严重程度评分（ISS）较低的创伤患者的死亡原因可能并不完全在于其受伤的严重程度。我们的目的是评估可能导致 ISS 分值低的患者死亡率和医院资源消耗的原有条件（PECs）：方法：采用t检验比较创伤患者的ISS、PEC状况与重症监护室（ICU）和住院时间（LOS）是否存在显著差异（P < .05）：1,689,392名轻伤患者[59.1%为男性，平均年龄45.2岁，8579人过期（0.5%）]。死亡率与多种危险因素有关，尤其是晚期指示[OR = 9.13，P < .001]、肝硬化[OR = 8.55，P < .001]、播散性癌症[OR = 8.53，P < .001]、充血性心力衰竭（CHF）[OR = 6.62，P < .001]、慢性肾功能衰竭（CRF）[OR = 6.16，P < .001]、癌症化疗[OR = 5.64，P < .001]、外周动脉疾病（PAD）[OR = 5.32，P < .001]、心肌梗死（MI）[OR = 4.96，P < .001]、痴呆[OR = 4.62，P < .001]和功能依赖性健康[OR = 4.57，P < .001]。此外，几种 PECs 的存在与 ICU 和住院时间延长之间也存在关系，尤其是肝硬化、CRF、CHF 和 PAD：讨论：非创伤因素和既往疾病与低ISS创伤患者死亡率和住院资源消耗增加有关。在对这些患者进行临床决策时应考虑到这些因素，否则他们可能会被伪装成低风险人群的一部分。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Surgeon 医学-外科

CiteScore

1.40

自引率

0.00%

发文量

623

期刊介绍： The American Surgeon is a monthly peer-reviewed publication published by the Southeastern Surgical Congress. Its area of concentration is clinical general surgery, as defined by the content areas of the American Board of Surgery: alimentary tract (including bariatric surgery), abdomen and its contents, breast, skin and soft tissue, endocrine system, solid organ transplantation, pediatric surgery, surgical critical care, surgical oncology (including head and neck surgery), trauma and emergency surgery, and vascular surgery.