A comparison of severely injured trauma patients admitted to level 1 trauma centres in Queensland and Germany.

BACKGROUND: The allocation of a trauma network in Queensland is still in the developmental phase. In a search for indicators to improve trauma care both locally as state-wide, a study was carried out comparing trauma patients in Queensland to trauma patients in Germany, a country with 82.4 million inhabitants and a well-established trauma system. METHODS: Trauma patients > or =15 years of age, with an Injury Severity Score (ISS) > or = 16 admitted to the Princess Alexandra Hospital (PAH) and to the 59 German hospitals participating in the Trauma Registry of the German Society for Trauma Surgery (DGU-G) during the year 2005 were retrospectively identified and analysed. RESULTS: Both cohorts are comparable when it comes to demographics and injury mechanism, but differ significantly in other important aspects. Striking is the low number of primary admitted patients in the PAH cohort: 58% versus 83% in the DGU-G cohort. PAH patients were less physiologically deranged and less severely injured: ISS 25.2 +/- 9.9 versus 29.9 +/- 13.1 (P < 0.001). Subsequently, they less often needed surgery (61% versus 79%), ICU admission (49% versus 92%) and had a lower mortality: 9.8% versus 17.9% of the DGU-G cohort. CONCLUSIONS: Relevant differences were the low number of primary admissions, the lesser severity of injuries, and the low mortality of the patients treated at the PAH. These differences are likely to be interrelated and Queensland's size and suboptimal organization of trauma care may have played an important role.

Patients beyond salvation? Various categories of trauma patients with a minimal Glasgow Coma Score.

INTRODUCTION: Trauma patients in an unresponsive state upon presentation to the Emergency Department have a poor prognosis. Rapid assessment of injuries combined with life-preserving therapy is required but defining the optimal strategy can be complicated when multiple organ systems are involved. This study analysed various categories of trauma patients with a Glasgow Coma Scale (GCS) of 3 on admission and evaluated the relation between injuries, clinical condition, treatment and outcome. PATIENTS AND METHODS: A retrospective cohort-study, performed at a level 1 Trauma Center from 2002 to 2005. Trauma patients of all ages with GCS of 3 (without sedation) and Injury Severity Score (ISS) > or = 16 were included. The collected patient data comprised data on demographics, mechanism of injury, physiological condition on admission, diagnosis, ISS, treatment, admission to Intensive Care Unit, complications and outcome. RESULTS: Ninety-seven patients were included and divided into three groups based on the pathology that caused the GCS of 3: traumatic brain injury N=48 (49%), anoxic brain injury N=27 (28%) and haemorrhagic shock N=22 (23%). The overall mortality was 81%; 91% of the haemorrhagic shock patients, 81% of the ABI patients and 77% of the TBI patients died. Eighteen patients survived of whom five patients (5%) made a good recovery. The pupillary light response and pH on admission were related to mortality. No relation with ISS, age or hypothermia was found. DISCUSSION: Distinguishing salvageable patients from those beyond salvation remains problematic. This study illustrated the diversity of patients, their injuries and their condition upon presentation to the hospital as well as the limitations of therapy. CONCLUSION: Trauma patients with a GCS of 3 have a poor outcome. Despite aggressive treatment only 5% of the patients made a good recovery. Pupil reactivity and the pH on admission were found to be related to mortality.

The Value of the Trauma Mechanism in the Triage of Severely Injured Elderly.

BACKGROUND: The triage of trauma patients is currently based on the trauma mechanism. However, it is known that elderly patients can sustain severe injuries due to insignificant trauma mechanisms. As such, triage methods might be questionable. OBJECTIVE: To evaluate whether current trauma triage criteria are appropriate in severely injured elderly patients. METHODS: To analyze the effect of the trauma mechanism on triage and treatment, consecutive patients ≥ 55 years of age, with an injury severity score > 15, treated from 2002 to 2005 were divided into those who sustained a high-energy trauma (HET) versus a low energy trauma (LET). Pre-hospital and in-hospital data, injury characteristics, and data on mortality and disablement one year postinjury (sickness impact profile) were analyzed for HET and LET groups. RESULTS: Age, sex and co-morbidity rate were similar in 84 HET patients and 107 LET patients. HET patients (mean ISS 28) received more sophisticated trauma care than LET patients (mean ISS 22), although mortality was similar (38 vs. 34%). Long-term disablement was also similar (median SIP scores 4 vs. 6). Severe head injuries and the Revised Trauma Score were related to mortality. Physical disablement was related to preexisting co-morbidities. No variables were related to psychosocial disablement. CONCLUSIONS: In elderly people a low energy trauma may lead to severe consequences. Not only the trauma mechanism, but also age, co-morbidity, and the likelihood of a brain injury should be leading in the triage and subsequent management of severely injured elderly.

Two cohorts of severely injured trauma patients, nearly two decades apart: unchanged mortality but improved quality of life despite higher age.

BACKGROUND: The care for trauma patients has undergone major changes during the last decades. Additionally, many injury prevention measures have been established. The objective of these efforts was to reduce the number of traumatic incidents and to reduce mortality and morbidity in injured patients. The aim of our study was to assess how these measures and improved care have altered trauma mechanisms, occurrence of injuries, treatment, and outcome in the trauma population treated at our trauma center. METHODS: Two cohorts of trauma patients with an Injury Severity Score >15, treated at the University Medical Center Groningen were compared. The first cohort was treated from 1985 to 1990, the second cohort from September 2002 to January 2005. RESULTS: The annual mean number of severely injured patients increased by 76%. Fourteen percent more patients had sustained an injury at home. The mean age increased from 33 +/- 22 years to 41 +/- 23 years. The presence of severe head and neck injuries in the patients increased from 62% to 73%. Inhospital mortality remained unchanged at 25%. The outcome of survivors improved; 67% of patients made a moderate or good recovery versus 40% almost 20 years ago. CONCLUSIONS: Striking are the consequences of the aging of the Dutch population: an almost 10-year increase in mean age and a rise in severe head and neck injuries in the population treated at our trauma center. The unchanged mortality and improved outcome of survivors represented the enhanced trauma care.

Myth or reality: hematocrit and hemoglobin differ in trauma.

BACKGROUND: Estimating blood loss in trauma patients usually involves the determination of hematocrit (Ht) or hemoglobin (Hb). However, in trauma patients, a poorly substantiated habit exists to determine both Ht and Hb in assessing acute blood loss. This suggests that Ht and Hb provide different information. Moreover, a survey of the literature showed a significant association of the subject trauma with the use of Ht. We investigated whether Ht and Hb differ in trauma patients. METHODS: Trauma patients with an Injury Severity Score>15 admitted from 1996 to 2004 to the University Medical Center Groningen were analyzed. All blood samples obtained during the first 7 days postinjury in which both Ht and Hb were determined were studied. Ht and Hb were measured with a Coulter Counter. The relation between Ht and Hb was analyzed with linear regression. The potential effect of hemolysis was studied by analyzing lactate dehydrogenase levels. RESULTS: In 671 patients 2,461 paired Ht levels and Hb levels were obtained. The mean Ht was 30.9%+/-6.9% (interquartile range 25.8%-35.8%). The mean concentration of Hb was 10.4+/-2.3 g/dL (interquartile range 8.7-12.1 g/dL). Ht and Hb had a Pearson's R of 0.99 and the following relations applied: Ht (%)=2.953xHb (g/dL) or Hb (g/dL)=0.334xHt (%). Lactate dehydrogenase was not related with Ht and Hb, indicating hemolysis was not relevant. CONCLUSIONS: In a large series of trauma patients, Ht and Hb behaved as identical parameters. The idea that Ht is different from or even superior to Hb is a misconception. There is no reason for determining both Ht and Hb in trauma patients.