Journal of Trauma-Injury Infection and Critical Care最新文献

{"title":"Traumatic brain injury and posttraumatic stress disorder: overlap in underlying substrates.","authors":"Delphine Le Moullec, Alexandre Salvadori, Pascal Constantin, Jean-Pierre Tourtier","doi":"10.1097/TA.0b013e31823a52cc","DOIUrl":"https://doi.org/10.1097/TA.0b013e31823a52cc","url":null,"abstract":"To the Editor: We read with interest the article titled “Routine Follow-Up Imaging of Kidney Injuries May Not Be Justified” written by Bukur et al. and wish to comment respectfully on the use of nephrectomy verses renorrhaphy in this interesting report. In this series, there seems to be a 100% nephrectomy rate in patients with blunt trauma who underwent operative management. This included 5 out of 5 patients with highgrade injury and the only patient with low-grade blunt trauma who underwent surgery.1 This is interesting in the light of an overall greater tendency toward renal repair rather than removal in academic centers.2 In their series of 94 patients with grade III-IV blunt renal injury, Shirazi et al. had a 41% rate of operative management, 31 cases (75%) of which underwent nephrorrhaphy. This higher rate of renal repair can however partly be explained by lower overall grade of injury in this series.3 In addition, no comment was made about whether gunshot wounds were also included in the series. In our opinion, the 21% nephrectomy rate in grade I-III renal injuries was suggestive of possible presence of gunshot wounds. As a conclusion, although the overall trend is obviously toward less invasive measures,4 the mentioned comparison seems to support institutional tendencies toward various management protocols in this ever-evolving topic, a fact pointing to a need for further standardization.","PeriodicalId":48894,"journal":{"name":"Journal of Trauma-Injury Infection and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/TA.0b013e31823a52cc","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30336471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurological, functional, and biomechanical characteristics after high-velocity behind armor blunt trauma of the spine.","authors":"Bo Zhang,&nbsp;Yifeng Huang,&nbsp;Zhenglin Su,&nbsp;Shuangping Wang,&nbsp;Shu Wang,&nbsp;Jianmin Wang,&nbsp;Aimin Wang,&nbsp;Xinan Lai","doi":"10.1097/TA.0b013e318231bce7","DOIUrl":"https://doi.org/10.1097/TA.0b013e318231bce7","url":null,"abstract":"<p><strong>Background: </strong>Behind armor blunt trauma (BABT) describes a nonpenetrating injury to the organs of an individual wearing body armor. The aim of this study was to investigate the neurologic and functional changes that occur in the central nervous system after high-velocity BABT of the spine as well as its biomechanical characteristics.</p><p><strong>Methods: </strong>This study evaluated 28 healthy adult white pigs. Animals were randomly divided into three experimental groups: (1) 15 animals (9 in the exposed group and 6 in the control group) were tested for neurologic changes; (2) 10 animals (5 in the exposed group and 5 in the control group) were used for studies of cognitive function; (3) and 3 animals were used for examination of biomechanics. In the group tested for neurologic changes, 9 anesthetized pigs wearing body armor (including a ceramic plate and polyethylene body armor) on the back were shot on the eighth thoracic vertebrae (T8) with a 5.56-mm rifle bullet (velocity appropriately 910 m/s). As a control, six pigs were shot with blank ammunition. Ultrastructural changes of the spinal cord and brain tissue were observed with light and electron microscopy. Expression levels of myelin basic protein, neuron-specific enolase (NSE), and glial cytoplasmic protein (S-100B) were investigated in the serum and cerebrospinal fluid using enzyme-linked immunosorbent assays. Electroencephalograms (EEGs) were monitored before and 10 minutes after the shot. Pressures in the spine, common carotid artery, and brain were detected. Acceleration of the 10th vertebrae (T10) was tested. Finally, cognitive outcomes between exposed and control groups were compared.</p><p><strong>Results: </strong>Neuronal degeneration and nerve fiber demyelination were seen in the spinal cord. The concentrations of neuron-specific enolase, myelin basic protein, and S-100B were significantly increased in the serum and cerebrospinal fluid 3 hours after trauma (p < 0.05). The electroencephalogram was suppressed within 3 to 6 minutes after trauma. The pressure detected in the brain was higher than that detected in the common carotid artery (p < 0.01). The trauma resulted in paralysis of two hind limbs and in cognitive dysfunction.</p><p><strong>Conclusion: </strong>The results from our animal model indicate that high-velocity BABT of the spine generates high pressure and acceleration in the spine, induces varying degrees of paralysis of hind limbs, and disturbs cerebral function. The neuronal degeneration caused by the pressure wave may be one of the important pathologic events involved in the development of trauma-related complications.</p>","PeriodicalId":48894,"journal":{"name":"Journal of Trauma-Injury Infection and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/TA.0b013e318231bce7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30336657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimal aortic injury after blunt trauma: selective nonoperative management is safe.","authors":"Jasmeet S Paul,&nbsp;Todd Neideen,&nbsp;Sean Tutton,&nbsp;David Milia,&nbsp;Parag Tolat,&nbsp;Dennis Foley,&nbsp;Karen Brasel","doi":"10.1097/TA.0b013e31823b9811","DOIUrl":"https://doi.org/10.1097/TA.0b013e31823b9811","url":null,"abstract":"<p><strong>Background: </strong>An increasing number of minimal aortic injuries (MAIs) are being identified with modern computed tomography (CT) imaging techniques. The optimal management and natural history of these injuries are unknown. We have adopted a policy of selective multidisciplinary nonoperative management of MAI. This study examines our experience with these patients from July 2004 to June 2009.</p><p><strong>Methods: </strong>Retrospective chart review of all blunt trauma patients who underwent chest CT angiography to evaluate for blunt aortic injury (BAI) was undertaken. All patients deemed to have a MAI were managed nonoperatively, and those with a severe aortic injury underwent repair. Data collected included age, mechanism of injury, Injury Severity Score, type and location of aortic injury, intensive care unit length of stay (LOS), overall LOS, ventilator days, disposition, and mortality. In addition, all BAIs were graded according to the Presley Trauma Center CT Grading System of Aortic Injury.</p><p><strong>Results: </strong>Forty-seven patients with BAI were identified. Thirty-two were classified as severe injuries, and 15 were considered MAI (32%). Nineteen underwent operative repair, 13 underwent endovascular stent graft repair, and 15 were managed nonoperatively. The average Injury Severity Score was 31 ± 10, and the average age was 44 ± 20 with no significant difference across treatment groups. There was no difference in overall or intensive care unit LOS. The nonoperative group had a shorter duration of ventilator days (1.1 vs. 4.28, p = 0.02). There were five deaths, none in the nonoperative group. None of these patients required subsequent intervention. All nonoperative patients had follow-up imaging at median of 4 days; on CT chest angiography, five injuries had resolved, eight had stable intimal flaps or pseudoaneurysm, and two had no detectable injury on subsequent aortogram.</p><p><strong>Conclusion: </strong>Almost one-third of our BAI were safely managed nonoperatively. Patients with MAI should be considered for selective nonoperative management in a multidisciplinary approach with close radiographic follow-up. We recommend that patients with MAIs should be considered for selective nonoperative management.</p>","PeriodicalId":48894,"journal":{"name":"Journal of Trauma-Injury Infection and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/TA.0b013e31823b9811","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30335600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Induced hypothermia after cardiac arrest in trauma patients: a case series.","authors":"Mazin A Tuma,&nbsp;Lynn G Stansbury,&nbsp;Deborah M Stein,&nbsp;Karen A McQuillan,&nbsp;Thomas M Scalea","doi":"10.1097/TA.0b013e31823c5a06","DOIUrl":"https://doi.org/10.1097/TA.0b013e31823c5a06","url":null,"abstract":"<p><strong>Background: </strong>Induced hypothermia after cardiac arrest is an accepted neuroprotective strategy. However, its role in cardiac arrest during acute trauma care is not yet defined. To characterize recent experience with this technique at our center, we undertook a detailed chart review of acute trauma patients managed with induced hypothermia after cardiac arrest.</p><p><strong>Patients: </strong>From Trauma Registry records, we identified all adult patients (older than 17 years) admitted to our Level I trauma center from July 1, 2008, through June 30, 2010, who experienced cardiac arrest during acute trauma care and were managed via our induced hypothermia protocol. This requires maintenance of core body temperature between 32°C and 34°C for 24 hours after arrest. Patient clinical records were then reviewed for selected factors.</p><p><strong>Results: </strong>Six acute trauma patients (3 male and 3 female; median age, 53 years) with cardiac arrest managed per protocol were identified. All injuries were due to blunt impact, and five of six injuries were motor-vehicle-associated. Median Injury Severity Score was 27; median prearrest Glasgow Coma Scale (GCS) score was 15. One patient arrested prehospital and the other 5 in-hospital. Median duration of arrest was 8 minutes. All were comatose after arrest. One death occurred, in the patient with a prehospital cardiac arrest. Two patients were discharged to chronic care facilities with GCS11-tracheostomy; three were discharged to active rehabilitation care facilities with GCS score of 14 to 15. There were no obvious complications related to cooling.</p><p><strong>Conclusions: </strong>Mild induced hypothermia can be beneficial in a selected group of trauma patients after cardiac arrest. Prospective trials are needed to explore the effects of targeted temperature management on coagulation in this patient group.</p>","PeriodicalId":48894,"journal":{"name":"Journal of Trauma-Injury Infection and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/TA.0b013e31823c5a06","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30335601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Posttraumatic brachial plexitis.","authors":"Sabri Aydin,&nbsp;Bashar Abuzayed,&nbsp;Hakan Bozkus,&nbsp;Evren Keles,&nbsp;Ari Boyaciyan,&nbsp;Ali Cetin Sarioglu","doi":"10.1097/TA.0b013e31821c33be","DOIUrl":"https://doi.org/10.1097/TA.0b013e31821c33be","url":null,"abstract":"","PeriodicalId":48894,"journal":{"name":"Journal of Trauma-Injury Infection and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/TA.0b013e31821c33be","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30336475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using principal component analysis to aid bayesian network development for prediction of critical care patient outcomes.","authors":"Cindy Crump,&nbsp;Christine Tsien Silvers,&nbsp;Bruce Wilson,&nbsp;Loretta Schlachta-Fairchild,&nbsp;Colleen A Lingley-Papadopoulos,&nbsp;Jeffrey S Ashley","doi":"10.1097/TA.0b013e3182250184","DOIUrl":"https://doi.org/10.1097/TA.0b013e3182250184","url":null,"abstract":"<p><strong>Background: </strong>Predicting an intensive care unit patient's outcome is highly desirable. An end goal is for computational techniques to provide updated, accurate predictions about changing patient condition using a manageable number of physiologic parameters.</p><p><strong>Methods: </strong>Principal component analysis was used to select input parameters for critical care patient outcome models. Vital signs and laboratory values from each patient's hospital stay along with outcomes (\"Discharged\" vs. \"Deceased\") were collected retrospectively at a Level I Trauma-Military Medical Center in the southwest; intensive care unit patients were included if they had been admitted for burn, infection, or hypovolemia during a 5-year period ending October 2007. Principal component analysis was used to determine which of the 24 parameters would serve as inputs in a bayesian network developed for outcome prediction.</p><p><strong>Results: </strong>Data for 581 patients were collected. Pulse pressure, heart rate, temperature, respiratory rate, sodium, and chloride were found to have statistically significant differences between Discharged and Deceased groups for \"Hypovolemia\" patients. For \"Burn\" patients, pulse pressure, hemoglobin, hematocrit, and potassium were found to have statistically significant differences. For a \"Combined\" group, heart rate, temperature, respiratory rate, sodium, and chloride had statistically significant differences. A bayesian network based on these results, developed for the Combined group, achieved an accuracy of 75% when predicting patient outcome.</p><p><strong>Conclusions: </strong>Outcome prediction for critical care patients is possible. Future work should explore model development using additional temporal data and should include prospective validation. Such technology could serve as the basis of real-time intelligent monitoring systems for critical patients.</p>","PeriodicalId":48894,"journal":{"name":"Journal of Trauma-Injury Infection and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/TA.0b013e3182250184","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30336529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"External fixator frames as interim damage control for limb injuries: experience in the 2010 Haiti earthquake.","authors":"Ehud Lebel,&nbsp;Nehemia Blumberg,&nbsp;Amit Gill,&nbsp;Ofer Merin,&nbsp;Reuven Gelfond,&nbsp;Elhanan Bar-On","doi":"10.1097/TA.0b013e3182147654","DOIUrl":"https://doi.org/10.1097/TA.0b013e3182147654","url":null,"abstract":"<p><strong>Background: </strong>An earthquake occurred in Haiti on January 12, 2010. The center of earthquake and the most extensive damage occurred near the capital Port-au-Prince. There were an estimated 230,000 deaths with more than 250,000 others injured. The Israeli Defense Forces Field Hospital (IDF hospital) is a military unit composed of army-recruited (volunteer) medical personnel that was sent to Haiti to serve as a stand-alone center for early response until larger medical missions could become functional and take on the task of more sophisticated and long-lasting medical support. This study describes the use of external fixator frames for orthopedic damage control whereby bone stabilization in conjunction with soft tissue care serves as a stopgap until more comprehensive therapy is forthcoming.</p><p><strong>Methods: </strong>Data were collected from patients' files (generated at the IDF hospital) regarding the use and immediate outcome of limbs stabilized by external fixator frames.</p><p><strong>Results: </strong>During the 10 days of the IDF hospital's activity, a total of 1,111 patients were admitted; 244 surgical procedures were performed under general or regional anesthesia and of these, the orthopedists performed 221 (90%) surgical procedures. Seventy-three fractures were stabilized operatively by application of an external fixator. Most of the frames were applied on fractures (closed and open) of the lower limbs (48 on femur and 24 on tibia/fibula). All procedures were performed in a field-style operating room. Sterile technique was possible only for elements actually inserted into the patient. Limb alignment was based on manual palpation: intraoperative fluoroscopy was not available; soft tissue care followed bone stabilization. No patient died. All patients completed urgent stabilization at the IDF hospital and were transferred to other facilities or discharged for home care.</p><p><strong>Conclusions: </strong>We describe \"orthopedic damage control\" using external fixator frames for bone stabilization and soft tissue care as a viable approach in the context of a mass casualty scenario. Technical aspects are described in detail in addition to the advantages and limitations of this approach, which could serve as guidelines for future military and civilian scenarios where large-scale orthopedic damage control would be practiced.</p>","PeriodicalId":48894,"journal":{"name":"Journal of Trauma-Injury Infection and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/TA.0b013e3182147654","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29823749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinal cord injury: outcomes of ventilatory weaning and extubation.","authors":"Mariah S Call,&nbsp;Matthew E Kutcher,&nbsp;Robert A Izenberg,&nbsp;Tanya Singh,&nbsp;Mitchell J Cohen","doi":"10.1097/TA.0b013e31821e87c2","DOIUrl":"https://doi.org/10.1097/TA.0b013e31821e87c2","url":null,"abstract":"<p><strong>Background: </strong>Spinal cord injury (SCI) carries potentially devastating respiratory implications depending on injury level. Optimal strategies for mechanical ventilation in this setting remain poorly described. We reviewed our experience of ventilatory weaning and extubation outcomes in this patient population.</p><p><strong>Methods: </strong>Eighty mechanically ventilated SCI patients over a 5-year period at a major Level I trauma center were assessed. Injury, clinical, and outcome data were extracted using our ICU database, chart, and registry data.</p><p><strong>Results: </strong>We identified 80 patients with SCI, classified by anatomic injury and motor functional level. There were no differences in injury severity between patients who were successfully extubated and those who failed (all p = NS). Seventy-four percent were extubated at the time of discharge; successful extubation was associated with lower level of cord injury (p = 0.001) and higher arrival Glasgow Coma Scale score (13.7 ± 2.6 vs. 10.8 ± 5.0, p = 0.021). Of extubation failures, 80% were due to pulmonary mechanical insufficiency, 22% inadequate pulmonary toilet, and 5% sedation or neurologic issues. Patients with weaning or extubation failures had longer ICU (29.9 days ± 24.5 days vs. 8.5 days ± 9.3 days; p < 0.001) and hospital stays (45.8 days ± 45.8 days vs. 26.6 days ± 23.9 days; p = 0.009), and higher rates of ventilator-associated pneumonia (83% vs. 15%, p < 0.001).</p><p><strong>Conclusion: </strong>Higher level of SCI correlates strongly with failure to wean and extubate; despite this, a subset of patients with high cord injury who can be safely weaned and extubated exists. A multicenter study is warranted to specifically identify patients with high SCI who merit weaning and extubation trials.</p>","PeriodicalId":48894,"journal":{"name":"Journal of Trauma-Injury Infection and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/TA.0b013e31821e87c2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30014831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association between anemia and the mortality of severe traumatic brain injury in emergency department.","authors":"Chia-Jung Yang,&nbsp;Kuang-Yu Hsiao,&nbsp;I-Chun Su,&nbsp;I-Chuan Chen","doi":"10.1097/TA.0b013e31820ea36b","DOIUrl":"https://doi.org/10.1097/TA.0b013e31820ea36b","url":null,"abstract":"<p><strong>Background: </strong>Anemia is a common medical problem for critically ill patients. Blood transfusion to augment oxygen delivery for these patients has been a traditional therapy. However, few studies have identified the impact of anemia on individuals suffering from severe traumatic brain injury (TBI). Hence, this study aims to evaluate the effects of initial anemia on patients with severe TBI admitted to the Emergency Unit.</p><p><strong>Methods: </strong>We reviewed the medical records of patients with isolated severe TBI admitted to the Emergency Unit of a university hospital from July 2003 to June 2008. Patients were divided into two groups based on their initial anemia data taken while in the Emergency Unit. The anemia datum is defined as hemoglobin (Hb) <10 mg/dL. The t test was used to identify the differences between the two groups, while logistic regression was applied to determine any significant differences found in the statistical analysis.</p><p><strong>Results: </strong>A total of 234 patients were signed up in our study. Based on their initial hemoglobin at emergency department, 23 patients (9.8%) comprised the anemia group, 17 patients (7.3%) comprised the nonanemia group, whereas 112 patients (47.9%) belonging to the nonanemia group were deceased. There is no significant difference between the two groups (p = 0.076; odds ratio, 0.97; confidence interval, 0.78-1.05).</p><p><strong>Conclusion: </strong>This study shows that initial anemia is not a mortality risk factor for patients with isolated severe blunt TBI.</p>","PeriodicalId":48894,"journal":{"name":"Journal of Trauma-Injury Infection and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/TA.0b013e31820ea36b","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29761093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of nontherapeutic hypothermia on outcomes after severe traumatic brain injury.","authors":"Agathoklis Konstantinidis,&nbsp;Kenji Inaba,&nbsp;Joe Dubose,&nbsp;Galinos Barmparas,&nbsp;Peep Talving,&nbsp;Jean-Stephane David,&nbsp;Lydia Lam,&nbsp;Demetrios Demetriades","doi":"10.1097/TA.0b013e3182159e31","DOIUrl":"https://doi.org/10.1097/TA.0b013e3182159e31","url":null,"abstract":"<p><strong>Introduction: </strong>In patients with isolated severe traumatic brain injury (TBI), the effect of controlled, therapeutic hypothermia on outcomes has been studied extensively. What is not well understood, however, and the purpose of this study, was to examine the impact of noninduced, nontherapeutic hypothermia on outcomes in these patients.</p><p><strong>Methods: </strong>A retrospective review of the institutional trauma registry at the Los Angeles County + University of Southern California Medical Center was performed to identify all trauma patients admitted to the surgical intensive care unit (SICU) with isolated severe TBI from January 2000 to December 2008. Patients were classified as hypothermic (core temperature [Tc] ≤35°C) or normothermic (Tc >35°C) based on their first Tc recorded on SICU admission. The primary outcome measure was in-hospital mortality, and secondary outcomes included SICU and hospital length of stay.</p><p><strong>Results: </strong>During the study period, 1,403 patients sustaining an isolated severe TBI were admitted to the SICU. After excluding 122 patients with missing temperature data, 1,281 patients were analyzed. Hypothermia (Tc ≤35°C) on SICU admission was identified in 10.9% (n = 140) of the study population, with the remaining 89.1% (n = 1,141) being normothermic (Tc >35°C). After adjusting for differences in baseline characteristics between the two groups, patients who were hypothermic on SICU admission were found to be significantly less likely to survive (odds ratio, 2.9; 95% confidence interval, 1.3, 6.7; p < 0.013). A penetrating mechanism of injury, Injury Severity Score ≥25, and undergoing an exploratory laparotomy before admission were found to be independent risk factors for the development of hypothermia on SICU admission.</p><p><strong>Conclusion: </strong>For patients who have sustained isolated severe TBI, the presence of noninduced, nontherapeutic hypothermia on SICU admission is associated with a significant increase in mortality. The impact of preventative measures used to avoid the development of hypothermia and the effectiveness of measures for restoring normothermia warrant further investigation.</p>","PeriodicalId":48894,"journal":{"name":"Journal of Trauma-Injury Infection and Critical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/TA.0b013e3182159e31","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29852912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}