Journal of trauma management & outcomes最新文献

{"title":"Complications related to deep venous thrombosis prophylaxis in trauma: a systematic review of the literature.","authors":"Indraneel Datta,&nbsp;Chad G Ball,&nbsp;Lucas Rudmik,&nbsp;S Morad Hameed,&nbsp;John B Kortbeek","doi":"10.1186/1752-2897-4-1","DOIUrl":"https://doi.org/10.1186/1752-2897-4-1","url":null,"abstract":"<p><p> Deep venous thrombosis prophylaxis is essential to the appropriate management of multisystem trauma patients. Without thromboprophylaxis, the rate of venous thrombosis and subsequent pulmonary embolism is substantial. Three prophylactic modalities are common: pharmacologic anticoagulation, mechanical compression devices, and inferior vena cava filtration. A systematic review was completed using PRISMA guidelines to evaluate the potential complications of DVT prophylactic options. Level one evidence currently supports the use of low molecular weight heparins for thromboprophylaxis in the trauma patient. Unfortunately, multiple techniques are not infrequently required for complex multisystem trauma patients. Each modality has potential complications. The risks of heparin include bleeding and heparin induced thrombocytopenia. Mechanical compression devices can result in local soft tissue injury, bleeding and patient non-compliance. Inferior vena cava filters migrate, cause inferior vena cava occlusion, and penetrate the vessel wall. While the use of these techniques can be life saving, they must be appropriately utilized.</p>","PeriodicalId":87652,"journal":{"name":"Journal of trauma management & outcomes","volume":"4 ","pages":"1"},"PeriodicalIF":0.0,"publicationDate":"2010-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1752-2897-4-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28755955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Autologous bone graft versus demineralized bone matrix in internal fixation of ununited long bones.","authors":"Oliver Pieske,&nbsp;Alexandra Wittmann,&nbsp;Johannes Zaspel,&nbsp;Thomas Löffler,&nbsp;Bianka Rubenbauer,&nbsp;Heiko Trentzsch,&nbsp;Stefan Piltz","doi":"10.1186/1752-2897-3-11","DOIUrl":"https://doi.org/10.1186/1752-2897-3-11","url":null,"abstract":"<p><strong>Background: </strong>Non-unions are severe complications in orthopaedic trauma care and occur in 10% of all fractures. The golden standard for the treatment of ununited fractures includes open reduction and internal fixation (ORIF) as well as augmentation with autologous-bone-grafting. However, there is morbidity associated with the bone-graft donor site and some patients offer limited quantity or quality of autologous-bone graft material. Since allogene bone-grafts are introduced on the market, this comparative study aims to evaluate healing characteristics of ununited bones treated with ORIF combined with either iliac-crest-autologous-bone-grafting (ICABG) or demineralized-bone-matrix (DBM).</p><p><strong>Methods and results: </strong>From 2000 to 2006 out of sixty-two consecutive patients with non-unions presenting at our Level I Trauma Center, twenty patients had ununited diaphyseal fractures of long bones and were treated by ORIF combined either by ICABG- (n = 10) or DBM-augmentation (n = 10). At the time of index-operation, patients of the DBM-group had a higher level of comorbidity (ASA-value: p = 0.014). Mean duration of follow-up was 56.6 months (ICABG-group) and 41.2 months (DBM-group). All patients were clinically and radiographically assessed and adverse effects related to bone grafting were documented. The results showed that two non-unions augmented with ICABG failed osseous healing (20%) whereas all non-unions grafted by DBM showed successful consolidation during the first year after the index operation (p = 0.146). No early complications were documented in both groups but two patients of the ICABG-group suffered long-term problems at the donor site (20%) (p = 0.146). Pain intensity were comparable in both groups (p = 0.326). However, patients treated with DBM were more satisfied with the surgical procedure (p = 0.031).</p><p><strong>Conclusion: </strong>With the use of DBM, the costs for augmentation of the non-union-site are more expensive compared to ICABG (calculated difference: 160 euro/case). Nevertheless, this study demonstrated that the application of DBM compared to ICABG led to an advanced outcome in the treatment of non-unions and simultaneously to a decreased quantity of adverse effects. Therefore we conclude that DBM should be offered as an alternative to ICABG, in particular to patients with elevated comorbidity and those with limited availability or reduced quality of autologous-bone graft material.</p>","PeriodicalId":87652,"journal":{"name":"Journal of trauma management & outcomes","volume":"3 ","pages":"11"},"PeriodicalIF":0.0,"publicationDate":"2009-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1752-2897-3-11","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28588492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Free abdominal fluid without obvious solid organ injury upon CT imaging: an actual problem or simply over-diagnosing?","authors":"Vanessa M Banz,&nbsp;Muhammad U Butt,&nbsp;Heinz Zimmermann,&nbsp;Victor Jeger,&nbsp;Aristomenis K Exadaktylos","doi":"10.1186/1752-2897-3-10","DOIUrl":"https://doi.org/10.1186/1752-2897-3-10","url":null,"abstract":"<p><p>Whereas a non-operative approach for hemodynamically stable patients with free intraabdominal fluid in the presence of solid organ injury is generally accepted, the presence of free fluid in the abdomen without evidence of solid organ injury not only presents a challenge for the treating emergency physician but also for the surgeon in charge. Despite recent advances in imaging modalities, with multi-detector computed tomography (CT) (with or without contrast agent) usually the imaging method of choice, diagnosis and interpretation of the results remains difficult. While some studies conclude that CT is highly accurate and relatively specific at diagnosing mesenteric and hollow viscus injury, others studies deem CT to be unreliable. These differences may in part be due to the experience and the interpretation of the radiologist and/or the treating physician or surgeon.A search of the literature has made it apparent that there is no straightforward answer to the question what to do with patients with free intraabdominal fluid on CT scanning but without signs of solid organ injury. In hemodynamically unstable patients, free intraabdominal fluid in the absence of solid organ injury usually mandates immediate surgical intervention. For patients with blunt abdominal trauma and more than just a trace of free intraabdominal fluid or for patients with signs of peritonitis, the threshold for a surgical exploration - preferably by a laparoscopic approach - should be low. Based on the available information, we aim to provide the reader with an overview of the current literature with specific emphasis on diagnostic and therapeutic approaches to this problem and suggest a possible algorithm, which might help with the adequate treatment of such patients.</p>","PeriodicalId":87652,"journal":{"name":"Journal of trauma management & outcomes","volume":"3 ","pages":"10"},"PeriodicalIF":0.0,"publicationDate":"2009-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1752-2897-3-10","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28588235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of falls on early mortality from severe traumatic brain injury.","authors":"Linda M Gerber, Quanhong Ni, Roger Härtl, Jamshid Ghajar","doi":"10.1186/1752-2897-3-9","DOIUrl":"10.1186/1752-2897-3-9","url":null,"abstract":"<p><strong>Background: </strong>The causes of severe traumatic brain injury (TBI) vary by age and other demographic characteristics. Mortality after trauma is higher for elderly than younger patients. This study is based on 2779 patients with severe TBI treated at 24 trauma centers enrolled in a New York State quality improvement program. The prospectively collected database includes information on age, sex, mechanism of injury, initial Glasgow Coma Scale score, blood pressure, pupillary assessment, and CT scan findings. This multi-center study was conducted to explore the impact of falls on early mortality from severe TBI among the elderly.</p><p><strong>Results: </strong>After exclusion criteria were applied, a total of 2162 patients were eligible for analysis. Falls contributed to 21% of all severe TBI, 12% occurring from > 3 meters and 9% from < 3 meters. Two-week mortality ranged from 18% due to injuries other than falls to 31% due to falls from < 3 meters (p =< 0.0001). Mortality after a severe TBI is much greater among older people, reaching 58% for people 65 years and older sustaining a fall from < 3 meters.</p><p><strong>Conclusion: </strong>Among those 65 and older, falls contributed to 61% of all injuries and resulted in especially high mortality among individuals experiencing low falls. Preventive efforts directed toward older people to avoid falls from < 3 meters could have a significant impact on mortality.</p>","PeriodicalId":87652,"journal":{"name":"Journal of trauma management & outcomes","volume":" ","pages":"9"},"PeriodicalIF":0.0,"publicationDate":"2009-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2739840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40001381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital mortality among major trauma victims admitted on weekends and evenings: a cohort study.","authors":"Kevin B Laupland,&nbsp;Chad G Ball,&nbsp;Andrew W Kirkpatrick","doi":"10.1186/1752-2897-3-8","DOIUrl":"https://doi.org/10.1186/1752-2897-3-8","url":null,"abstract":"<p><strong>Background: </strong>Patient care may be inconsistent during off hours. We sought to determine whether victims of major trauma admitted to hospital on evenings, nights, and weekends suffer increased mortality rates. All victims of major trauma admitted to all four major acute care hospitals in the Calgary Health Region between April 1, 2002 and March 31, 2006 were included. Clinical and outcome information was obtained from regional databases. Weekends were defined as anytime Saturday or Sunday, evenings as 18:00-22:59, and nights as 23:00-07:59.</p><p><strong>Results: </strong>Four thousand patients were included; 2,901 (73%) were male, the median age was 39.5 [inter-quartile range (IQR), 22.4-58.2] years, and the median injury severity score (ISS) was 20 (IQR, 16-26). Thirty-five percent (1,405) of patients were admitted on a weekend, 30% (1,197) during evenings, and 36% (1,422) at night. Seventy-eight percent (3,106) of cases presented during the \"after hours\" (evenings, nights, and/or weekends). The in-hospital case-fatality rate was 447 (11%), and was not significantly different during daytime (165/1,381; 37%), evening (128/1,197; 30%), and night (154/1,422; 36%) admissions (p = 0.53), or among patients admitted on weekends as compared to weekdays (157/1,405; 11% vs. 290/2,595; 11%; p = 1.0). Admission during the after hours as compared to business hours (343/3,106; 11% vs. 104/894; 12%; p = 0.63) did not increased risk. A multivariable logistic regression model was developed to assess factors associated with in-hospital death (n = 3,891). Neither admission on weekends nor on evenings or nights increased the risk for in-hospital mortality.</p><p><strong>Conclusion: </strong>In our region, the time of admission during the day or day of the week does not influence the risk for adverse outcome and may reflect our highly developed multi-hospital acute care and trauma system.</p>","PeriodicalId":87652,"journal":{"name":"Journal of trauma management & outcomes","volume":"3 ","pages":"8"},"PeriodicalIF":0.0,"publicationDate":"2009-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1752-2897-3-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28330266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A multicenter review of deep venous thrombosis prophylaxis practice patterns for blunt hepatic trauma.","authors":"Indraneel Datta,&nbsp;Chad G Ball,&nbsp;Lucas R Rudmik,&nbsp;Damian Paton-Gay,&nbsp;Deepak Bhayana,&nbsp;Peter Salat,&nbsp;Colin Schieman,&nbsp;Dean F Smith,&nbsp;Mary Vanwijngaarden-Stephens,&nbsp;John B Kortbeek","doi":"10.1186/1752-2897-3-7","DOIUrl":"https://doi.org/10.1186/1752-2897-3-7","url":null,"abstract":"<p><strong>Background: </strong>Non-operative management of blunt hepatic trauma is successful in the majority of hemodynamically stable patients. Due to the risk of recurrent hemorrhage, pharmacologic deep venous thrombosis (DVT) prophylaxis is often delayed. The optimal timing of prophylaxis is unclear. A multi-centre, retrospective review of patients with blunt hepatic injuries presenting between 2000 and 2004 was performed. All patients had an ISS >/= 12 and a CT scan confirming hepatic trauma. Patients were categorized into: (1) early DVT prophylaxis (</= 48 hrs of admission), (2) delayed prophylaxis (>48 hrs), and (3) no prophylaxis.</p><p><strong>Methods and results: </strong>Thirty-seven (25%) and 45 (42%) patients received early and delayed DVT prophylaxis respectively. The remainder (32%) received none. Mean hepatic injury grades were lower in the early prophylaxis group (II) compared to the delayed and no prophylaxis cohorts (III)(p = 0.002). The number of patients requiring post-admission blood transfusions was highest in the delayed group (44%) compared to the early (26%) and no prophylaxis (6%) groups (p = 0.03). No patient in the early prophylaxis cohort developed a DVT or required delayed angiographic or operative intervention. Two patients in the delayed group failed non-operative management. Eight (18%) patients in the delayed group developed a clinically significant DVT; 1 (2%) progressed to a PE.</p><p><strong>Conclusion: </strong>Practice patterns indicate that chemical DVT prophylaxis initiated within 48 hours of admission may be safe in patients with significant blunt hepatic trauma. Delays in prevention result in venothromboembolic events, but not in fewer blood transfusions or a decreased need for subsequent angiographic or operative therapies.</p>","PeriodicalId":87652,"journal":{"name":"Journal of trauma management & outcomes","volume":"3 ","pages":"7"},"PeriodicalIF":0.0,"publicationDate":"2009-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1752-2897-3-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28217661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advocating \"spine damage control\" as a safe and effective treatment modality for unstable thoracolumbar fractures in polytrauma patients: a hypothesis.","authors":"Philip F Stahel, Michael A Flierl, Ernest E Moore, Wade R Smith, Kathryn M Beauchamp, Anthony Dwyer","doi":"10.1186/1752-2897-3-6","DOIUrl":"10.1186/1752-2897-3-6","url":null,"abstract":"<p><strong>Background: </strong>The \"ideal\" timing and modality of fracture fixation for unstable thoracolumbar spine fractures in multiply injured patients remains controversial. The concept of \"damage control orthopedics\" (DCO), which has evolved globally in the past decade, provides a safe guidance for temporary external fixation of long bone or pelvic fractures in multisystem trauma. In contrast, \"damage control\" concepts for unstable spine injuries have not been widely implemented, and the scarce literature in the field remains largely anecdotal. The current practice standards are reflected by two distinct positions, either (1) immediate \"early total care\" or (2) delayed spine fixation after recovery from associated injuries. Both concepts have inherent risks which may contribute to adverse outcome.</p><p><strong>Presentation of hypothesis: </strong>We hypothesize that the concept of \"spine damage control\" - consisting of immediate posterior fracture reduction and instrumentation, followed by scheduled 360 degrees completion fusion during a physiological \"time-window of opportunity\" - will be associated with less complications and improved outcomes of polytrauma patients with unstable thoracolumbar fractures, compared to conventional treatment strategies.</p><p><strong>Testing of hypothesis: </strong>We propose a prospective multicenter trial on a large cohort of multiply injured patients with an associated unstable thoracolumbar fracture. Patients will be assigned to one of three distinct study arms: (1) Immediate definitive (anterior and/or posterior) fracture fixation within 24 hours of admission; (2) Delayed definitive (anterior and/or posterior) fracture fixation at > 3 days after admission; (3) \"Spine damage control\" procedure by posterior reduction and instrumentation within 24 hours of admission, followed by anterior 360 degrees completion fusion at > 3 days after admission, if indicated. The primary and secondary endpoints include length of ventilator-free days, length of ICU and hospital stay, mortality, incidence of complications, neurological status and functional recovery.</p><p><strong>Implications of hypothesis: </strong>A \"spine damage control\" protocol may save lives and improve outcomes in severely injured patients with associated spine injuries.</p>","PeriodicalId":87652,"journal":{"name":"Journal of trauma management & outcomes","volume":"3 ","pages":"6"},"PeriodicalIF":0.0,"publicationDate":"2009-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2686673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28167120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome after severe head injury: focal surgical lesions do not imply a better Glasgow Outcome Score than diffuse injuries at 3 months.","authors":"Paul Leach,&nbsp;Omar N Pathmanaban,&nbsp;Hiren C Patel,&nbsp;Julian Evans,&nbsp;Raphael Sacho,&nbsp;Richard Protheroe,&nbsp;Andrew T King","doi":"10.1186/1752-2897-3-5","DOIUrl":"https://doi.org/10.1186/1752-2897-3-5","url":null,"abstract":"<p><strong>Background: </strong>Historically neurosurgeons have accepted head injured patients only in the presence of a mass lesion requiring surgical decompression. Underpinning this is an assumption that these patients have a better outcome than patients without a surgical lesion. This has meant that many patients without a surgical lesion have been managed locally in the referring hospital. However, there is now evidence that treatment of all head injured patients in a specialist centre leads to improved outcomes. Therefore, we have asked the question: does the presence of a surgical lesion imply better outcome from severe head injury?</p><p><strong>Results: </strong>We prospectively recorded the Glasgow Outcome score (GOS), at 3 months, of all the severely head injured patients treated at our institution over a two and a half year period. Of 116 patients admitted with an initial Glasgow Coma Score (GCS) of 8 or less, 58 had surgical lesions and 58 non-surgical head injuries. The two groups were well matched for presenting GCS and age. Overall our favourable outcome rate (GOS 4 and 5) at 3-months for the patients with a surgical lesion and for the non-surgical group were 47.3% and 46.6% respectively, with no significant difference between the two (P = 0.54).</p><p><strong>Conclusion: </strong>The assumption in the past has always been that patients presenting in coma from traumatic diffuse brain injury will do worse than those that have a mass lesion amenable to surgical decompression. Our series would suggest that this is not the case and all severely head injured patients should expect similar outcome when cared for in a neuroscience centre.</p>","PeriodicalId":87652,"journal":{"name":"Journal of trauma management & outcomes","volume":"3 ","pages":"5"},"PeriodicalIF":0.0,"publicationDate":"2009-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1752-2897-3-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28092449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe traumatic injury during long duration spaceflight: Light years beyond ATLS.","authors":"Andrew W Kirkpatrick,&nbsp;Chad G Ball,&nbsp;Mark Campbell,&nbsp;David R Williams,&nbsp;Scott E Parazynski,&nbsp;Kenneth L Mattox,&nbsp;Timothy J Broderick","doi":"10.1186/1752-2897-3-4","DOIUrl":"10.1186/1752-2897-3-4","url":null,"abstract":"<p><p> Traumatic injury strikes unexpectedly among the healthiest members of the human population, and has been an inevitable companion of exploration throughout history. In space flight beyond the Earth's orbit, NASA considers trauma to be the highest level of concern regarding the probable incidence versus impact on mission and health. Because of limited resources, medical care will have to focus on the conditions most likely to occur, as well as those with the most significant impact on the crew and mission. Although the relative risk of disabling injuries is significantly higher than traumatic deaths on earth, either issue would have catastrophic implications during space flight. As a result this review focuses on serious life-threatening injuries during space flight as determined by a NASA consensus conference attended by experts in all aspects of injury and space flight.In addition to discussing the impact of various mission profiles on the risk of injury, this manuscript outlines all issues relevant to trauma during space flight. These include the epidemiology of trauma, the pathophysiology of injury during weightlessness, pre-hospital issues, novel technologies, the concept of a space surgeon, appropriate training for a space physician, resuscitation of injured astronauts, hemorrhage control (cavitary and external), surgery in space (open and minimally invasive), postoperative care, vascular access, interventional radiology and pharmacology.Given the risks and isolation inherent in long duration space flight, a well trained surgeon and/or surgical capability will be required onboard any exploration vessel. More specifically, a broadly-trained surgically capable emergency/critical care specialist with innate capabilities to problem-solve and improvise would be desirable. It will be the ultimate remote setting, and hopefully one in which the most advanced of our societies' technologies can be pre-positioned to safeguard precious astronaut lives. Like so many previous space-related technologies, these developments will also greatly improve terrestrial care on earth.</p>","PeriodicalId":87652,"journal":{"name":"Journal of trauma management & outcomes","volume":"3 ","pages":"4"},"PeriodicalIF":0.0,"publicationDate":"2009-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1752-2897-3-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28148338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alcohol-positive multiple trauma patients with and without blood transfusion: an outcome analysis.","authors":"Manuel F Struck,&nbsp;Thomas Schmidt,&nbsp;Ralph Stuttmann,&nbsp;Peter Hilbert","doi":"10.1186/1752-2897-3-3","DOIUrl":"https://doi.org/10.1186/1752-2897-3-3","url":null,"abstract":"<p><strong>Background: </strong>Blood transfusion is a common therapy for multiple trauma patients, and is often performed soon after hospital admission. It is unclear whether the need for a blood transfusion in multiply injured patients presenting with a positive blood alcohol concentration (BAC) is associated with increased morbidity/mortality, since their risk behavior differs significantly from patients with a negative BAC. In this study, we evaluated the role of blood transfusion in the treatment of BAC-positive multiple trauma patients.</p><p><strong>Patients: </strong>In a three-year period, 164 patients at a single trauma center presented with a positive BAC, and 145 met the inclusion criteria for further evaluation and regression analysis. We compared patients who were transfused (n = 76) with those who were not transfused (n = 69).</p><p><strong>Results: </strong>In both groups, the most common causes of trauma were traffic accidents and falls. Most patients were admitted to the hospital from the scene of the accident (77.2%) and were male (89.0%). Transfused patients had a lower GCS (p </= .001) and her ISS (p </= .001), were more likely to have severe head injuries (p </= .001), tended to have higher BACs (p = .053), had lower hemoglobin levels and prothrombin times in the first 24 hours (p </= .001), had lower lactate levels, had higher rates of intubation (p </= .001) and ICU admission, and had longer ICU stays and artificial ventilation times (p </= .001). Mortality was significantly higher in transfused patients (n = 15 vs. n = 3, p </= .001). Non-survivors were more likely to have severe head injuries; be intubated and ventilated; be older; have higher ISS scores, lactate levels, and numbers of transfusions in the first 24 hours; and have lower GCS scores, hemoglobin measurements, and prothrombin levels. In a binary logistic regression model, only age (p = .009) and ISS (p = .004) independently predicted mortality.</p><p><strong>Conclusion: </strong>In our single-center study, the BAC of multiple trauma patients and the number of blood transfusions they received did not predict mortality in multiple trauma patients if used as independent predictors. Prospective studies with greater sample sizes should be performed to clarify the role of blood transfusions in the outcome of this sub-population.</p>","PeriodicalId":87652,"journal":{"name":"Journal of trauma management & outcomes","volume":"3 ","pages":"3"},"PeriodicalIF":0.0,"publicationDate":"2009-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1752-2897-3-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28027777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}