Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Assessment of the Initial Risk Factors for Mortality among Patients with Severe Trauma on Admission to the Emergency Department

  • Park, Hyun Oh (Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine) ;
  • Choi, Jun Young (Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine) ;
  • Jang, In Seok (Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine) ;
  • Kim, Jong Duk (Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine) ;
  • Choi, Jae Won (Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine) ;
  • Lee, Chung Eun (Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine)
  • Received : 2019.05.10
  • Accepted : 2019.08.10
  • Published : 2019.12.05
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Abstract

Background: For decades, trauma has been recognized globally as a major cause of death. Reducing the mortality of patients with trauma is an extremely pressing issue, particularly for those with severe trauma. An early and accurate assessment of the risk of mortality among patients with severe trauma is important for improving patient outcomes. Methods: We performed a retrospective medical record review of 582 patients with severe trauma admitted to the emergency department between July 2011 and June 2016. We analyzed the associations of in-hospital mortality with the baseline characteristics and initial biochemical markers of patients with severe trauma on admission. Results: The overall in-hospital mortality rate was 14.9%. Multivariate logistic regression analysis showed that the patient's Rapid Emergency Medicine Score (REMS; odds ratio [OR], 1.186; 95% confidence interval [CI], 1.018-1.383; p=0.029), Emergency Trauma Score (EMTRAS; OR, 2.168; 95% CI, 1.570-2.994; p<0.001), serum lactate levels (SLL; OR, 1.298; 95% CI, 1.118-1.507; p<0.001), and Injury Severity Score (ISS; OR, 1.038; 95% CI, 1.010-1.130; p=0.021) were significantly associated with in-hospital mortality. Conclusion: The REMS, EMTRAS, and SLL can easily and rapidly be used as alternatives to the injury severity score to predict in-hospital mortality for patients who present to the emergency department with severe trauma.

Keywords

References

  1. Schoeneberg C, Schilling M, Burggraf M, Fochtmann U, Lendemans S. Reduction in mortality in severely injured patients following the introduction of the "treatment of patients with severe and multiple injuries" guideline of the German society of trauma surgery: a retrospective analysis of a level 1 trauma center (2010-2012). Injury 2014;45:635-8. https://doi.org/10.1016/j.injury.2013.11.024
  2. Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet 2006;367:1747-57. https://doi.org/10.1016/S0140-6736(06)68770-9
  3. Park HO, Kim JW, Kim SH, et al. Usability verification of the Emergency Trauma Score (EMTRAS) and Rapid Emergency Medicine Score (REMS) in patients with trauma: a retrospective cohort study. Medicine (Baltimore) 2017;96:e8449. https://doi.org/10.1097/md.0000000000008449
  4. Lendrum RA, Lockey DJ. Trauma system development. Anaesthesia 2013;68 Suppl 1:30-9. https://doi.org/10.1111/anae.12049
  5. Jelodar S, Jafari P, Yadollahi M, et al. Potential risk factors of death in multiple trauma patients. Emerg (Tehran) 2014;2:170-3.
  6. Copes WS, Champion HR, Sacco WJ, Lawnick MM, Keast SL, Bain LW. The Injury Severity Score revisited. J Trauma 1988;28:69-77. https://doi.org/10.1097/00005373-198801000-00010
  7. Jang HN, Park HO, Yang TW, et al. Biochemical markers as predictors of in-hospital mortality in patients with severe trauma: a retrospective cohort study. Korean J Crit Care Med 2017;32:240-6. https://doi.org/10.4266/kjccm.2017.00360
  8. Sammour T, Kahokehr A, Caldwell S, Hill AG. Venous glucose and arterial lactate as biochemical predictors of mortality in clinically severely injured trauma patients: a comparison with ISS and TRISS. Injury 2009;40:104-8. https://doi.org/10.1016/j.injury.2008.07.032
  9. Mikhail J. The trauma triad of death: hypothermia, acidosis, and coagulopathy. AACN Clin Issues 1999;10:85-94. https://doi.org/10.1097/00044067-199902000-00008
  10. Olsson T, Terent A, Lind L. Rapid Emergency Medicine score: a new prognostic tool for in-hospital mortality in nonsurgical emergency department patients. J Intern Med 2004;255:579-87. https://doi.org/10.1111/j.1365-2796.2004.01321.x
  11. Raum MR, Nijsten MW, Vogelzang M, et al. Emergency trauma score: an instrument for early estimation of trauma severity. Crit Care Med 2009;37:1972-7. https://doi.org/10.1097/CCM.0b013e31819fe96a
  12. Centers for Disease Control and Prevention. Cost of injuries and violence in the United States [Internet]. Atlanta (GA): Centers for Disease Control and Prevention [cited 2018 Mar 13]. Available from: http://www.cdc.gov/injury/wisqars/overview/cost_of_injury.html.
  13. Palmer C. Major trauma and the injury severity score: where should we set the bar? Annu Proc Assoc Adv Automot Med 2007;51:13-29.
  14. Yeen W, Carrillo EH, Bragg S, Marsh W, Gilson S, Meltzer T. Cost analysis of vertical deceleration injury in the acute setting. Eur J Trauma Emerg Surg 2007;33:251-5. https://doi.org/10.1007/s00068-007-6057-1
  15. Brown JB, Gestring ML, Leeper CM, et al. The value of the injury severity score in pediatric trauma: time for a new definition of severe injury? J Trauma Acute Care Surg 2017;82:995-1001. https://doi.org/10.1097/TA.0000000000001440
  16. Imhoff BF, Thompson NJ, Hastings MA, Nazir N, Moncure M, Cannon CM. Rapid Emergency Medicine Score (REMS) in the trauma population: a retrospective study. BMJ Open 2014;4:e004738. https://doi.org/10.1136/bmjopen-2013-004738
  17. Wong DT, Crofts SL, Gomez M, McGuire GP, Byrick RJ. Evaluation of predictive ability of APACHE II system and hospital outcome in Canadian intensive care unit patients. Crit Care Med 1995;23:1177-83. https://doi.org/10.1097/00003246-199507000-00005
  18. Nakhjavan-Shahraki B, Baikpour M, Yousefifard M, et al. Rapid acute physiology score versus rapid emergency medicine score in trauma outcome prediction: a comparative study. Emerg (Tehran) 2017;5:e30.
  19. Mangini M, Di Valvasone S, Greco C, et al. Validation of the new proposed Emergency Trauma Score (EMTRAS). Crit Care 2010;14(Suppl 1):252.
  20. Goodwin ML, Harris JE, Hernandez A, Gladden LB. Blood lactate measurements and analysis during exercise: a guide for clinicians. J Diabetes Sci Technol 2007;1:558-69. https://doi.org/10.1177/193229680700100414
  21. Kellum JA, Kramer DJ, Lee K, Mankad S, Bellomo R, Pinsky MR. Release of lactate by the lung in acute lung injury. Chest 1997;111:1301-5. https://doi.org/10.1378/chest.111.5.1301
  22. Abramson D, Scalea TM, Hitchcock R, Trooskin SZ, Henry SM, Greenspan J. Lactate clearance and survival following injury. J Trauma 1993;35:584-8. https://doi.org/10.1097/00005373-199310000-00014
  23. Parsikia A, Bones K, Kaplan M, et al. The predictive value of initial serum lactate in trauma patients. Shock 2014;42:199-204. https://doi.org/10.1097/SHK.0000000000000208
  24. Owen JL, Bolenbaucher RM, Moore ML. Trauma registry databases: a comparison of data abstraction, interpretation, and entry at two level I trauma centers. J Trauma 1999;46:1100-4. https://doi.org/10.1097/00005373-199906000-00025

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