Impact of a streamlined trauma management approach and determinants of mortality among hemodynamically unstable patients with severe multiple injuries: a before-and-after retrospective cohort study
| Autor: | Atsushi Uehata, Sadaki Inokuchi, Toshiki Sato, Hiroyuki Otsuka, Naoki Sakoda, Keiji Sakurai, Takeshi Yamagiwa, Hiromichi Aoki, Shinichi Iizuka |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
endovascular procedures shock Critical Care and Intensive Care Medicine 03 medical and health sciences 0302 clinical medicine hemorrhagic Trauma management medicine 030212 general & internal medicine Original Research medicine.diagnostic_test business.industry 030208 emergency & critical care medicine Interventional radiology Retrospective cohort study Evidence-based medicine Blood pressure Hemostasis Emergency medicine Cohort hemostasis Injury Severity Score Surgery multiple trauma business |
| Zdroj: | Trauma Surgery & Acute Care Open |
| ISSN: | 2397-5776 |
| Popis: | BackgroundTrauma management requires a multidisciplinary approach, but coordination of staff and procedures is challenging in patients with severe trauma. In October 2014, we implemented a streamlined trauma management system involving emergency physicians trained in severe trauma management, surgical techniques, and interventional radiology. We evaluated the impact of streamlined trauma management on patient management and outcomes (study 1) and evaluated determinants of mortality in patients with severe trauma (study 2).MethodsWe conducted a retrospective cohort study of 125 patients admitted between January 2011 and 2019 with severe trauma (Injury Severity Score ≥16) and persistent hypotension (≥2 systolic blood pressure measurements ResultsCompared with the Before cohort (n=59), the After cohort (n=66) had a significantly lower in-hospital mortality (36.4% vs. 64.4%); required less time from hospital arrival to initiation of surgery/interventional radiology (median, 41.0 vs. 71.5 minutes); and was more likely to undergo resuscitative endovascular balloon occlusion of the aorta (24.2% vs. 6.8%). Plasma administration before initiating hemostasis (adjusted OR 1.49 (95% CI 1.04 to 2.14)), resuscitative endovascular balloon occlusion of the aorta (9.48 (95% CI 1.25 to 71.96)), and shorter time to initiation of surgery/interventional radiology (0.97 (95% CI 0.96 to 0.99)) were associated with significantly lower mortality.DiscussionImplementing a streamlined trauma management protocol improved outcomes among hemodynamically unstable patients with severe multiple trauma.Level of evidenceLevel III. |
| Databáze: | OpenAIRE |
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