Hypothermia and associated outcomes in seriously injured trauma patients in a predominantly sub-tropical climate

Aim

This study aimed to determine factors linked to hypothermia (<35 °C) in Queensland trauma patients. The relationship of hypothermia with mortality, admission to intensive care and hospital length of stay was also explored.

Methods

A retrospective analysis of data from the Queensland Trauma Registry was undertaken, and included all patients admitted to hospital for ≥24 h during 2003 and 2004 with an injury severity score (ISS) > 15. Demographic, injury, environmental, care and clinical status factors were considered.

Results

A total of 2182 patients were included; 124 (5.7%) had hypothermia on admission to the definitive care hospital, while a further 156 (7.1%) developed hypothermia during hospitalisation. Factors associated with hypothermia on admission included winter, direct admission to a definitive care hospital, an ISS ≥ 40, a Glasgow Coma Scale of 3 or ventilated and sedated, and hypotension on admission. Hypothermia on admission to the definitive care hospital was an independent predictor of mortality (odds ratio [OR] = 4.05; 95% confidence interval [CI] 2.26–7.24) and hospital length of stay (incidence rate ratio [IRR] = 1.22; 95% CI 1.03–1.43). Hypothermia during definitive care hospitalisation was independently associated with mortality (OR = 2.52; 95% CI 1.52–4.17), intensive care admission (OR = 1.73; 95% CI 1.20–2.93) and hospital length of stay (IRR = 1.18; 95% CI 1.02–1.36).

Conclusions

Trauma patients in a predominantly sub-tropical climate are at risk of accidental and endogenous hypothermia, with associated higher mortality and care requirements. Prevention of hypothermia is important for all severely injured patients.     

Mortality among seriously injured patients treated in remote rural trauma centers before and after implementation of a statewide trauma system.

BACKGROUND: Injury mortality in rural regions remains high with little evidence that trauma system implementation has benefited rural populations. OBJECTIVE: To evaluate risk-adjusted mortality in remote regions of Oregon before and after implementation of a statewide trauma system. RESEARCH DESIGN: A retrospective cohort study assessing injury mortality through 30 days after hospital discharge. SETTING: Nine rural Oregon hospitals serving counties with populations <18 persons per square mile. SUBJECTS: Severely injured patients presenting to four level-3 and five level-4 trauma hospitals 3 years before and 3 years after trauma system implementation. MEASURES: Interhospital transfer, hospital death, and demise within 30 days following hospital discharge. RESULTS: A total of 940 patients were analyzed. After trauma system implementation, patients presenting to level-4 hospitals were more likely transferred to level-2 facilities (P <0.001). Interhospital transfer times from level-3 hospitals lengthened significantly after system implementation (P <0.001). Overall mortality rates were higher in the postsystem period (8.3%) than the presystem period (6.7%), but not significantly. Controlling for covariates, no additional benefit to risk-adjusted mortality was associated with trauma system implementation. Additional deaths, occurring after trauma system implementation, included head-injured patients transferred from rural hospitals to nonlevel-1 trauma center hospitals. CONCLUSIONS: Increased injury survival after Oregon trauma system implementation, demonstrated in urban and statewide analyses, was not confirmed in remote regions of the state. Efforts to improve trauma systems in rural areas should focus on the processes of care for head-injured patients transferred to higher designation trauma centers.     

Evaluation of geriatric patients with trauma scores after motor vehicle trauma

IntroductionThe aim of this study was to investigate the factors affecting in-hospital mortality among geriatric trauma patients who presented to the emergency department (ED) following a motor vehicle collision.MethodsA retrospective cohort study was carried out in a high-volume tertiary care facility in the central Anatolian Region. Clinical data were extracted from hospital databases for all eligible geriatric patients (either driver, passenger or pedestrian) with entries dated between January 1, 2007, and December 31, 2009. Multivariate logistic regression analysis was used to assess the in-hospital mortality effects of variables including demographic characteristics, trauma mechanisms, injured body parts and various trauma scores.ResultsThere were 395 geriatric motor vehicle trauma presentations to the ED during the 3-year period. Of these patients, 371 (93.9%) survived, and 24 (6.1%) died in the ED, operating room or intensive care unit. The multivariate logistic regression model included the following variables: heart failure, cranial trauma, abdominal trauma, thoracic trauma, pelvic trauma, Glasgow Coma Score and Injury Severity Score (ISS). These variables were chosen because univariate analysis indicated that they were potential predictors of mortality. The multivariate logistic regression showed that the presence of heart failure (OR: 20.2), cranial trauma (OR: 3.6), abdominal trauma (OR: 26.9), pelvic trauma (OR: 9.9) and ISS (OR: 1.2) were predictors of in-hospital mortality in the study population.ConclusionIn our study, heart failure, cranial trauma, abdominal trauma, pelvic trauma, and ISS were found to be the most important predictors of in-hospital mortality among geriatric motor vehicle trauma patients.     

Hypothermia for prediction of death in severely injured blunt trauma patients

Hypothermia is considered an independent predictor of death after trauma. The aim of this study was to assess these premises based on data from the TraumaRegistry DGU? (TR-DGU) using its outcome predication tool, the Revised Injury Severity Classification (RISC) score, in comparison with three previously published regression models by Shafi, Martin, and Wang. We hypothesized that body temperature on admission would improve accuracy of the RISC score. Data of 5,197 patients with documented body temperature on admission (T) and complete data for RISC score prognosis were selected from TR-DGU. Hypothermia was defined as T of 35°C or less. Patients were divided into hypothermia and normothermia group. Differences were assessed using Mann-Whitney U and chi-squared tests. Statistical significance was accepted at P < 0.01(*). Moreover, we performed multivariate logistic regression analyses using TR-DGU data on the four models (including RISC) with hospital mortality as dependant variable. Results are given as mean or odds ratio (OR) with 95% confidence intervals (95% CIs). Hypothermic patients were more severely injured (Injury Severity Score, 35.0 vs. 29.2 points*) and had higher rates of shock (38.3 vs. 16.8%*), organ failure (71.8 vs. 46%*), and sepsis (17.5 vs. 10.6%*). Survival was worse (29.2 vs. 13.7%*). Comparison of the above models revealed hypothermia as an independent risk factor (Martin: OR, 1.43 [95% CI, 2.21-1.42*]; and Wang: OR, 1.77 [95% CI, 2.21-1.42*]) only, although it would drop out from the model (RISC: OR, 1.12 [95% CI, 1.41-0.89; P = 0.33] and Shafi: OR, 1,.21 [95% CI, 1.60-0.92; P = 0.17]) as long as parameters to indicate hemorrhage and/or coagulopathy were included in sufficient number, a finding confirmed by a subsequent sensitivity analysis. We conclude that hypothermia is a result of injury severity and therefore unlikely to be an independent predictor of mortality. Our data suggest that hypothermia belongs closely to the hemorrhage/coagulopathy group of predictors.     

Characteristics and outcomes of trauma patients with ICU lengths of stay 30 days and greater: a seven-year retrospective study

Introduction  

Prolonged intensive care unit lengths of stay (ICU LOS) for critical illness can have acceptable mortality rates and quality of life despite significant costs. Only a few studies have specifically addressed prolonged ICU LOS after trauma. Our goals were to examine characteristics and outcomes of trauma patients with LOS ≥ 30 days, predictors of prolonged stay and mortality.     

1例地震伤致植物生存状态患者的护理

探讨对植物生存状态患者实施整体护理后的效果.对一例由5.12汶川地震致植物生存状态患者从预防并发症、长期坚持促醒护理、家属健康教育并参与护理等方面对患者实施有针对性的整体护理,使患者得到最大程度的康复.经过近2年的治疗和护理,患者目前为止无尿路感染、肺部感染、褥疮等并发症发生,并且由最初的护理人员照顾模式成功转型为家属照顾模式,有利于患者更好地回归家庭、回归社会.对植物生存状态患者实施有针对性的整体护理,并对患者家属实施有效的心理护理及健康教育,有助于促进患者的全面康复,预防并发症,改善患者及家属的生活质量,维持家庭的社会功能,降低医疗消耗.     

1例地震伤致植物生存状态患者的护理

探讨对植物生存状态患者实施整体护理后的效果.对一例由5.12汶川地震致植物生存状态患者从预防并发症、长期坚持促醒护理、家属健康教育并参与护理等方面对患者实施有针对性的整体护理,使患者得到最大程度的康复.经过近2年的治疗和护理,患者目前为止无尿路感染、肺部感染、褥疮等并发症发生,并且由最初的护理人员照顾模式成功转型为家属照顾模式,有利于患者更好地回归家庭、回归社会.对植物生存状态患者实施有针对性的整体护理,并对患者家属实施有效的心理护理及健康教育,有助于促进患者的全面康复,预防并发症,改善患者及家属的生活质量,维持家庭的社会功能,降低医疗消耗.     

Characteristics of verbal impairment in closed head injured patients

One hundred twenty-five closed head injured postcoma patients in a rehabilitation medicine center underwent standardized aphasia tests to determine the presence and nature of verbal deficits. Mean time since injury for the group was 45 weeks. All patients evidenced linguistic impairment which was only apparent on testing, not in conversation. The population fell into three relatively equally sized groups: classic aphasia, dysarthria accompanied by linguistic deficits, and "subclinical" aphasic deficits. No patient with a history of coma after closed head injury was spared defective performance on selected language tasks. The patient groups reflected a severity continuum ranging from aphasia, the most severely impaired group, to the least impaired, the subclinical aphasia group. Further, closed head injured patients with a history of coma who manifest motor speech impairment (dysarthria) also manifest linguistic processing deficits. The study results suggest that linguistic functions are particularly vulnerable in severe head injury.     

Drug use in motor vehicle drivers presenting to an Australian, adult major trauma centre

Objectives: To determine the drug use in injured Victorian drivers involved in motor vehicle collisions and subsequently transported to a major adult trauma centre in Victoria. Methods: A blood sample was obtained from patients who had been taken to The Alfred Emergency & Trauma Centre (Prahran, Vic., Australia) following a motor vehicle collision. This was performed at the same time and under the same law as compulsory blood screening in Victoria (Section 56 of the Road Safety Act). Four hundred and thirty‐six specimens were analysed. Blood stored in vacutainer tubes containing preservative were screened for drugs using enzyme‐linked immunosorbent assay and gas chromatography–mass spectometry analysis. Medically administered drugs were excluded from the results. Results: Four hundred and thirty‐six specimens were analysed. Metabolites of cannabis were the most commonly found drug (46.7%), the active form of cannabis (Δ9‐tetrahydrocannabinol) was found in 33 specimens (7.6%). The next most prevalent drugs were benzodiazepines (15.6%), opiates (11%), amphetamines (4.1%) and methadone (3%). Cocaine was detected in 1.4% of cases. Of the motor vehicle collisions 66% involved males and females of 15–44 years old and Δ9‐tetrahydrocannabinol was almost exclusively found in this age group. In motor vehicle collisions involving older drivers there was an increasing use of benzodiazepines. In women >65 years old 30% were positive for benzodiazepines. Conclusions: Drug usage found in this group of injured drivers was disturbingly high. The introduction of further initiatives to decrease the prevalence of drug use in motor vehicle drivers is required.