Trauma in pregnancy: An analysis of the adverse perinatal outcomes and the injury severity score.

BACKGROUND: Trauma during pregnancy is one of the most important causes of non-obstetric maternal and fetal mortality and morbidity. The aim of our study is to evaluate the adverse perinatal outcomes that may occur according to the type and severity of the trauma. METHODS: In this retrospective cohort study, pregnant traumatized women aged 18-50 years and referred for consultation to the Prof. Dr. Cemil Tascioglu City Hospital's emergency services of the departments of gynecology and obstetrics, between January 1, 2017, and December 31, 2022, were evaluated. Demographic characteristics, trauma findings, Injury Severity Scoring (ISS), and obstet-ric outcomes were recorded. RESULTS: A total of 1825 trauma patients, including 900 pregnants were referred to our emergency gynecology clinic for consulta-tion. One hundred and fifty three pregnant patients, whose birth information we reached, were selected as the study group. The mean age of the patients was 25.56±5.99 years and the mean gestational week at the time of trauma was 21.59±9.89 weeks, the patients had fallen (67.97%), had been exposed to violence (30.07%), and had a traffic accient (1.96%). The patient's delivery and hospitalization status on the day of trauma, fracture and ISS ≥9 were statistically significantly at a higher rate in the 3rd trimester. Rates of hospitaliza-tion and 3rd trimester traumas were found to be significantly higher in the ISS ≥9 group. (P=0.0001, P=0.028, respectively). CONCLUSION: Compared to the general population, the rates of preterm premature rupture of membranes-premature rupture of membranes, fetal death, fetal distress, cesarean delivery, placental abruption, and preterm delivery increased in traumatized pregnant women. Patients with low ISS scores should also be followed closely during pregnancy in terms of perinatal complications, as well as the severe trauma group.

Heterogeneity in defining multiple trauma: a systematic review of randomized controlled trials.

INTRODUCTION: While numerous randomized controlled trials (RCTs) have been conducted in the field of trauma, a substantial portion of them are yielding negative results. One potential contributing factor to this trend could be the lack of agreement regarding the chosen definitions across different trials. The primary objective was to identify the terminology and definitions utilized for the characterization of multiple trauma patients within randomized controlled trials (RCTs). METHODS: A systematic review of the literature was performed in MEDLINE, EMBASE and clinicaltrials.gov between January 1, 2002, and July 31, 2022. RCTs or RTCs protocols were eligible if they included multiple trauma patients. The terms employed to characterize patient populations were identified, and the corresponding definitions for these terms were extracted. The subsequent impact on the population recruited was then documented to expose clinical heterogeneity. RESULTS: Fifty RCTs were included, and 12 different terms identified. Among these terms, the most frequently used were "multiple trauma" (n = 21, 42%), "severe trauma" (n = 8, 16%), "major trauma" (n = 4, 8%), and trauma with hemorrhagic shock" (n = 4, 8%). Only 62% of RCTs (n = 31) provided a definition for the terms used, resulting a total of 21 different definitions. These definitions primarily relied on the injury severity score (ISS) (n = 15, 30%), displaying an important underlying heterogeneity. The choice of the terms had an impact on the study population, affecting both the ISS and in-hospital mortality. Eleven protocols were included, featuring five different terms, with "severe trauma" being the most frequent, occurring six times (55%). CONCLUSION: This systematic review uncovers an important heterogeneity both in the terms and in the definitions employed to recruit trauma patients within RCTs. These findings underscore the imperative of promoting the use of a unique and consistent definition.

Epidemiology of pediatric trauma in Makkah, Kingdom of Saudi Arabia: An observational cohort study.

OBJECTIVES: To explore the epidemiology and patterns of pediatric trauma in addition to length of hospital stay and outcome. METHODS: A single-center retrospective study of 605 patients aged 14 years and younger was carried out from January to December 2022. The study included all patients who experienced intentional or unintentional trauma aged 14 years or below in 2022 and excluded trauma that did not prompt an emergency room visit. RESULTS: Most pediatric trauma cases involved boys (69.1%, n=418), and girls comprised only 30.9% (n=187). Trauma was most common in children one to 5 years old (41.5%, n=251). Falling from a height was the most common mode of injury in both girls and boys (n=253, 41.8%). The most common body parts involved were the extremities (n=357, 59%), followed by the head (n=210, 34.7%). Most children were transferred to hospital via emergency medical services (n=234, 38.7%). In most cases, the child was admitted to the surgical ward (n=458, 75.7%), while others were managed in the emergency department without admission (n=93, 15.4%). Most patients were stable after receiving standard care (n=558, 92.2%). CONCLUSION: To reduce health care expenses and improve public health outcomes, prioritizing preventive measures is crucial. This includes increasing public awareness, implementing safety protocols, and enacting government regulations to prevent avoidable injuries.

Enterobacter cloacae infection characteristics and outcomes in battlefield trauma patients.

Enterobacter cloacae is a Gram-negative rod with multidrug-resistant potential due to chromosomally-induced AmpC ß-lactamase. We evaluated characteristics, antibiotic utilization, and outcomes associated with battlefield-related E. cloacae infections (2009-2014). Single initial and serial E. cloacae isolates (≥24 hours from initial isolate from any site) associated with a clinical infection were examined. Susceptibility profiles of initial isolates in the serial isolation group were contrasted against last isolate recovered. Characteristics of 112 patients with E. cloacae infections (63 [56%] with single initial isolation; 49 [44%] with serial isolation) were compared to 509 patients with bacterial infections not attributed to E. cloacae. E. cloacae patients sustained more blast trauma (78%) compared to non-E. cloacae infections patients (75%; p<0.001); however, injury severity scores were comparable (median of 34.5 and 33, respectively; p = 0.334). Patients with E. cloacae infections had greater shock indices (median 1.07 vs 0.92; p = 0.005) and required more initial blood products (15 vs. 14 units; p = 0.032) compared to patients with non-E. cloacae infections. Although E. cloacae patients had less intensive care unit admissions (80% vs. 90% with non-E. cloacae infection patients; p = 0.007), they did have more operating room visits (5 vs. 4; p = 0.001), longer duration of antibiotic therapy (43.5 vs. 34 days; p<0.001), and lengthier hospitalizations (57 vs. 44 days; p<0.001). Patients with serial E. cloacae had isolation of infecting isolates sooner than patients with single initial E. cloacae (median of 5 vs. 8 days post-injury; p = 0.046); however, outcomes were not significantly different between the groups. Statistically significant resistance to individual antibiotics did not develop between initial and last isolates in the serial isolation group. Despite current combat care and surgical prophylaxis guidelines recommending upfront provision of AmpC-inducing antibiotics, clinical outcomes did not differ nor did significant antibiotic resistance develop in patients who experienced serial isolation of E. cloacae versus single initial isolation.

A National Comparison of Volume and Acuity for Adult and Pediatric Trauma: A Trauma Quality Improvement Program Cohort Study.

INTRODUCTION: Most injured children receive trauma care outside of a pediatric trauma center. Differences in physiology, dosing, and injury pattern limit extrapolation of adult trauma principles to pediatrics. We compare US trauma center experience with pediatric and adult trauma resuscitation. MATERIALS AND METHODS: We queried the 2019 Trauma Quality Improvement Program to describe the experience of US trauma centers with pediatric (<15 y) and adult trauma. We quantified blunt, penetrating, burn, and unspecified traumas and compared minor, moderate, severe, and critical traumas (ISS 1-8 Minor, ISS 9-14 Moderate, ISS 15-24 Severe, ISS 25+ Critical). We estimated center-level volumes for adults and children. Institutional identifiers were generated based on unique center specific factors including hospital teaching status, hospital type, verification level, pediatric verification level, state designation, state pediatric designation, and bed size. RESULTS: A total of 755,420 adult and 76,449 pediatric patients were treated for traumatic injuries. There were 21 times as many critical or major injuries in adults compared to children, 17 times more moderate injuries, and 6 times more minor injuries. Children and adults presented with similar rates of blunt trauma, but penetrating injuries were more common in adults and burn injuries were more common in children. Comparing center-level data, adult trauma exceeded pediatric for every severity and mechanism. CONCLUSIONS: There is relatively limited exposure to high-acuity pediatric trauma at US centers. Investigation into pediatric trauma resuscitation education and simulation may promote pediatric readiness and lead to improved outcomes.

Does the Probability of Survival Calculated by the Trauma and Injury Severity Score Method Accurately Reflect the Severity of Neurotrauma Patients Admitted to Regional Trauma Centers in Korea?

BACKGROUND: Assessing and improving the quality of trauma care is crucial in modern trauma systems and centers. In Korea, evaluations of regional trauma centers are conducted annually to assess and improve trauma management quality. This includes using the Trauma and Injury Severity Score (TRISS) method to calculate the W-score and mortality Observed-to-Expected ratio (O:E ratio), which are used to evaluate the quality of care. We analyzed the potential for overestimation of the probability of survival using TRISS method for patients with neurotrauma, as well as the potential for errors when evaluating and comparing regional trauma centers. METHODS: We included patients who visited the regional trauma center between 2019 and 2021 and compared their probability of survival of the TRISS method, W-score, mortality O:E ratio, and misclassification rates. The patient groups were further subdivided into smaller subgroups based on age, Glasgow Coma Scale (GCS), and Injury Severity Score, and comparisons were made between the neurotrauma and non-neurotrauma groups within each subgroup. RESULTS: A total of 4,045 patients were enrolled in the study, with 1,639 of them having neurotrauma. The neurotrauma patient group had a W-score of -0.68 and a mortality O:E ratio of 1.044. The misclassification rate was found to be 13.3%, and patients with a GCS of 8 or less had a higher misclassification rate of 37.4%. CONCLUSION: The limitations of using the TRISS method for predicting outcomes in patients with severe neurotrauma are exposed in this study. The TRISS methodology demonstrated a high misclassification rate of approximately 40% in subgroups of patients with GCS less than 9, indicating that it may be less reliable in predicting outcomes for severely injured patients with low GCS. Clinicians and researchers should be cautious when using the TRISS method and consider alternative methods to evaluate patient outcomes and compare the quality of care provided by different trauma centers.

Timing of regional analgesia in elderly patients with blunt chest-wall injury.

BACKGROUND: Rib fractures represent a typical injury pattern in older people and are associated with respiratory morbidity and mortality. Regional analgesia modalities are adjuncts for pain management, but the optimal timing for their initiation remains understudied. We hypothesized that early regional analgesia would have similar outcomes to late regional analgesia. METHODS: We retrospectively reviewed the American College of Surgeons Trauma Quality Improvement Program database from 2017 to 2019. We included patients ≥65 years old admitted with blunt chest wall trauma who received regional analgesia. We divided patients into 2 groups: (1) early regional analgesia (within 24 hours of admission) and (2) late regional analgesia (>24 hours). The outcomes evaluated were ventilator-associated pneumonia, mortality, unplanned intensive care unit admission, unplanned intubation, discharge to home, and duration of stay. Univariable analysis and multivariable logistic regression adjusting for patient and injury characteristics, trauma center level, and respiratory interventions were performed. RESULTS: In the study, 2,248 patients were included. The mean (standard deviation) age was 75.3 (6.9), and 52.7% were male. The median injury severity score (interquartile range) was 13 (9-17). The early regional analgesia group had a decreased incidence of unplanned intubation (2.7% vs 5.3%, P = .002), unplanned intensive care unit admission (4.9% vs 8.4%, P < .001), and shorter mean duration of stay (5.5 vs 6.5 days, P = .002). In multivariable analysis, early regional analgesia was associated with decreased odds of unplanned intubation (odds ratio, 0.58; 95% confidence interval, 0.36-0.94; P = .026), unplanned intensive care unit admission (odds ratio, 0.60; 95% confidence interval, 0.041-0.86; P = .006), and increased odds of discharge to home (odds ratio, 1.27; 95% confidence interval, 1.04-1.55; P = .019). After multivariable adjustment, no significant difference was found for ventilator-associated pneumonia or mortality (odds ratio, 0.60; 95% confidence interval, 0.34-1.04; P = .070). CONCLUSION: Early regional analgesia initiation is associated with improved outcomes in older people with blunt chest wall injuries. Geriatric trauma care bundles targeting early initiation of regional analgesia can potentially decrease complications and resource use.

The effect of transport mode on mortality following isolated penetrating torso Trauma.

BACKGROUND: Prehospital interventions may increase the time to definitive care. Compared to ground ambulance, we hypothesize improved mortality for patients with isolated, penetrating torso injuries transported via private vehicle. METHODS: We reviewed the National Trauma Data Bank (2017-2021) for adults with isolated, penetrating torso injuries stratified by mechanism (stabbing vs. firearm) and transport mode (private vehicle vs. ground ambulance). We performed a multivariable logistic regression to estimate the effect of transport mode on mortality. RESULTS: 48,444 patients met our inclusion criteria. Patients transported by ambulance, injured by stabbing (n = 26,633) and by firearm (n = 21,811) had adjusted odds ratios of 1.81 (95%CI 1.05-3.14, p = 0.03) and 1.66 (95%CI 1.32-2.09,p < 0.001) respectively for mortality compared to private vehicle transport. CONCLUSION: Patients with penetrating torso injuries have nearly twice the odds of mortality when transported by ground ambulance than private vehicles, despite injury severity. The "scoop and run" strategy may confer a survival benefit in this population.

Age, admission platelet count, and mortality in severe isolated traumatic brain injury: A retrospective cohort study.

BACKGROUND: We asked whether patients >50 years of age with acute traumatic brain injury (TBI) present with lower platelet counts and whether lower platelet counts are independently associated with mortality. METHODS: We combined trauma registry and laboratory data on a retrospective cohort of all patients ≥18 years of age admitted to our Level 1 US regional trauma center 2015-2021 with severe (Head Abbreviated Injury Score [AIS] ≥3), isolated (all other AIS <3) TBI who had a first platelet count within 1 h of arrival. Age and platelet count were assessed continuously and as groups (age 18-50 vs. >50, platelet normals, and at conventional transfusion thresholds). Outcomes such as mean admission platelet counts and in-hospital mortality were assessed categorically and with logistic regression. RESULTS: Of 44,056 patients, 1298 (3%, median age: 52 [IQR 33,68], 76.1% male) met all inclusion criteria with no differences between younger and older age groups for (ISS; 18 [14,26] vs. 17 [14,26], p = .22), New ISS (NISS; 29 [19,50] vs. 28 [17,50], p = .36), or AIS-Head (4 [3,5] vs. 4 [3,5]; p = .87). Patients aged >50 had lower admission platelet counts (219,000 ± 93,000 vs. 242,000 ± 76,000/µL; p < .001) and greater in-hospital mortality (24.5% vs. 15.6%, p < .001) than those 18-50. In multivariable regression, firearms injuries (OR9.08), increasing age (OR1.004), NISS (OR1.007), and AIS-Head (OR1.05), and decreasing admission platelet counts (OR0.998) were independently associated with mortality (p < .001-.041). Platelet transfusion in the first 4 h of care was more frequent among older patients (p < .001). CONCLUSIONS: Older patients with TBI had lower admission platelet counts, which were independently associated with greater mortality.

Emergency Department Shock Index Outperforms Prehospital and Delta Shock Indices in Predicting Outcomes of Trauma Patients.

INTRODUCTION: Multiple shock indices (SIs), including prehospital, emergency department (ED), and delta (ED SI - Prehospital SI) have been developed to predict outcomes among trauma patients. This study aims to compare the predictive abilities of these SIs for outcomes of polytrauma patients on a national level. METHODS: This was a retrospective analysis of the American College of Surgeons Trauma Quality Improvement Program (2017-2018). We included adult (≥18 y) trauma patients and excluded patients who were transferred, had missing vital signs, and those with severe head injuries (Head-Abbreviated Injury Scale>3). Outcome measures were 24-h and in-hospital mortality, 24-h packed red blood cells transfusions, and intensive care unit and hospital length of stay. Predictive performances of these SIs were evaluated by the Area Under the Receiver Operating Characteristics for the entire study cohort and across all injury severities. RESULTS: A total of 750,407 patients were identified. Meanstandard deviation age and lowest systolic blood pressure were 53 ± 21 y, and 81 ± 32 mmHg, respectively. Overall, 24-h and in-hospital mortality were 1.2% and 2.5%, respectively. On multivariable analysis, all three SIs were independently associated with higher rates of 24-h and in-hospital mortality, blood product requirements, intensive care unit and hospital length of stay (P < 0.001). ED SI was superior to prehospital and delta SIs (P < 0.001) for all outcomes. On subanalysis of patients with moderate injuries, severe injuries, and positive delta SI, the results remained the same. CONCLUSIONS: ED SI outperformed both prehospital and delta SIs across all injury severities. Trauma triage guidelines should prioritize ED SI in the risk stratification of trauma patients who may benefit from earlier and more intense trauma activations.

Pain in Trauma Patients: Measurement and Predisposing Factors.

INTRODUCTION: Acute pain is common after injury. This study intended to evaluate the feasibility of quantifying pain experience over an entire admission using "area under the pain curve" and to identify factors associated with increased pain. METHODS: This retrospective single-center study included all trauma patients admitted from 2013 to 2020. Maximum pain scores were extracted for each day. Pain was defined as area under the curve (AUC) of maximum pain scores/day plotted against time. Injury patterns were analyzed by dichotomizing Abbreviated Injury Scale (AIS) scores (AIS < 3 versus AIS ≥ 3) for each body region. Urinary drug screen results were collected from admission data. A general linear model was used to determine which injury patterns, mechanisms, and age groups were predictive of increased AUC in all patients together and separate by operative and nonoperative groups. RESULTS: We identified 21,640 patients, of which 70% were male and 83% had suffered blunt injury. Overall injury severity was associated with increased pain experience. Serious head injury, younger age, and older age (compared to 45-49 y) were associated with decreased pain. Spinal injuries, thoraco-abdominal injuries, and combined thoracic and lower extremity injuries were predictive of increased pain. Compared to patients with no positive test for illicit substances or documentation of prehospital narcotic medications, the pain experience was greater for both, those who had been administered a narcotic in the prehospital setting and those who tested positive for illicit substances. CONCLUSIONS: This study extends the concept of total pain experience using AUC methodology. Our results demonstrate associations between increased pain and certain patterns of injury, ages, and presence of drugs on admission. Measuring total pain experience could assist in comparing pain-management strategies. Future research should focus on validating pain experience against quality-of-life measurements.

Loss of independence after traumatic injury: A patient-centered study.

BACKGROUND: Patient-reported outcomes of postdischarge functional status can provide insight into patient recovery experiences not typically reflected in trauma registries. Injuries may be characterized by a long-term loss of independence. We sought to examine factors predictive of patient-reported, postdischarge loss of independence in trauma patients. METHODS: Trauma patients admitted to 1 of 3 level I trauma centers were contacted by phone between 6 to 12 months after hospital discharge to complete the Revised Trauma Quality of Life survey. Loss of independence was defined as a new need for assistance with at least one activity of daily living or transition to living in an institutional setting. Patients with severe traumatic brain injury or spinal cord injury were excluded. Multivariable logistic regression analyses were performed to identify predictors of loss of independence. RESULTS: 801 patients were included. The median age was 65 (interquartile range: 46-76) years, 46.1% were female, and the median Injury Severity Score was 9 (interquartile range: 9-13). Two hundred seventy-one patients (33.8%) experienced a loss of independence, most commonly requiring assistance walking up stairs. The main predictors of loss of independence were persistent daily pain (odds ratio: 3.83, 95% confidence interval: [2.90-5.04], P < .001), length of hospital stay (odds ratio: 1.04, 95% confidence interval: [1.01-1.09], P = .021) and income below the national median (odds ratio: 1.46, 95% confidence interval: [1.12-1.91], P = .006). Perceived social support (odds ratio: 0.75, 95% confidence interval: [0.66-0.85], P < .001) was protective against loss of independence. CONCLUSION: Injury is associated with a relatively high rate of long-term loss of independence. Ensuring adequate social support systems for patients postdischarge may help them regain functional independence after injury.

A Comprehensive Analysis of the Radiation Exposure and the Diagnostic Benefit of PanCT in Pediatric Cases with Multiple Trauma.

Background and Objectives: The primary objective of this study was to obtain quantitative data, taking into account the amount of radiation exposure, about the clinical and diagnostic benefit obtained from panCT in pediatric trauma cases. Thus, we aim to create greater awareness in all physicians and primarily emergency medicine physicians regarding correct selection in terms of the patient group where this effective radiological method is to be applied, and to protect children from the adverse effects of radiation. Materials and Methods: The computed tomography (CT) images were retrieved from the hospital radiological archive system (PACS). The effective dose (Ed) was calculated using the standardized method including the tissue weighted parameters. The radiological pathologies determined as a result of CT imaging of the cases were categorized according to clinical significance in accordance with the Modified CT Colonography Reporting and Data System (C-RADS). Results: The data for a total of 268 patients were analyzed, comprising 89 (33.2%) females and 179 (66.8%) males with a mean age of 8.81 ± 5.21 years. The mean Ed was determined to be 18.14 ± 10.44 mSv. The Ed was determined to be statistically significantly higher in the 1-5 years age group than in the 15-18 years age group (p = 0.024). A statistically significant difference was determined between the age groups in terms of the pathologies determined (p = 0.028). Conclusions: In order to prevent performing unnecessary CT imaging, trauma teams in Emergency Departments (ED) should work in harmony and individual decision-making should be based on the severity of the trauma mechanism, the severity of the predicted injury, and the clinical status of the injured child.

Pre-Trauma Pain Is the Strongest Predictor of Persistent Enhanced Pain Patterns after Severe Trauma: Results of a Single-Centre Retrospective Study.

Background and Objectives: Traumatic injuries are a significant public health issue worldwide, with persistent enhanced pain being a common complication following severe trauma. Persistent and chronic pain can have a profound impact on patients' quality of life, affecting physical, emotional, and social functioning. This study aimed to investigate the pain patterns of trauma patients before and after severe trauma, and identify the predictors of persisting pain after injury. Materials and Methods: A total of 596 patients of a level-one trauma centre with severe trauma were included in this study. The Trauma Outcome Profile Scale was used to assess pain severity before and after trauma, and a logistic regression analysis was performed to determine the most significant predictors of relevant pain after severe trauma. Results: The mean age of the included patients was 48.2 years, and 72% were males. The most frequent cause of injury was traffic accidents, and the mean Injury Severity Score was 17.6. Nearly half of the patients experienced reduced pain-related quality of life after trauma, with persisting pain predominantly occurring in the neck, spine, shoulder, pelvis, hip, knee, and feet. Even minor injuries led to increased pain scores. Preexisting pain before injury (OR: 5.43; CI: 2.60-11.34), older age (OR: 2.09, CI: 1.22-3.27), female gender (OR: 1.08, CI: 0.73-1.59), and high injury severity (OR: 1.80, CI: 1.20-2.69) were identified as significant predictors of enhanced pain. Conclusions: These findings highlight the importance of considering pre-existing pain, body area, and injury severity in assessing the risk of persistent pain in trauma patients.

Evaluation of Neural Machine translation for conversion of International Classification of disease codes to the Abbreviated injury Scale.

The Abbreviated Injury Scale (AIS) is an essential tool for injury research since it allows for comparisons of injury severity among patients, however, the International Classification of Diseases (ICD) is more widely used to capture medical information. The problem of conversion between these two medical coding systems has similarities to the challenges encountered in language translation. We therefore hypothesize that neural machine translation (NMT), a deep learning technique which is commonly used for human language translation, could be used to convert ICD codes to AIS. The objective of this study was to compare the accuracy of a NMT model for determining injury severity compared to two established methods of conversion. The injury severity classifications used for this study were Injury Severity Score (ISS) ≥ 16, Maximum AIS severity (MAIS) ≥ 3, and MAIS ≥ 2. Data from a US national trauma registry, which has patient injuries coded in both AIS and ICD, was used to train a NMT model. Testing data from a separate year was used to determine the accuracy of the NMT model predictions against the actual ISS recorded in the registry. The prediction accuracy of the NMT model was compared to that of the official Association for the Advancement of Automotive Medicine (AAAM) ICD-AIS map and the R package 'ICD Program for Injury Categorization in R' (ICDPIC-R). The results show that the NMT model was the most accurate across all injury severity classifications, followed by the ICD-AIS map and then ICDPIC-R package. The NMT model also showed the highest correlation between the predicted and observe ISS scores. Overall, NMT appears to be a promising method for predicting injury severity from ICD codes, however, validation in external databases is needed.

Trauma-induced disturbances in ionized calcium levels correlate parabolically with coagulopathy, transfusion, and mortality: a multicentre cohort analysis from the TraumaRegister DGU®.

BACKGROUND: To which extent trauma- induced disturbances in ionized calcium (iCa2+) levels have a linear relationship with adverse outcomes remains controversial. The goal of this study was to determine the association between the distribution and accompanying characteristics of transfusion-independent iCa2+ levels versus outcome in a large cohort of major trauma patients upon arrival at the emergency department. METHODS: A retrospective observational analysis of the TraumaRegister DGU® (2015-2019) was performed. Adult major trauma patients with direct admission to a European trauma centre were selected as the study cohort. Mortality at 6 h and 24 h, in-hospital mortality, coagulopathy, and need for transfusion were considered as relevant outcome parameters. The distribution of iCa2+ levels upon arrival at the emergency department was calculated in relation to these outcome parameters. Multivariable logistic regression analysis was performed to determine independent associations. RESULTS: In the TraumaRegister DGU® 30 183 adult major trauma patients were found eligible for inclusion. iCa2+ disturbances affected 16.4% of patients, with hypocalcemia (< 1.10 mmol/l) being more frequent (13.2%) compared to hypercalcemia (≥ 1.30 mmol/l, 3.2%). Patients with hypo- and hypercalcemia were both more likely (P < .001) to have severe injury, shock, acidosis, coagulopathy, transfusion requirement, and haemorrhage as cause of death. Moreover, both groups had significant lower survival rates. All these findings were most distinct in hypercalcemic patients. When adjusting for potential confounders, mortality at 6 h was independently associated with iCa2+ < 0.90 mmol/L (OR 2.69, 95% CI 1.67-4.34; P < .001), iCa2+ 1.30-1.39 mmol/L (OR 1.56, 95% CI 1.04-2.32, P = 0.030), and iCa2+ ≥ 1.40 mmol/L (OR 2.87, 95% CI 1.57-5.26; P < .001). Moreover, an independent relationship was determined for iCa2+ 1.00-1.09 mmol/L with mortality at 24 h (OR 1.25, 95% CI 1.05-1.48; P = .0011), and with in-hospital mortality (OR 1.29, 95% CI 1.13-1.47; P < .001). Both hypocalcemia < 1.10 mmol/L and hypercalcemia ≥ 1.30 mmol/L had an independent association with coagulopathy and transfusion. CONCLUSIONS: Transfusion-independent iCa2+ levels in major trauma patients upon arrival at the emergency department have a parabolic relationship with coagulopathy, need for transfusion, and mortality. Further research is needed to confirm whether iCa2+ levels change dynamically and are more a reflection of severity of injury and accompanying physiological derangements, rather than an individual parameter that needs to be corrected as such.

Adherence to the transfer recommendations of the German Trauma Society in severely injured children: a retrospective study from the TraumaRegister DGU.

Particularly for pediatric trauma patients, it is of utmost importance that the right patient be treated in the right place at the right time. While unnecessary interhospital transfers must be avoided, the decision against transfer should not lead to higher complication rates in trauma centers without added pediatric qualifications. We therefore identified independent predictive factors for an early transfer of severely injured patients and compared these factors with the current transfer recommendations of the German Trauma Society. Additionally, the quality of the self-assessment based on the mortality of children who were not transferred was evaluated. A national dataset from the TraumaRegister DGU® was used to retrospectively identify factors for an early interhospital transfer (< 48 h) to a superordinate trauma center. Severely injured pediatric patients (age < 16 years) admitted between 2010 and 2019 were included in this analysis. Adjusted odds ratios (OR) with 95% confidence intervals (CI) for early transfer were calculated from a multivariable model. Prognostic factors for hospital mortality in non-transferred patients were also analyzed. In total, 6069 severely injured children were included. Of these, 65.2% were admitted to a Level I trauma center, whereas 27.7% and 7.1% were admitted to Level II and III centers, respectively. After the initial evaluation in the emergency department, 25.5% and 50.1% of children primarily admitted to a Level II or III trauma center, respectively, were transferred early. Statistically significant predictors of an early transfer were: Serious traumatic brain injury (OR 1.76, 95% CI 1.28-2.43), Injury severity score (ISS) ≥ 16 points (ISS 16-24: OR 2.06, 95% CI 1.59-2.66; ISS 25-33: OR 3.0, 95% CI 2.08-4.31; ISS 34-75: OR 5.42, 95% CI 3.0-9.81, reference category: ISS 9-15), age < 10 years (age 0-1: OR 1.91, 95% CI 1.34-2.71; age 2-5: 2.04, 95% CI 1.50-2.78; age 6-9: 1.62, 95% CI 1.23-2.14; reference category: age 10-15). The most important independent factor for mortality in non-transferred patients was age < 10 years (age 0-1: 5.35, 95% CI 3.25-8.81; age 2-5: 2.46, 95% CI 1.50-4.04; age 6-9: OR 1.7, 95% CI 1.05-2.75; reference category: age 10-15). Knowing the independent predictors for an early transfer, such as a young patient's age, a high injury severity, serious traumatic brain injury (TBI), may improve the choice of the appropriate trauma center. This may guide the rapid decision for an early interhospital transfer. There is still a lack of outcome data on children with early interhospital transfers in Germany, who are the most vulnerable group.

Predictors of mortality in patients with geriatric trauma in the emergency service.

OBJECTIVE: In our study, it was aimed to compare the power of trauma scores (Glasgow Coma Score, Revised Trauma Score, Abbreviated Injury Scale, Injury Severity Score, and Trauma Score-Injury Severity Score) in order to predict mortality in patients with geriatric trauma and to determine the predictive values of these scores in mortality. METHODS: Demographic data, clinical features, etiological causes, laboratory results, and trauma scores of the patients were statistically analyzed. SPSS 20 for Windows was used for this evaluation. RESULTS: It was determined that as the Glasgow Coma Score value of the patients increased, the Abbreviated Injury Scale and Injury Severity Score scores decreased and the Trauma Score-Injury Severity Score score increased. Abbreviated Injury Scale and Injury Severity Score values increased and Revised Trauma Score and Trauma Score-Injury Severity Score values decreased as the lactate levels of the patients increased. It was determined that the Abbreviated Injury Scale and Injury Severity Score scores of the patients hospitalized in the intensive care unit were significantly higher, while their Trauma Score-Injury Severity Score scores were lower. CONCLUSION: Glasgow Coma Score, Revised Trauma Score, Trauma Score-Injury Severity Score, Abbreviated Injury Scale, and Injury Severity Score scores and blood lactate levels are important parameters that can be used in the emergency department for the early detection of high-risk patients in geriatric trauma and the evaluation of the prognosis of geriatric trauma patients.