| Popis: |
Public Health Significance: Trauma represents the leading cause of mortality for young adults in their most productive years and incurs substantial short and long term disability. Death from trauma results in an annual loss of 492 years of productivity per 100,000 and costs $230 million a day. Most of these mortality and related medical expenses incurred early during the critical care unit stay. Improving the outcome during ICU phase will have substantial effects on trauma mortality and morbidity. Subjective: Hypovolemic shock is a major consequence of trauma and usually represented with hypotension and hypothermia. Despite the documented risk of hypotension and hypothermia in increasing mortality and morbidity, that risk has not been practically quantified. In this study, we assessed the effect of hypotension and hypothermia severity on the outcome during first and second ICU days. Methods: Trauma patients admitted to University of Pittsburgh trauma center during 1999-2000 were reviewed (n=783). Data on patients demography, injury, vital signs, diagnosis, and outcome have been collected. The lowest recorded systolic blood pressure and duration in minutes of all episodes of SBP less or equal to 90 mm Hg were collected. The lowest temperature and duration in minutes of all episodes of hypothermia of less or equal to 36 °C were also obtained. The outcome variable was death during hospitalization and length of ICU stay. Relative risk, Pearson Chi2, t-test, regression, and survival analysis were used. Results: Patients with hypotension during the first 48 hours in ICU and hypothermia during the first 24 hours of ICU had an increased risk of mortality. The length of ICU stay increased upon the increase in the severity of hypotension and hypothermia. Each 5-degree reduction in SBP and 1°C reduction in temperature increased the risk of mortality by 1.37 and 1.51 respectively. Each 1-hour increase in SBP and temperature increased the mortality by 1.22 and 1.10 respectively. Conclusion: A brief episode of hypotension during ICU day one was associated with increased mortality and mortality. For patients who survived ICU day one, hypotension in ICU day two predicts the outcome better than hypotension records of ICU day one. Hypothermia added significant information beside hypotension in quantifying the risk of shock. Hypotension and hypothermia should not only be treated promptly but also should be prevented. |
