ABSTRACT
This study aimed to evaluate non-survivors who were admitted to a level I trauma center but later died, in terms of predicting who would expire early vs late. This is a single-center study of Trauma Registry data, from July 3, 2016, to February 24, 2022. The inclusion criteria were based upon age (≥18 years) and in-hospital mortality. 546 patients (mean age 58) were included in the analysis. Trauma patients who may experience an earlier death were those with increasing injury severity scores, activation of massive transfusion protocol, comorbid advanced directive limiting care, COPD, personality disorder, and ED death location. Patients were more likely to experience later in-hospital mortality, including those with increasing ICU stays, and comorbid dementia.
Subject(s)
Blood Transfusion , Wounds and Injuries , Humans , Middle Aged , Adolescent , Hospital Mortality , Injury Severity Score , Hospitalization , Trauma Centers , Wounds and Injuries/therapy , Retrospective StudiesABSTRACT
BACKGROUND: Massive transfusion (MT) is required to resuscitate traumatically injured patients with complex derangements. Scoring systems for MT typically require laboratory values and radiological imaging that may delay the prediction of MT. STUDY DESIGN: The Trauma ALgorithm Examining the Risk of massive Transfusion (Trauma ALERT) study was an observational cohort study. Prehospital and admission ALERT scores were constructed with logistic regression of prehospital and admission vitals, and FAST examination results. Internal validation was performed with bootstrap analysis and cross-validation. RESULTS: The development cohort included 2,592 patients. Seven variables were included in the prehospital ALERT score: systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), respiratory rate (RR), SpO2, motor Glasgow Coma Scale (GCS) score, and penetrating mechanism. Eight variables from 2,307 patients were included in the admission ALERT score: admission SBP, HR, RR, GCS score, temperature, FAST examination result, and prehospital SBP and DBP.The area under the receiving operator characteristic curve for the prehospital and admission models were 0.754 (95% bootstrapped CI 0.735-0.794, Pâ<â0.001) and 0.905 (95% bootstrapped CI 0.867-0.923, Pâ<â0.001), respectively. The prehospital ALERT score had equivalent diagnostic accuracy to the ABC score (Pâ=â0.97), and the admission ALERT score outperformed both the ABC and the prehospital ALERT scores (Pâ<â0.0001). CONCLUSION: The prehospital and admission ALERT scores can accurately predict massive transfusion in trauma patients without the use of time-consuming laboratory studies, although prospective studies need to be performed to validate these findings. Early identification of patients who will require MT may allow for timely mobilization of scarce resources and could benefit patients by making blood products available for treating hemorrhagic shock.
Subject(s)
Algorithms , Blood Transfusion , Emergency Medical Services , Shock, Hemorrhagic/therapy , Wounds and Injuries/complications , Adult , Blood Pressure , Female , Hospitalization , Humans , Male , Middle Aged , Predictive Value of Tests , ROC Curve , Retrospective Studies , Risk Assessment , Shock, Hemorrhagic/etiology , Trauma Centers , Trauma Severity Indices , Wounds and Injuries/therapyABSTRACT
The use of local anesthetics for improved pain management is well established. However, significant morbidity may be caused by local anesthetic systemic toxicity (LAST) from inadvertent intravascular injection or excessive dosing of local anesthetics. Despite incomplete understanding of the mechanism of action of intravenous lipid emulsions (ILE), their use has become a first-line therapy for treating LAST. We present a case report of LAST, successfully treated with ILE with a secondary effect of complete reversal of a successful peripheral nerve block as quickly as the LAST symptoms resolved.
