Prognostic value of lactate to hematocrit ratio score in patients with severe thoracoabdominal trauma.

BACKGROUND: Significant portion of trauma-related deaths occur in the 1st h; therefore, rapid diagnosis and adequate resuscita-tion in trauma patients are essential preventing mortality. In this study, we aimed to evaluate the role of lactate-to-hematocrite ratio (LHR) score for predicting mortality in patients with severe thoracoabdominal trauma. METHODS: In this retrospective, cross-sectional study, we evaluated patients who applied to the emergency room between January 1, 2016, and December 31, 2019, due to multiple trauma. We measured the blood gas analysis values and LHR score of patients with severe thoracoabdominal trauma included in the study and investigated the effectiveness of the LHR score in predicting mortality. RESULTS: 106 patients with severe thoracoabdominal trauma were included in the study. The 30-day mortality rate of the patients was 42.5% (n=45). Considering the 30-day mortality rates, the initial hematocrit, lactate, base deficit, and LHR score were statistically different between patients who died and survived. When the cutoff value for the LHR score was taken as 0.187 on the ROC curve to distinguish mortality, the sensitivity was found to be 77.8%, specificity to be 90.2%. CONCLUSION: LHR score is an effective parameter with high sensitivity and specificity in predicting mortality in patients with severe thoracoabdominal trauma.

Attention: Cardiac contusion.

BACKGROUND: The objective of the study is to investigate diagnostic and clinical processes performed for cardiac contusion in patients with blunt thoracic trauma. METHODS: This study was conducted retrospectively on 65 patients admitted with isolated blunt thoracic trauma to the Emergency Medicine Department. The CT images, the cardiac enzyme levels, the periodic 4-h follow-up electrocardiography (ECGs) in the emer-gency department, and the results of echocardiography, performed at admission and when required according to the clinical status, were investigated. The 1-h and 4-h high-sensitivity troponin I levels were studied, and values above 0.04 ng/ml were considered as positive. RESULTS: Sixty-five patients with isolated thoracic trauma were included in the study, 23 (35.38%) had pulmonary and cardiac contu-sions both. In 23 (35.38%) patients, pulmonary contusion had been present, and cardiac contusion had not been identified at the initial evaluation. However, during clinical follow-up, troponin became positive, dysrhythmia developed, and the trauma affected the heart in four of these patients. In six (9.24%) patients, cardiac contusion was identified without pulmonary contusion. In 13 (20%) patients, no cardiac or pulmonary contusion was identified. troponin elevation was detected in 10 patients without a diagnosis of cardiac contusion who had a pulmonary contusion, hemothorax, and/or pneumothorax at the time of hospital admission and then with normal troponin levels at 4-h control. We found that there was a statistical agreement between cardiac contusion and troponin-ECG results at 4th h. CONCLUSION: We advise that all blunt thoracic trauma patients should be screened for cardiac contusion by continuous ECG monitoring and troponin levels.