ABSTRACT
INTRODUCTION: Rhabdomyolysis in general trauma patients is a cause of acute kidney injury. However, there are limited data on prevalence, risk factors and the dynamics of creatine kinase (CK) as a surrogate marker for rhabdomyolysis. AIM: This study aimed to examine the characteristics of CK elevation in general trauma patients and identify the risk factors of acute kidney injury (AKI). METHOD: A retrospective study of trauma patients at Songklanagarind Hospital from January 2009 to August 2014 using CK, clinical characteristics and trauma severity as predictors and AKI as defined by the Acute Kidney Injury Network, 2005 criteria as the outcomes. RESULTS: Of the 372 patients included in the study, the prevalence of rhabdomyolysis was 40.3%, the mean injury severity score (ISS) was 19.5 and 7% had AKI. The CK level peaked at 40 hours after admission with a rate change of 50.98 U/L/h. An initial mean arterial pressure < 65 mmHg, ISS ≥ 25 and CK elevation > 1,000 U/L/h were independently associated with AKI. CONCLUSION: Traumatic rhabdomyolysis resulting in AKI occurs in patients with a high peak CK with an increasing rate of change and a high ISS. These parameters could identify patients who needed close monitoring of CK and renal function.
ABSTRACT
OBJECTIVE: The association of scapular fractures with other life-threatening injuries including blunt thoracic aortic injury is widely recognized. Few studies have investigated this presumed association. In this study, we investigated the incidence of significant associated injuries with scapular fracture and their outcomes. METHODS: A retrospective study was conducted from 2005 to 2009 in a level I trauma center in Thailand. All blunt trauma patients were identified. Patients?demographics, injury mechanism, associated injuries, Injury Severity Score (ISS), and survival outcomes were recorded. The management of associated injuries with scapular fracture was reviewed, and the risk factors for mortality were identified. RESULTS: Among the 7 345 trauma patients admitted, scapular fractures occurred in 84 cases (1.1%). The mean age was (37.98+/-15.21) years. Motorcycle crash was the most frequent mechanism of injury, occurring in 51 cases (60.7%). Seventy-four patients (88.1%) suffering from scapular fractures had associated injuries: 5 (6.0%) had significant chest injuries, but none of them had blunt thoracic aortic injury. Two patients (2.4%) with scapular fractures died. Factors determining the likelihood of mortality were: (1) ISS larger than 25 (LR equal to 8.5, P less than 0.05); (2) significant associated chest injury (AIS larger than 3, LR equal to 5.3, P less than 0.05) and (3) significant associated abdominal injury (AIS larger than 3, LR equal to 5.3, P larger than 0.05). CONCLUSION: A blunt scapular fracture may not accompany a blunt thoracic aortic injury but it is strongly related to other injuries like chest injury, extremity injury, head injury, etc. If a scapular fracture is found with a high ISS score, high chest or abdomen AIS score, the patient would have a high risk of mortality.