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https://www.readbyqxmd.com/read/27893619/substituting-systolic-blood-pressure-with-shock-index-in-the-national-trauma-triage-protocol
#1
Ansab A Haider, Asad Azim, Peter Rhee, Narong Kulvatunyou, Kareem Ibraheem, Andrew Tang, Terence O'Keeffe, Hajira Iftikhar, Gary Vercruysse, Bellal Joseph
INTRODUCTION: The National Trauma Triage Protocol (NTTP) is an algorithm that guides emergency medical services providers through four decision steps to identify the patients that would benefit from trauma center care. The NTTP defines a systolic blood pressure (SBP) of less than 90 mm Hg as one of the criteria for trauma center need. The aim of our study was to determine the impact of substituting SBP of less than 90 mm Hg with shock index (SI) on triage performance. METHODS: A 2-year (2011-2012) retrospective analysis of all trauma patients 18 years or older in the National Trauma Databank was performed...
December 2016: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/27876077/post-traumatic-acute-kidney-injury-a-cross-sectional-study-of-trauma-patients
#2
Wei-Hung Lai, Cheng-Shyuan Rau, Shao-Chun Wu, Yi-Chun Chen, Pao-Jen Kuo, Shiun-Yuan Hsu, Ching-Hua Hsieh, Hsiao-Yun Hsieh
BACKGROUND: The causes of post-traumatic acute kidney injury (AKI) are multifactorial, and shock associated with major trauma has been proposed to result in inadequate renal perfusion and subsequent AKI in trauma patients. This study aimed to investigate the true incidence and clinical presentation of post-traumatic AKI in hospitalized adult patients and its association with shock at a Level I trauma center. METHODS: Detailed data of 78 trauma patients with AKI and 14,504 patients without AKI between January 1, 2009 and December 31, 2014 were retrieved from the Trauma Registry System...
November 22, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/27842639/elevated-international-normalised-ratios-correlate-with-severity-of-injury-and-outcome
#3
M A Noorbhai, H M Cassimjee, B Sartorius, D J J Muckart
BACKGROUND: Haemorrhagic shock is the leading cause of preventable early deaths from trauma. Acute coagulopathy on admission to a trauma unit is associated with worse outcomes. The relationship of haemorrhage to early mortality remains consistent regardless of mechanism of injury. Haemorrhage and haemorrhagic shock are increasingly amenable to interventions that result in reductions in morbidity and mortality. OBJECTIVES: To assess the prevalence of coagulopathy in patients admitted to the level 1 trauma unit at Inkosi Albert Luthuli Central Hospital, Durban, South Africa, and correlate it with in-hospital mortality...
November 2, 2016: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
https://www.readbyqxmd.com/read/27785636/the-association-between-illicit-drug-use-and-infectious-complications-among-trauma-patients
#4
V Agrawal, J D Amos
Management of patients with traumatic injury is a complex endeavor requiring a concerted effort of multi-organ stabilization and prevention of septic shock. Given that traumatic injury is frequently mediated by illicit drug use, which has previously been associated with immune suppression, it is hypothesized that infectious complications may occur more prevalently in this patient population. In this study, we evaluate the incidence of infectious complications in trauma patients who screened positive for illicit drug abuse...
October 26, 2016: European Journal of Clinical Microbiology & Infectious Diseases
https://www.readbyqxmd.com/read/27602889/reducing-transfusions-in-critically-injured-patients-using-a-restricted-criteria-order-set
#5
Christopher P Michetti, Heather A Prentice, Elena Lita, Jeffrey Wright, Edmond Ng, Anna B Newcomb
BACKGROUND: We sought to examine the effect on blood usage of a new electronic order set restricting transfusion orders to specific evidence-based criteria for each unit (U) of red blood cells (RBC), plasma, and platelets. METHODS: Prospectively collected transfusion data for Trauma ICU patients were compared for the 12 months before (PRE) and 8 months after (POST) order set implementation. Criteria for RBC transfusion were 1 U only for hemoglobin <7 g/dL in stable patients or <8 g/dL with angina, myocardial infarction, or cardiogenic shock; 2 U for hemoglobin <5 g/dL; and multiple U in the presence of shock, hypotension, or bleeding...
November 2016: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/27598587/impact-of-atls-guidelines-trauma-team-introduction-and-24-hour-mortality-due-to-severe-trauma-in-a-busy-metropolitan-italian-hospital-a-case-control-study
#6
Stefano Magnone, Andrea Allegri, Eugenia Belotti, Claudio Carlo Castelli, Marco Ceresoli, Federico Coccolini, Roberto Manfredi, Cecilia Merli, Fabrizio Palamara, Dario Piazzalunga, Tino Martino Valetti, Luca Ansaloni
BACKGROUND: Advanced Trauma Life Support (ATLS) guidelines are widely accepted for use in initial management of trauma patients. The application of ATLS guidelines and introduction of management by means of trauma team (TT) both took place in April 2011. The aim of the present study was to evaluate related effects on mortality in the shock room (SR) and at 24 hours after admission. METHODS: Data were retrieved by administrative software based on patient admission for trauma of at least 48 hours...
May 2016: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
https://www.readbyqxmd.com/read/27512331/extremes-of-shock-index-predicts-death-in-trauma-patients
#7
Stephen R Odom, Michael D Howell, Alok Gupta, George Silva, Charles H Cook, Daniel Talmor
CONTEXT: We noted a bimodal relationship between mortality and shock index (SI), the ratio of heart rate to systolic blood pressure. AIMS: To determine if extremes of SI can predict mortality in trauma patients. SETTINGS AND DESIGNS: Retrospective evaluation of adult trauma patients at a tertiary care center from 2000 to 2012 in the United States. MATERIALS AND METHODS: We examined the SI in trauma patients and determined the adjusted mortality for patients with and without head injuries...
July 2016: Journal of Emergencies, Trauma, and Shock
https://www.readbyqxmd.com/read/27448282/clinical-presentation-of-geriatric-polytrauma-patients-with-severe-pelvic-fractures-comparison-with-younger-adult-patients
#8
Shozo Kanezaki, Masashi Miyazaki, Naoki Notani, Hiroshi Tsumura
BACKGROUND: Elderly polytrauma patients with pelvic fractures are at higher risk than young adults for severe medical outcomes and/or death in the early post-trauma phase. The aim of our study was to identify predictive factors of medical severity among geriatric polytrauma patients. METHODS: We conducted a retrospective cross-sectional study of polytrauma patients treated at our center, who had a pelvic fracture and at least two other injuries with an abbreviated injury score ≥3...
December 2016: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
https://www.readbyqxmd.com/read/27399737/prediction-of-massive-transfusion-in-trauma-patients-with-shock-index-modified-shock-index-and-age-shock-index
#9
Cheng-Shyuan Rau, Shao-Chun Wu, Spencer C H Kuo, Kuo Pao-Jen, Hsu Shiun-Yuan, Yi-Chun Chen, Hsiao-Yun Hsieh, Ching-Hua Hsieh, Hang-Tsung Liu
OBJECTIVES: The shock index (SI) and its derivations, the modified shock index (MSI) and the age shock index (Age SI), have been used to identify trauma patients with unstable hemodynamic status. The aim of this study was to evaluate their use in predicting the requirement for massive transfusion (MT) in trauma patients upon arrival at the hospital. PARTICIPANTS: A patient receiving transfusion of 10 or more units of packed red blood cells or whole blood within 24 h of arrival at the emergency department was defined as having received MT...
2016: International Journal of Environmental Research and Public Health
https://www.readbyqxmd.com/read/27329440/the-use-of-the-reverse-shock-index-to-identify-high-risk-trauma-patients-in-addition-to-the-criteria-for-trauma-team-activation-a-cross-sectional-study-based-on-a-trauma-registry-system
#10
Spencer C H Kuo, Pao-Jen Kuo, Shiun-Yuan Hsu, Cheng-Shyuan Rau, Yi-Chun Chen, Hsiao-Yun Hsieh, Ching-Hua Hsieh
OBJECTIVES: The presentation of decrease blood pressure with tachycardia is usually an indicator of significant blood loss. In this study, we used the reverse shock index (RSI), a ratio of systolic blood pressure (SBP) to heart rate (HR), to evaluate the haemodynamic status of trauma patients. As an SBP lower than the HR (RSI<1) may indicate haemodynamic instability, the objective of this study was to assess whether RSI<1 can help to identify high-risk patients with potential shock and poor outcome, even though these patients do not yet meet the criteria for multidisciplinary trauma team activation (TTA)...
June 21, 2016: BMJ Open
https://www.readbyqxmd.com/read/27231926/systolic-blood-pressure-lower-than-heart-rate-upon-arrival-at-and-departure-from-the-emergency-department-indicates-a-poor-outcome-for-adult-trauma-patients
#11
Wei-Hung Lai, Shao-Chun Wu, Cheng-Shyuan Rau, Pao-Jen Kuo, Shiun-Yuan Hsu, Yi-Chun Chen, Hsiao-Yun Hsieh, Ching-Hua Hsieh
BACKGROUND: Hemorrhage is a leading cause of preventable trauma death. In this study, we used the reverse shock index (RSI), a ratio of systolic blood pressure (SBP) to heart rate (HR), to evaluate the hemodynamic stability of trauma patients. As an SBP lower than the HR (RSI < 1) may indicate hemodynamic instability, the objective of this study was to assess the associated complications in trauma patients with an RSI < 1 upon arrival at the emergency department (ED) (indicated as (A)RSI) and at the time of departure from the ED (indicated as (L)RSI) to the operative room or for admission...
May 25, 2016: International Journal of Environmental Research and Public Health
https://www.readbyqxmd.com/read/27213011/resuscitative-endovascular-balloon-occlusion-of-the-aorta-for-uncontrollable-nonvariceal-upper-gastrointestinal-bleeding
#12
Hidefumi Sano, Junya Tsurukiri, Akira Hoshiai, Taishi Oomura, Yosuke Tanaka, Shoichi Ohta
BACKGROUND: Although resuscitative endovascular balloon occlusion of the aorta (REBOA) in various clinical settings was found to successfully elevate central blood pressure in hemorrhagic shock, this intervention is associated with high mortality and may represent a last-ditch option for trauma patients. We conducted a retrospective study of patients with nonvariceal upper gastrointestinal bleeding (UGIB) who underwent REBOA to identify the effectiveness of REBOA and reviewed published literatures...
2016: World Journal of Emergency Surgery: WJES
https://www.readbyqxmd.com/read/27023577/using-the-reverse-shock-index-at-the-injury-scene-and-in-the-emergency-department-to-identify-high-risk-patients-a-cross-sectional-retrospective-study
#13
Wei-Hung Lai, Cheng-Shyuan Rau, Shiun-Yuan Hsu, Shao-Chun Wu, Pao-Jen Kuo, Hsiao-Yun Hsieh, Yi-Chun Chen, Ching-Hua Hsieh
BACKGROUND: The ratio of systolic blood pressure (SBP) to heart rate (HR), called the reverse shock index (RSI), is used to evaluate the hemodynamic stability of trauma patients. A SBP lower than the HR (RSI < 1) indicates the probability of hemodynamic shock. The objective of this study was to evaluate whether the RSI as evaluated by emergency medical services (EMS) personnel at the injury scene (EMS RSI) and the physician in the emergency department (ED RSI) could be used as an additional variable to identify patients who are at high risk of more severe injury...
March 24, 2016: International Journal of Environmental Research and Public Health
https://www.readbyqxmd.com/read/26861172/use-of-the-reverse-shock-index-for-identifying-high-risk-patients-in-a-five-level-triage-system
#14
Jung-Fang Chuang, Cheng-Shyuan Rau, Shao-Chun Wu, Hang-Tsung Liu, Shiun-Yuan Hsu, Hsiao-Yun Hsieh, Yi-Chun Chen, Ching-Hua Hsieh
BACKGROUND: The ratio of systolic blood pressure (SBP) to heart rate (HR), called the reverse shock index (RSI), is used to evaluate the hemodynamic stability of trauma patients. To minimize undertriage in emergency departments (EDs), we evaluated whether RSI < 1 (i.e., SBP lower than HR) could be used as an additional variable to identify patients at high risk for more severe injury within a level category of the five-level Taiwan Triage and Acuity Scales (TTAS) system. METHODS: Data obtained from the Trauma Registry System, including triage level according to the TTAS system, were retrospectively reviewed for trauma admissions from January 2009 through December 2013 in a Level I trauma center...
February 9, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/26635315/nosocomial-acinetobacter-pneumonia-treatment-and-prognostic-factors-in-356-cases
#15
Tülay Özvatan, Halis Akalın, Melda Sınırtaş, Gökhan Ocakoğlu, Emel Yılmaz, Yasemin Heper, Nermin Kelebek, Remzi İşçimen, Ferda Kahveci
BACKGROUND AND OBJECTIVE: Acinetobacter baumannii and A. baumannii/calcoaceticus complex are commonly encountered pathogens in nosocomial infections. This study aimed to evaluate the treatment and prognostic risk factors in nosocomial pneumonia caused by these microorganisms. METHODS: The study was conducted retrospectively in Uludag University Hospital and included 356 adult non-neutropenic patients with nosocomial pneumonia. RESULTS: Of the subjects, 94...
February 2016: Respirology: Official Journal of the Asian Pacific Society of Respirology
https://www.readbyqxmd.com/read/26620118/secondary-stroke-in-patients-with-polytrauma-and-traumatic-brain-injury-treated-in-an-intensive-care-unit-karlovac-general-hospital-croatia
#16
M Belavić, E Jančić, P Mišković, A Brozović-Krijan, B Bakota, J Žunić
Traumatic brain injury (TBI) is divided into primary and secondary brain injury. Primary brain injury occurs at the time of injury and is the direct consequence of kinetic energy acting on the brain tissue. Secondary brain injury occurs several hours or days after primary brain injury and is the result of factors including shock, systemic hypotension, hypoxia, hypothermia or hyperthermia, intracranial hypertension, cerebral oedema, intracranial bleeding or inflammation. The aim of this retrospective analysis of a prospective database was to determine the prevalence of secondary stroke and stroke-related mortality, causes of secondary stroke, treatment and length of stay in the ICU and hospital...
November 2015: Injury
https://www.readbyqxmd.com/read/26463286/activation-of-massive-transfusion-for-elderly-trauma-patients
#17
Jason S Murry, Andrea A Zaw, David M Hoang, Devorah Mehrzadi, Danielle Tran, Miriam Nuno, Matthew Bloom, Nicolas Melo, Daniel R Margulies, Eric J Ley
Massive transfusion protocol (MTP) is used to resuscitate patients in hemorrhagic shock. Our goal was to review MTP use in the elderly. All trauma patients who required activation of MTP at an urban Level I trauma center from January 1, 2011 to December 31, 2013 were reviewed retrospectively. Elderly was defined as age ≥ 60 years. Sixty-six patients had MTP activated: 52 nonelderly (NE) and 14 elderly (E). There were no statistically significant differences between the two cohorts for gender, injury severity score, head abbreviated injury scale, emergency department Glasgow Coma Scale, initial hematocrit, intensive care unit length of stay, or hospital length of stay...
October 2015: American Surgeon
https://www.readbyqxmd.com/read/26206647/impact-of-hemorrhagic-shock-on-pituitary-function
#18
Bellal Joseph, Ansab A Haider, Viraj Pandit, Narong Kulvatunyou, Tahereh Orouji, Mohammad Khreiss, Andrew Tang, Terence O'Keeffe, Randall Friese, Peter Rhee
BACKGROUND: Hypopituitarism after hypovolemic shock is well established in certain patient cohorts. However; the effects of hemorrhagic shock on pituitary function in trauma patients remains unknown. The aim of this study was to assess pituitary hormone variations in trauma patients with hemorrhagic shock. STUDY DESIGN: Patients with acute traumatic hemorrhagic shock presenting to our level 1 trauma center were prospectively enrolled. Hemorrhagic shock was defined as systolic blood pressure (SBP) ≤ 90 mmHg on arrival or within 10 minutes of arrival in the emergency department, and requirement of ≥2 units of packed red blood cell transfusion...
August 2015: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/26151518/correlation-of-computed-tomographic-signs-of-hypoperfusion-and-clinical-hypoperfusion-in-adult-blunt-trauma-patients
#19
Lauren Smithson, Joseph Morrell, Urszula Kowalik, William Flynn, Weidun Alan Guo
BACKGROUND: The computed tomographic signs of hypoperfusion (CTSHs) have been reported in radiology literature as preceding the onset of clinical shock in children, but its correlation with tenuous hemodynamic status in adult blunt trauma patients has not been well studied. We hypothesized that these CT findings represent a clinically hypoperfused state and predict patient outcomes. METHODS: We retrospectively reviewed 52 adult blunt trauma patients who presented to our Level I trauma center with an Injury Severity Score (ISS) greater than 15 and a systolic blood pressure less than 90 mm Hg and who underwent torso CT scans during a period of 5...
June 2015: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/26056540/association-of-low-non-invasive-near-infrared-spectroscopic-measurements-during-initial-trauma-resuscitation-with-future-development-of-multiple-organ-dysfunction
#20
Bret A Nicks, Kevin M Campons, William P Bozeman
BACKGROUND: Near-infrared spectroscopy (NIRS) non-invasively monitors muscle tissue oxygen saturation (StO2). It may provide a continuous noninvasive measurement to identify occult hypoperfusion, guide resuscitation, and predict the development of multiple organ dysfunction (MOD) after severe trauma. We evaluated the correlation between initial StO2 and the development of MOD in multi-trauma patients. METHODS: Patients presenting to our urban, academic, Level I Trauma Center/Emergency Department and meeting standardized trauma-team activation criteria were enrolled in this prospective trial...
2015: World Journal of Emergency Medicine
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