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Trauma-related Admissions to Intensive Care Unit: Single Center Experience for Major Trauma

Yıl 2021, Cilt: 74 Sayı: 1, 104 - 111, 29.04.2021

Süheyla Karadağ Erkoç

Öz

Objectives: Major trauma is one of the main reasons for admission to the intensive care unit (ICU) with the increase in complications and mortality. The aim of this studyis to investigate the complications and characteristics of major trauma patients admitted to ICU.

Materials and Methods: In this study, we retrospectively analyzed major trauma patients with an “injury severity score” (ISS)>15 who were admitted to ICU between 2015 and 2018. Demographic and clinical data including age, sex, type of injury, rates of complications and 30-day mortality, length of stay (LOS) in ICU and hospital were determined. Acute physiology and chronic health evaluation (APACHE II) score, ISS, trauma revised injury severity score (TRISS), revised trauma score (RTS) and Glasgow coma scale (GCS) score were calculated. Risk factors causing mortality and complications in patients were investigated.

Results: Sixty-one patients [19 (31.1%) males and 42 (68.9%) females] aged between 15 and 88 years (mean 42.6±19.2 years) were admitted to our intensive care unit during the study period. Blunt trauma rate (86.8%) was higher than the penetrating injury rate (13.1%). Complications developed in 67.2% of trauma patients, and acutekidney injury (AKI, 45%), pneumonia (34.4%), severe sepsis or septic shock (32.8%) and pulmonary embolism (PE, 9.8%) were detected respectively according to their prevalence. Mortality rates and LOS in ICU and hospital were higher in patients with complications than in those without complications (p<0.05). There were no statistically significant risk factors for the development of complications according to univariate logistic regression analysis (p>0.05). The 30-day mortality rate was 27.8%. Risk factors for mortality were determined as age, APACHE II, RTS, GCS, ISS, TRISS, AKI, PTE by univariate Cox regression analysis and age, RTS, GCS, AKI, PE by multivariate Cox regression analysis (p<0.05).

Conclusion: Major trauma is an important cause of mortality due to both itself and complications occurring during ICU treatment. AKI and PE were observed to be complications that increased mortality.

Anahtar Kelimeler

Major Trauma Intensive Care Unit Mortality Complications

Etik Beyan

Etik Kurul Onayı: Ankara Üniversitesi Tıp Fakültesi Klinik Araştırmalar Etik Kurul onayı alınmıştır (Tarih: 11.03.2019 ve karar no: 05-392-19). Hasta Onayı: Retrospektif çalışmadır. Hakem Değerlendirmesi: Editörler kurulunun dışından olan kişiler tarafından değerlendirilmiştir. Yazarlık Katkıları Cerrahi ve Medikal Uygulama: M.K.B., S.K.E., V.B., Konsept: S.K.E., M.K.B., Dizayn: M.K.B., A.A.Y., Veri Toplama veya İşleme: P.K., S.K.E., Analiz veya Yorumlama: S.K.E., M.K.B., A.A.Y., Literatür Arama: S.K.E., V.B., P.K., Yazan: S.K.E., M.K.B., A.A.Y. Çıkar Çatışması: Yazarlar tarafından çıkar çatışması bildirilmemiştir. Finansal Destek: Yazarlar bu çalışma için mali destek almadıklarını beyan etmişlerdir.

Destekleyen Kurum

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Proje Numarası

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Teşekkür

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Kaynakça

  • 1. Krug EG, Sharma GK, Lozano R. The global burden of injuries. Am J Public Health. 2000;90:523-526.
  • 2. Domingues CA, Coimbra R, Poggetti RS, et al. New Trauma and Injury Severity Score (TRISS) adjustments for survival prediction. World J Emerg Surg. 2018;13:12.
  • 3. Kehoe A, Smith JE, Edwards A, et al. The changing face of major trauma in the UK. Emerg Med J. 2015;32:911-915.
  • 4. Prin M, Li G. Complications and in-hospital mortality in trauma patients treated in intensive care units in the United States, 2013. Inj Epidemiol. 2016;3:18.
  • 5. Mondello S, Cantrell A, Italiano D, et al. Complications of trauma patients admitted to the ICU in level I academic trauma centers in the United States. Biomed Res Int. 2014;2014:473419.
  • 6. Shafi S, Barnes S, Nicewander D, et al. Health care reform at trauma centers--mortality, complications, and length of stay. J Trauma. 2010;69:1367-1371.
  • 7. Ingraham AM, Xiong W, Hemmila MR, et al. The attributable mortality and length of stay of trauma-related complications: a matched cohort study. Ann Surg. 2010;252:358-362.
  • 8. Busse JW, Bhandari M, Devereaux PJ. The impact of time of admission on major complications and mortality in patients undergoing emergency trauma surgery. Acta Orthop Scand. 2004;75:333-338.
  • 9. Harrois A, Soyer B, Gauss T, et al. Prevalence and risk factors for acute kidney injury among trauma patients: a multicenter cohort study. Crit Care. 2018;22:344.
  • 10. Bahloul M, Chaari A, Dammak H, et al. Post-traumatic pulmonary embolism in the intensive care unit. Ann Thorac Med. 2011;6:199-206.
  • 11. Gudipati S, Fragkakis EM, Ciriello V, et al. A cohort study on the incidence and outcome of pulmonary embolism in trauma and orthopedic patients. BMC Med. 2014;12:39.
  • 12. Ho KM, Burrell M, Rao S, et al. Incidence and risk factors for fatal pulmonary embolism after major trauma: a nested cohort study. Br J Anaesth. 2010;105:596-602.
  • 13. Dezman ZDW, Comer AC, Smith GS, et al. Repeat lactate level predicts mortality better than rate of clearance. Am J Emerg Med. 2018;36:2005-2009.
  • 14. Halvachizadeh S, Baradaran L, Cinelli P, et al. How to detect a polytrauma patient at risk of complications: A validation and database analysis of four published scales. PLoS One. 2020;15:0228082.
  • 15. Moore HB, Moore EE, Liras IN, et al. Targeting resuscitation to normalization of coagulating status: Hyper and hypocoagulability after severe injury are both associated with increased mortality. Am J Surg. 2017;214:1041-1045.
  • 16. Yousefzadeh-Chabok S, Hosseinpour M, Kouchakinejad-Eramsadati L, et al. Comparison of Revised Trauma Score, Injury Severity Score and Trauma and Injury Severity Score for mortality prediction in elderly trauma patients. Ulus Travma Acil Cerrahi Derg. 2016;22:536-540.
  • 17. Paffrath T, Lefering R, Flohé S; Trauma Register DGU. How to define severely injured patients? -- an Injury Severity Score (ISS) based approach alone is not sufficient. Injury. 2014;45:64-69.
  • 18. Waydhas C, Bieler D, Hamsen U, et al. ISS alone, is not sufficient to correctly assign patients post hoc to trauma team requirement. Eur J Trauma Emerg Surg. 2020 Jun 16.
  • 19. Roden-Foreman JW, Rapier NR, Foreman ML, et al. Rethinking the definition of major trauma: The need for trauma intervention outperforms Injury Severity Score and Revised Trauma Score in 38 adult and pediatric trauma centers. J Trauma Acute Care Surg. 2019;87:658-665.
  • 20. Korkmaz Toker M, Gülleroğlu A, Karabay AG, ve ark. SAPS III or APACHE IV: Which score to choose for acute trauma patients in intensive care unit? Ulus Travma Acil Cerrahi Derg. 2019;25:247-252.
  • 21. Darbandsar Mazandarani P, Heydari K, Hatamabadi H, et al. Acute Physiology and Chronic Health Evaluation (APACHE) III Score compared to Trauma-Injury Severity Score (TRISS) in Predicting Mortality of Trauma Patients. Emerg (Tehran). 2016;4:88-91.
  • 22. Dossett LA, Redhage LA, Sawyer RG, et al. Revisiting the validity of APACHE II in the trauma ICU: improved risk stratification in critically injured adults. Injury. 2009;40:993-998.
  • 23. Adams SD, Cotton BA, McGuire MF, et al. Unique pattern of complications in elderly trauma patients at a Level I trauma center. J Trauma Acute Care Surg. 2012;72:112-118.
  • 24. Kirshenbom D, Ben-Zaken Z, Albilya N, et al. Older Age, Comorbid Illnesses, and Injury Severity Affect Immediate Outcome in Elderly Trauma Patients. J Emerg Trauma Shock. 2017;10:146-150.
  • 25. Wang CY, Chen YC, Chien TH, et al. Impact of comorbidities on the prognoses of trauma patients: Analysis of a hospital-based trauma registry database. PLoS One. 2018;13:0194749.
  • 26. Lai CH, Chen KH, Wang CH, et al. Comparison of mortality among severe trauma patients treated in a trauma centre versus a non-trauma centre. Hong Kong J Emergency Med. 2017;24:18-24.
  • 27. Harnod D, Chen R-J, Chang WH, et al. Mortality factors in major trauma patients: nation-wide population-based research in Taiwan. Int J Gerontol. 2014;8:18-21

Yıl 2021, Cilt: 74 Sayı: 1, 104 - 111, 29.04.2021

Süheyla Karadağ Erkoç

Öz

Proje Numarası

-

Kaynakça

  • 1. Krug EG, Sharma GK, Lozano R. The global burden of injuries. Am J Public Health. 2000;90:523-526.
  • 2. Domingues CA, Coimbra R, Poggetti RS, et al. New Trauma and Injury Severity Score (TRISS) adjustments for survival prediction. World J Emerg Surg. 2018;13:12.
  • 3. Kehoe A, Smith JE, Edwards A, et al. The changing face of major trauma in the UK. Emerg Med J. 2015;32:911-915.
  • 4. Prin M, Li G. Complications and in-hospital mortality in trauma patients treated in intensive care units in the United States, 2013. Inj Epidemiol. 2016;3:18.
  • 5. Mondello S, Cantrell A, Italiano D, et al. Complications of trauma patients admitted to the ICU in level I academic trauma centers in the United States. Biomed Res Int. 2014;2014:473419.
  • 6. Shafi S, Barnes S, Nicewander D, et al. Health care reform at trauma centers--mortality, complications, and length of stay. J Trauma. 2010;69:1367-1371.
  • 7. Ingraham AM, Xiong W, Hemmila MR, et al. The attributable mortality and length of stay of trauma-related complications: a matched cohort study. Ann Surg. 2010;252:358-362.
  • 8. Busse JW, Bhandari M, Devereaux PJ. The impact of time of admission on major complications and mortality in patients undergoing emergency trauma surgery. Acta Orthop Scand. 2004;75:333-338.
  • 9. Harrois A, Soyer B, Gauss T, et al. Prevalence and risk factors for acute kidney injury among trauma patients: a multicenter cohort study. Crit Care. 2018;22:344.
  • 10. Bahloul M, Chaari A, Dammak H, et al. Post-traumatic pulmonary embolism in the intensive care unit. Ann Thorac Med. 2011;6:199-206.
  • 11. Gudipati S, Fragkakis EM, Ciriello V, et al. A cohort study on the incidence and outcome of pulmonary embolism in trauma and orthopedic patients. BMC Med. 2014;12:39.
  • 12. Ho KM, Burrell M, Rao S, et al. Incidence and risk factors for fatal pulmonary embolism after major trauma: a nested cohort study. Br J Anaesth. 2010;105:596-602.
  • 13. Dezman ZDW, Comer AC, Smith GS, et al. Repeat lactate level predicts mortality better than rate of clearance. Am J Emerg Med. 2018;36:2005-2009.
  • 14. Halvachizadeh S, Baradaran L, Cinelli P, et al. How to detect a polytrauma patient at risk of complications: A validation and database analysis of four published scales. PLoS One. 2020;15:0228082.
  • 15. Moore HB, Moore EE, Liras IN, et al. Targeting resuscitation to normalization of coagulating status: Hyper and hypocoagulability after severe injury are both associated with increased mortality. Am J Surg. 2017;214:1041-1045.
  • 16. Yousefzadeh-Chabok S, Hosseinpour M, Kouchakinejad-Eramsadati L, et al. Comparison of Revised Trauma Score, Injury Severity Score and Trauma and Injury Severity Score for mortality prediction in elderly trauma patients. Ulus Travma Acil Cerrahi Derg. 2016;22:536-540.
  • 17. Paffrath T, Lefering R, Flohé S; Trauma Register DGU. How to define severely injured patients? -- an Injury Severity Score (ISS) based approach alone is not sufficient. Injury. 2014;45:64-69.
  • 18. Waydhas C, Bieler D, Hamsen U, et al. ISS alone, is not sufficient to correctly assign patients post hoc to trauma team requirement. Eur J Trauma Emerg Surg. 2020 Jun 16.
  • 19. Roden-Foreman JW, Rapier NR, Foreman ML, et al. Rethinking the definition of major trauma: The need for trauma intervention outperforms Injury Severity Score and Revised Trauma Score in 38 adult and pediatric trauma centers. J Trauma Acute Care Surg. 2019;87:658-665.
  • 20. Korkmaz Toker M, Gülleroğlu A, Karabay AG, ve ark. SAPS III or APACHE IV: Which score to choose for acute trauma patients in intensive care unit? Ulus Travma Acil Cerrahi Derg. 2019;25:247-252.
  • 21. Darbandsar Mazandarani P, Heydari K, Hatamabadi H, et al. Acute Physiology and Chronic Health Evaluation (APACHE) III Score compared to Trauma-Injury Severity Score (TRISS) in Predicting Mortality of Trauma Patients. Emerg (Tehran). 2016;4:88-91.
  • 22. Dossett LA, Redhage LA, Sawyer RG, et al. Revisiting the validity of APACHE II in the trauma ICU: improved risk stratification in critically injured adults. Injury. 2009;40:993-998.
  • 23. Adams SD, Cotton BA, McGuire MF, et al. Unique pattern of complications in elderly trauma patients at a Level I trauma center. J Trauma Acute Care Surg. 2012;72:112-118.
  • 24. Kirshenbom D, Ben-Zaken Z, Albilya N, et al. Older Age, Comorbid Illnesses, and Injury Severity Affect Immediate Outcome in Elderly Trauma Patients. J Emerg Trauma Shock. 2017;10:146-150.
  • 25. Wang CY, Chen YC, Chien TH, et al. Impact of comorbidities on the prognoses of trauma patients: Analysis of a hospital-based trauma registry database. PLoS One. 2018;13:0194749.
  • 26. Lai CH, Chen KH, Wang CH, et al. Comparison of mortality among severe trauma patients treated in a trauma centre versus a non-trauma centre. Hong Kong J Emergency Med. 2017;24:18-24.
  • 27. Harnod D, Chen R-J, Chang WH, et al. Mortality factors in major trauma patients: nation-wide population-based research in Taiwan. Int J Gerontol. 2014;8:18-21
Toplam 27 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Anesteziyoloji
Bölüm Makaleler
Yazarlar

Süheyla Karadağ Erkoç 0000-0001-5086-5916

Proje Numarası -
Yayımlanma Tarihi 29 Nisan 2021
Yayımlandığı Sayı Yıl 2021 Cilt: 74 Sayı: 1

Kaynak Göster

APA Karadağ Erkoç, S. (2021). Trauma-related Admissions to Intensive Care Unit: Single Center Experience for Major Trauma. Ankara Üniversitesi Tıp Fakültesi Mecmuası, 74(1), 104-111. https://doi.org/10.4274/atfm.galenos.2020.62534
AMA Karadağ Erkoç S. Trauma-related Admissions to Intensive Care Unit: Single Center Experience for Major Trauma. Ankara Üniversitesi Tıp Fakültesi Mecmuası. Nisan 2021;74(1):104-111. doi:10.4274/atfm.galenos.2020.62534
Chicago Karadağ Erkoç, Süheyla. “Trauma-Related Admissions to Intensive Care Unit: Single Center Experience for Major Trauma”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 74, sy. 1 (Nisan 2021): 104-11. https://doi.org/10.4274/atfm.galenos.2020.62534.
EndNote Karadağ Erkoç S (01 Nisan 2021) Trauma-related Admissions to Intensive Care Unit: Single Center Experience for Major Trauma. Ankara Üniversitesi Tıp Fakültesi Mecmuası 74 1 104–111.
IEEE S. Karadağ Erkoç, “Trauma-related Admissions to Intensive Care Unit: Single Center Experience for Major Trauma”, Ankara Üniversitesi Tıp Fakültesi Mecmuası, c. 74, sy. 1, ss. 104–111, 2021, doi: 10.4274/atfm.galenos.2020.62534.
ISNAD Karadağ Erkoç, Süheyla. “Trauma-Related Admissions to Intensive Care Unit: Single Center Experience for Major Trauma”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 74/1 (Nisan 2021), 104-111. https://doi.org/10.4274/atfm.galenos.2020.62534.
JAMA Karadağ Erkoç S. Trauma-related Admissions to Intensive Care Unit: Single Center Experience for Major Trauma. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2021;74:104–111.
MLA Karadağ Erkoç, Süheyla. “Trauma-Related Admissions to Intensive Care Unit: Single Center Experience for Major Trauma”. Ankara Üniversitesi Tıp Fakültesi Mecmuası, c. 74, sy. 1, 2021, ss. 104-11, doi:10.4274/atfm.galenos.2020.62534.
Vancouver Karadağ Erkoç S. Trauma-related Admissions to Intensive Care Unit: Single Center Experience for Major Trauma. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2021;74(1):104-11.
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