|
1
|
Seo GY, Das A, Manzanero S, Kim K, Lisec C, Muller M. The influence of pre-injury anticoagulant or antiplatelet agents on outcomes in trauma patients sustaining abdominal solid organ injuries: A scoping review. Injury 2025; 56:112175. [PMID: 39842106 DOI: 10.1016/j.injury.2025.112175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Revised: 01/16/2025] [Accepted: 01/16/2025] [Indexed: 01/24/2025]
Abstract
BACKGROUND Indications for, and usage of, anticoagulant (AC) and antiplatelet (AP) agents is increasing. In this context, it is important to understand the evidence base of the effect of pre-injury AC/AP agents on patient outcomes in the context of traumatic solid organ injury (SOI) to inform management protocols. METHODS A scoping review of the literature was undertaken with a systematic search strategy within the PubMed and Scopus databases. Study characteristics, clinical outcomes and outcome measures including mortality, hospital length of stay, admission to intensive care units, length of stay in intensive care and management details were extracted from included studies. RESULTS The search identified six eligible studies reporting results from a total of 26,960 patients. Patients on AC/AP are more likely to fail non-operative management (NOM) than their non-AC/AP counterparts; at the same time, they are less likely to be operated on as a first line of management. Clinical outcome measures (mortality, length of stay, admission to intensive care units, and length of intensive care unit stay) were heterogeneous across studies, but it is likely that AC/AP patients have poorer outcomes in SOI. Results on transfusion requirements were inconclusive. CONCLUSION Few studies have examined the effect of pre-injury anticoagulation on outcomes in trauma patients sustaining solid organ injuries. Future studies should more closely examine solid organ trauma within the elderly group, as well as the effect of newer AC/AP agents in current use.
Collapse
Affiliation(s)
- Gi Young Seo
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Department of General Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Arpita Das
- Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Silvia Manzanero
- Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia; Australian Institute of Bioengineering and Nanotechnology, University of Queensland, Brisbane, Queensland, Australia
| | - Keeyeon Kim
- Department of General Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Carl Lisec
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Department of General Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Trauma Service, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Michael Muller
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Department of General Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Trauma Service, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
| |
Collapse
|
|
2
|
Ghneim MH, Stein DM. Age-related disparities in older adults in trauma. Surgery 2024; 176:1771-1773. [PMID: 39317516 DOI: 10.1016/j.surg.2024.08.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 07/06/2024] [Accepted: 08/18/2024] [Indexed: 09/26/2024]
Abstract
As the population of older adults (≥65 years of age) continues to grow, the incidence of traumatic injuries in this demographic is also increasing nationwide. It has been well established that older adults experience worse outcomes, that is, an increased morbidity and mortality, when compared to younger adults. Moreover, survivors often experience accelerated cognitive and functional decline, loss of independence, and recurring injuries and hospitalizations. This manuscript examines the multifaceted challenges and disparities faced by older adults in trauma care. Factors such as age-related physiological changes, racial disparities, access to health care, and structural ageism that contribute to poor outcomes in geriatric patients who experience trauma. This is exacerbated by the sparsity of geriatric-specific practice management guidelines, thier poor implementation, and the critical under-representation of older adults in trauma research. However, significant efforts are being made to improve the care of older adults, including geriatric patients who experience trauma, through age-friendly systems, and initiatives aimed at promoting inclusive and effective care. These endeavors hold promise for a future where trauma care for older adults is comprehensive and equitable.
Collapse
Affiliation(s)
- Mira H Ghneim
- Program in Trauma, University of Maryland School of Medicine, R Adam Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD.
| | - Deborah M Stein
- Program in Trauma, University of Maryland School of Medicine, R Adam Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD. https://twitter.com/SteinSister
| |
Collapse
|
|
3
|
Halter M, Jarman H, Moss P, Kulnik ST, Baramova D, Gavalova L, Cole E, Crouch R, Baxter M. Configurations and outcomes of acute hospital care for frail and older patients with moderate to major trauma: a systematic review. BMJ Open 2023; 13:e066329. [PMID: 36810176 PMCID: PMC9944672 DOI: 10.1136/bmjopen-2022-066329] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/15/2022] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVE To systematically review research on acute hospital care for frail or older adults experiencing moderate to major trauma. SETTING Electronic databases (Medline, Embase, ASSIA, CINAHL Plus, SCOPUS, PsycINFO, EconLit, The Cochrane Library) were searched using index and key words, and reference lists and related articles hand-searched. INCLUDED ARTICLES Peer-reviewed articles of any study design, published in English, 1999-2020 inclusive, referring to models of care for frail and/or older people in the acute hospital phase of care following traumatic injury defined as either moderate or major (mean or median Injury Severity Score ≥9). Excluded articles reported no empirical findings, were abstracts or literature reviews, or referred to frailty screening alone. METHODS Screening abstracts and full text, and completing data extractions and quality assessments using QualSyst was a blinded parallel process. A narrative synthesis, grouped by intervention type, was undertaken. OUTCOME MEASURES Any outcomes reported for patients, staff or care system. RESULTS 17 603 references were identified and 518 read in full; 22 were included-frailty and major trauma (n=0), frailty and moderate trauma (n=1), older people and major trauma (n=8), moderate or major trauma (n=7) 0r moderate trauma (n=6) . Studies were observational, heterogeneous in intervention and with variable methodological quality.Specific attention given to the care of older and/or frail people with moderate to major trauma in the North American context resulted in improvements to in-hospital processes and clinical outcomes, but highlights a relative paucity of evidence, particularly in relation to the first 48 hours post-injury. CONCLUSIONS This systematic review supports the need for, and further research into an intervention to address the care of frail and/or older patients with major trauma, and for the careful definition of age and frailty in relation to moderate or major trauma. INTERNATIONAL PROSPECTIVE REGISTER OF SYSTEMATIC REVIEWS PROSPERO: CRD42016032895.
Collapse
Affiliation(s)
- Mary Halter
- Faculty of Health, Social Care and Education, Kingston University and St George's University of London, London, UK
| | - Heather Jarman
- Emergency Department Clinical Research Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Phil Moss
- Emergency department, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Stefan Tino Kulnik
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
| | - Desislava Baramova
- Emergency Department, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Lucia Gavalova
- Faculty of Health, Social Care and Education, Kingston University and St George's University of London, London, UK
| | - Elaine Cole
- Trauma Sciences, Queen Mary University of London, London, UK
| | - Robert Crouch
- Health Sciences, University of Southampton, Southampton, UK
| | - Mark Baxter
- Geriatric Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| |
Collapse
|
|
4
|
Schaffer KB, Wang J, Nasrallah FS, Bayat D, Dandan T, Ferkich A, Biffl WL. Disparities in triage and management of the homeless and the elderly trauma patient. Inj Epidemiol 2020; 7:39. [PMID: 32654664 PMCID: PMC7358191 DOI: 10.1186/s40621-020-00262-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/22/2020] [Indexed: 11/10/2022] Open
Abstract
Background Trauma systems are designed to provide specialized treatment for the most severely injured. As populations change, it is imperative for trauma centers to remain dynamic to provide the best care to all members of the community. Methods A retrospective review of all trauma patients treated at one Level II trauma center in Southern CA over 5 years. Three cohorts of patients were studied: geriatric (> 65 years), the homeless, and all other trauma patients. Triage, hospitalization, and outcomes were collected and analyzed. Results Of 8431 patients treated, 30% were geriatric, 3% homeless and 67% comprised all other patients. Trauma activation criteria was met for 84% of all other trauma patients, yet only 61% of homeless and geriatric patients combined. Injury mechanism for homeless included falls (38%), pedestrian/bicycle related (27%) and assaults (24%), often while under the influence of alcohol and drugs. Average length of hospital stay (LOS) was greater for homeless and geriatric patients and frequently attributed to discharge planning challenges. Both the homeless and geriatric groups demonstrated increased complications, comorbidities, and death rates. Conclusions Homeless trauma patients reflect similar challenges in care as with the elderly, requiring additional resources and more complex case management. It is prudent to identify and understand the issues surrounding patients transported to our trauma center requiring a higher level of care yet are under-triaged upon arrival to the Emergency Department. Although a monthly review is done for all under-triaged patients, and geriatric patients are acknowledged to be a cohort continually having delays, the homeless cohort continues to be under-triaged. The admitted homeless trauma patient has similar complex case management issues as the elderly related to pre-existing health issues and challenges with discharge planning, both which can add to longer lengths of hospital stay as compared to other trauma patients. Given the lack of social support that is endemic to both populations, these cohorts represent a unique challenge to trauma centers. Further research into specialized care is required to determine best practices to address disparities evident in the homeless and elderly, and to promote health equity in marginalized populations.
Collapse
Affiliation(s)
- Kathryn B Schaffer
- Trauma Service, Scripps Memorial Hospital La Jolla, 9888 Genesee Ave., LJ601, La Jolla, CA, 92037, USA.
| | - Jiayan Wang
- Trauma Service, Scripps Memorial Hospital La Jolla, 9888 Genesee Ave., LJ601, La Jolla, CA, 92037, USA
| | - Fady S Nasrallah
- Trauma Service, Scripps Memorial Hospital La Jolla, 9888 Genesee Ave., LJ601, La Jolla, CA, 92037, USA
| | - Dunya Bayat
- Trauma Service, Scripps Memorial Hospital La Jolla, 9888 Genesee Ave., LJ601, La Jolla, CA, 92037, USA
| | - Tala Dandan
- Trauma Service, Scripps Memorial Hospital La Jolla, 9888 Genesee Ave., LJ601, La Jolla, CA, 92037, USA
| | - Anthony Ferkich
- Trauma Service, Scripps Memorial Hospital La Jolla, 9888 Genesee Ave., LJ601, La Jolla, CA, 92037, USA
| | - Walter L Biffl
- Trauma Service, Scripps Memorial Hospital La Jolla, 9888 Genesee Ave., LJ601, La Jolla, CA, 92037, USA
| |
Collapse
|
|
5
|
Bérubé M, Pasquotti T, Klassen B, Brisson A, Tze N, Moore L. Implementation of the best practice guidelines on geriatric trauma care: a Canadian perspective. Age Ageing 2020; 49:227-232. [PMID: 31790137 DOI: 10.1093/ageing/afz153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 10/07/2019] [Accepted: 11/03/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND traumatic injuries are increasingly affecting older patients who are prone to more complications and poorer recovery compared to younger patients. Practices of trauma health care providers therefore need to be adapted to meet the needs of geriatric trauma patients. OBJECTIVE to assess the implementation of the American College of Surgeons best practice guidelines on geriatric trauma management across level I to III Canadian trauma centres. METHODS 69 decision-makers working in Canadian trauma centres were approached to complete a web-based practice survey. Percentages and means were calculated to describe the level of best practice guideline implementation. RESULTS 50 decision-makers completed the survey for a response rate of 72%. Specialised geriatric trauma resources were utilised in 37% of centres. Implementation of mechanisms to evaluate common geriatric issues (e.g. frailty, malnutrition and delirium) varied from 28 to 78% and protocols for the optimisation of geriatric care (e.g. Beers criteria to adjust medication, anticoagulant reversal and early mobilisation) from 8 to 56%. Guideline recommendations were more often implemented in level I and level II trauma centres. The adjustment of trauma team activation criteria to the geriatric population and transition of care protocols were more frequently used by level III centres. CONCLUSION despite the growing number of older patients admitted in Canadian trauma centres annually, the implementation of best practice guidelines on geriatric trauma management is still limited. Prospective multicentre studies are required to develop and evaluate interdisciplinary knowledge translation initiatives that will promote the uptake of guidelines by trauma centres.
Collapse
Affiliation(s)
- Melanie Bérubé
- Faculty of Nursing, Université Laval, Québec City, Québec G1V 0A6, Canada
- Research Center of CHU de Québec, Population Health and Optimal Health Practises Research Unit, Trauma—Emergency—Critical Care Medicine, Québec City, Québec G1V 1Z4, Canada
| | | | - Barbara Klassen
- Hamilton General Hospital, Hamilton, Ontario L8L 2X2, Canada
| | - Angie Brisson
- Vancouver General Hospital, Vancouver, British Columbia V5Z 1M9, Canada
| | - Nancy Tze
- McGill University Health Center, Montreal, Quebec H3G 1A4, Canada
| | - Lynne Moore
- Research Center of CHU de Québec, Population Health and Optimal Health Practises Research Unit, Trauma—Emergency—Critical Care Medicine, Québec City, Québec G1V 1Z4, Canada
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec City, Québec G1V 0A6, Canada
| |
Collapse
|
|
6
|
Ferrah N, Cameron P, Gabbe B, Fitzgerald M, Judson R, Marasco S, Kowalski T, Beck B. Ageing population has changed the nature of major thoracic injury. Emerg Med J 2019; 36:340-345. [DOI: 10.1136/emermed-2018-207943] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 03/13/2019] [Accepted: 03/19/2019] [Indexed: 12/18/2022]
Abstract
IntroductionAn increasing proportion of the major trauma population are older persons. The pattern of injury is different in this age group and serious chest injuries represent a significant subgroup, with implications for trauma system design. The aim of this study was to examine trends in thoracic injuries among major trauma patients in an inclusive trauma system.MethodsThis was a retrospective review of all adult cases of major trauma with thoracic injuries of Abbreviated Injury Scale score of 3 or more, using data from the Victorian State Trauma Registry from 2007 to 2016. Prevalence and pattern of thoracic injury was compared between patients with multitrauma and patients with isolated thoracic injury. Poisson regression was used to determine whether population-based incidence had changed over the study period.ResultsThere were 8805 cases of hospitalised major trauma with serious thoracic injuries. Over a 10-year period, the population-adjusted incidence of thoracic injury increased by 8% per year (incidence rate ratio [IRR] 1.08, 95% CI 1.07 to 1.09). This trend was observed across all age groups and mechanisms of injury. The greatest increase in incidence of thoracic injuries, 14% per year, was observed in people aged 85 years and older (IRR 1.14, 95% CI 1.09 to 1.18).ConclusionsAdmissions for thoracic injuries in the major trauma population are increasing. Older patients are contributing to an increase in major thoracic trauma. This is likely to have important implications for trauma system design, as well as morbidity, mortality and use of healthcare resources.
Collapse
|
|
7
|
Karamanukyan T, Pakula A, Martin M, Francis A, Skinner R. Application of a Geriatric Injury Protocol Demonstrates High Survival Rates for Geriatric Trauma Patients with High Injury Acuity. Am Surg 2017. [DOI: 10.1177/000313481708301022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Geriatric trauma has historically been associated with poor outcomes, particularly in the setting of severe polytrauma. Although geriatric trauma protocols are common, there are limited data on their impact in patients with high injury severity. In this study, we sought to investigate the impact of a geriatric injury protocol on outcomes in patients with severe trauma acuity. Ninety-eight geriatric patients (age ≥65) admitted to our trauma center with injury severity scores (ISS) ≥15 comprised the study cohort. The mean age was 75 ± 7.7 yrs. The mean ISS was 25 ± 9.2, and the mean geriatric trauma outcome score was 150 ± 3. Mortality was 17 per cent and 70 per cent were due to central nervous system injury. When patients with nonsurvivable injuries or advanced directives resulting in early care withdrawal were excluded, the mortality was 6 per cent. Extremes of age did not impact mortality [(>80 years, 21%) vs (65–79, 16%, P = 0.5)]. Most patients (53%) were discharged home. The application of our geriatric trauma protocol led to favorable results despite high injury acuity. These data suggest that even at the extremes of age, a large percentage of patients can be expected to survive. A prospective validation of these findings is warranted.
Collapse
Affiliation(s)
- Tigran Karamanukyan
- Department of Surgery, Trauma Division, Kern Medical, Bakersfield, California
| | - Andrea Pakula
- Department of Surgery, Trauma Division, Kern Medical, Bakersfield, California
| | - Maureen Martin
- Department of Surgery, Trauma Division, Kern Medical, Bakersfield, California
| | - Ashwitha Francis
- Department of Surgery, Trauma Division, Kern Medical, Bakersfield, California
| | - Ruby Skinner
- Department of Surgery, Trauma Division, Kern Medical, Bakersfield, California
| |
Collapse
|
|
8
|
Llompart-Pou JA, Pérez-Bárcena J, Chico-Fernández M, Sánchez-Casado M, Raurich JM. Severe trauma in the geriatric population. World J Crit Care Med 2017; 6:99-106. [PMID: 28529911 PMCID: PMC5415855 DOI: 10.5492/wjccm.v6.i2.99] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 03/03/2017] [Accepted: 03/17/2017] [Indexed: 02/06/2023] Open
Abstract
Geriatric trauma constitutes an increasingly recognized problem. Aging results in a progressive decline in cellular function which leads to a loose of their capacity to respond to injury. Some medications commonly used in this population can mask or blunt the response to injury. Falls constitute the most common cause of trauma and the leading cause of trauma-related deaths in this population. Falls are complicated by the widespread use of antiplatelets and anticoagulants, especially in patients with brain injury. Under-triage is common in this population. Evaluation of frailty could be helpful to solve this issue. Appropriate triaging and early aggressive management with correction of coagulopathy can improve outcome. Limitation of care and palliative measures must be considered in cases with a clear likelihood of poor prognosis.
Collapse
|
|
9
|
Southerland LT, Gure TR, Ruter DI, Li MM, Evans DC. Early geriatric consultation increases adherence to TQIP Geriatric Trauma Management Guidelines. J Surg Res 2017; 216:56-64. [PMID: 28807214 DOI: 10.1016/j.jss.2017.03.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/31/2017] [Accepted: 03/23/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The American College of Surgeons' Trauma Quality Improvement Program (TQIP) Geriatric Trauma Management Guidelines recommend geriatric consultation for injured older adults. However it is not known how or whether geriatric consultation improves compliance to these quality measures. METHODS This study is a retrospective chart review of our institutional trauma databank. Adherence to quality measures was compared before and after implementation of specific triggers for geriatric consultation. Secondary analyses evaluated adherence by service: trauma service (Trauma) or a trauma service with early geriatric consultation (GeriTrauma). RESULTS The average age of the 245 patients was 76.7 years, 47% were women, and mean Injury Severity Score was 9.5 (SD ±8.1). Implementation of the GeriTrauma collaborative increased geriatric consultation rates from 2% to 48% but had minimal effect on overall adherence to TQIP quality measures. A secondary analysis comparing those in the post implementation group who received geriatric consultation (n = 94) to those who did not (n = 103) demonstrated higher rates of delirium diagnosis (36.2% vs 14.6%, P < 0.01) and better documentation of initial living situation, code status, and medication list in the GeriTrauma group. Physical therapy was consulted more frequently for GeriTrauma patients (95.7% vs 68.0%, P < 0.01) Documented goals of care discussions were rare and difficult to abstract. A subgroup analysis of only patients with fall-related injuries demonstrated similar outcomes. CONCLUSIONS Early geriatric consultation increases adherence to TQIP guidelines. Further research into the long term significance and validity of these geriatric trauma quality indicators is needed.
Collapse
Affiliation(s)
| | - Tanya R Gure
- Department of Internal Medicine, Division of General Internal Medicine and Geriatrics, The Ohio State University, Columbus, OH
| | - Daniel I Ruter
- The Ohio State University College of Medicine, Columbus, OH
| | - Michael M Li
- The Ohio State University College of Medicine, Columbus, OH
| | - David C Evans
- Department of Surgery, The Ohio State University, Columbus, OH
| |
Collapse
|
|
10
|
Age and preexisting conditions as risk factors for severe adverse events and failure to rescue after injury. J Surg Res 2016; 205:368-377. [PMID: 27664885 DOI: 10.1016/j.jss.2016.06.082] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 06/01/2016] [Accepted: 06/26/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND Failure to rescue (FTR: the conditional probability of death after complication) has been studied in trauma cohorts, but the impact of age and preexisting conditions (PECs) on risk of FTR is not well known. We assessed the relationship between age and PECs on the risk of experiencing serious adverse events (SAEs) subsequent FTR in trauma patients with the hypothesis that increased comorbidity burden and age would be associated with increased FTR. MATERIALS AND METHODS We performed a retrospective cohort analysis at an urban level 1 trauma center in Pennsylvania. All patients aged ≥16 y with minimum Abbreviated Injury Scale score ≥2 from 2009 to 2013 were included. Univariate logistic regression models for SAE and FTR were developed using age, PECs, demographics, and injury physiology. Variables found to be associated with the end point of interest (P ≤ 0.2) in univariate analysis were included in separate multivariable logistic regression models for each outcome. RESULTS SAE occurred in 1136 of 7533 (15.1 %) patients meeting inclusion criteria (median age 42 [interquartile range 26-59], 53% African-American, 72% male, 79% blunt, median ISS 10 [interquartile range 5-17]). Of those who experienced an SAE, 129 of 1136 patients subsequently died (FTR = 11.4%). Development of SAE and FTR was associated with age ≥ 70 y (odds ratio 1.58-1.78, 95% confidence interval 1.13-2.82). Renal disease was the only preexisting condition associated with both SAE and FTR. CONCLUSIONS Trauma patients with renal disease are mostly at increased risk for both SAE and FTR, but other PECs associated with SAE are not necessarily those associated with FTR. Future interventions designed to reduce FTR events should target this high-risk cohort.
Collapse
|