BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been increasingly used as part of damage control resuscitation for patients with non-compressible truncal hemorrhage. We hypothesized that there might be a select group of patients that could have benefited from prehospital placement of the REBOA. STUDY DESIGN: This was a retrospective cohort study including patients who presented to a Level I trauma center with cardiac arrest between January 2014 and March 2018. The findings of a full autopsy were reviewed for the details of internal injuries. A patient was determined to be a REBOA candidate if the patient sustained abdominal organ injuries or pelvic fractures and no associated severe head injuries. The candidate group was compared with the non-candidate group based on prehospital vital signs and other patient characteristics. A multiple logistic regression analysis was performed to identify certain prehospital factors associated with candidacy for prehospital REBOA.
RESULTS:A total of 198 patients met our inclusion criteria. Of those, 27 (13.6%) patients were deemed REBOA candidates. Median Injury Severity Score was 22 (interquartile range 17 to 29). Patients in the candidate group were more likely to have a Glasgow Coma Scale score 9 (48% vs 15%; p ¼ 0.012), oxygen saturation >90% (56% vs 35%; p ¼ 0.03), and systolic blood pressure <90 mmHg (48% vs 26%; p ¼ 0.04) in the field. Logistic regression showed that these 3 clinical parameters of prehospital vital signs were significantly associated with REBOA candidacy. CONCLUSIONS: Our data suggest that >10% of trauma patients who presented with cardiac arrest could have benefited from prehospital REBOA. Additional prospective studies are warranted to validate the use of field vital signs in selecting candidates. (J Am Coll Surg 2019;229:383e388.
Objective: Frostbite injuries are important causes of morbidity and mortality after trauma. Epidemiology, injury patterns, and outcomes after frostbite among patients presenting to trauma centers are incompletely defined. The purpose of this study was to delineate patient demographics, clinical characteristics, and independent predictors of outcomes after frostbite. Material and Methods: Patients with frostbite injury were identified from the National Trauma Data Bank (NTDB) (2007-2014). Demographics, clinical/ injury data, and outcomes were collected. Patients were dichotomized into study groups based on intensive care unit (ICU) admission. Univariate analysis was performed with the Mann-Whitney U, Fisher's exact, or Chi-Square test as appropriate. Multivariate analysis using logistic regression determined independent predictors of outcomes. Results: Over the study period, 241 patients were identified. Median body temperature on admission was 36.3⁰C (IQR 33.4-36.7). Mortality was 3% (n= 7). ICU admission was required in 101 (42%) patients and 48 (20%) underwent surgical intervention. On multivariate analyses, mortality was predicted by lower admission GCS (p= 0.027) and amputation by higher HR (p= 0.013). Need for ICU admission was predicted by older age (p= 0.010), male gender (p= 0.040), higher HR (p= 0.031) and ISS (p< 0.001), and lower GCS (p= 0.001). Prolonged hospital LOS was predicted by higher heart rate (p< 0.001) and ISS (p< 0.001). Conclusion: Frostbite injuries are uncommon but can necessitate surgical intervention and cause mortality. Lower GCS and higher heart rate, but not body temperature, portend poor outcomes. These findings can be used to triage patients appropriately upon admission and to better inform prognosis after frostbite injuries.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.