Change of initial and ICU treatment over time in trauma patients. An analysis from the TraumaRegister DGU®

Böhmer, Andreas; Poels, Marcel; Kleinbrahm, Kathrin; Lefering, Rolf; Paffrath, Thomas; Bouillon, Bertil; Defosse, Jérôme; Gerbershagen, Mark U.; Wappler, Frank; Joppich, R.

doi:10.1007/s00423-016-1428-x

Cited by 10 publications

(8 citation statements)

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“…Findings reporting on mechanical ventilation time are contradictory. While some authors did not find changes with regard to mechanical ventilation time [ 43 , 44 ], Probst et al described a decrease from 11.6 days to 8.7 days during a 30 year observation period [ 45 ]. However, the majority of data are derived from general trauma populations, which were not adjusted for patients with severe chest trauma.…”

Section: Resultsmentioning

confidence: 99%

Thoracic trauma now and then: A 10 year experience from 16,773 severely injured patients

et al. 2017

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Background and purposeThoracic trauma remains to be a relevant injury to the polytraumatised patient. However, literature regarding how far changes in clinical guidelines for pre- and in-hospital trauma management and diagnostic procedures affect the outcome of multiple injured patients with severe chest injury during a long-term observation period is sparse.MethodsMultiple traumatised patients (age≥16y) documented in the TraumaRegister DGU® (TR-DGU) from January 1st 2005 to December 31st 2014 with severe chest trauma (AIS≥3) were included in this study. Demographic data, the pattern of injury, injury severity, radiographic emergency procedures, indication for intubation, duration of mechanical ventilation, emergency surgery, occurrence of complications and mortality were evaluated per year and over time.ResultsA total of 16,773 patients were analysed. The use of whole body computer tomography increased (p<0.001), while the incidence of plain x-rays decreased (p<0.001). Furthermore, incidence of AISThorax = 3 graded injuries increased (p<0.001) while AISThorax = 4 decreased (p<0.001). Both, rate of patients being intubated at the time of ICU admission decreased (p<0.001) and the time of mechanical ventilation decreased (p<0.001). Additionally, need for emergency surgery, lung failure, sepsis, and multi organ failure all decreased (p<0.001). However, mortality remained unchanged.InterpretationSeverity of severe chest trauma and associated complications decreased while diagnostics and treatment improved over time. However, mortality remained unchanged. Our results are in line with those expected in the context of the incidence of CT diagnostics, which has increased parallel to the clinical outcome Thus, our data demonstrate a positive trend in the treatment of patients with severe chest trauma.

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Section: Resultsmentioning

confidence: 99%

Thoracic trauma now and then: A 10 year experience from 16,773 severely injured patients

et al. 2017

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“…Furthermore, the severity of pulmonary contusion correlates with the development of pulmonary infections, respiratory failure, sepsis, MOF, and mortality [4, 28]. Böhmer et al have recently published an analysis of changes of ICU treatment over a period of 10 years [29] . This study confirmed a general trend towards reduced ventilation time and shorter stay in ICU as well.…”

Section: Discussionmentioning

confidence: 99%

Trends in intubation rates and durations in ventilated severely injured trauma patients: an analysis from the TraumaRegister DGU®

et al. 2016

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BackgroundEndotracheal intubation in severely injured patients is known to be a risk factor for systemic complications. We aimed to examine the changes in intubation rates and durations in severely injured trauma patients, and rates of the systemic complications associated with ventilation changes by using a large trauma registry over the period of 13 years.MethodsPatient demographics, Injury Severity Score (ISS), ventilation days, ventilation free days (VFD), and prevalence of systemic complications (sepsis and multiple organ failure (MOF)) were obtained from the TraumaRegister DGU® and were compared over the study period.ResultsDuring the study period (2002 – 2014), 35,232 patients were recorded in TraumaRegister DGU®. 72.7 % of patients (n = 25,629) were intubated, and 27.3 % (n = 9603) of patients did not require mechanical ventilation throughout their hospital stay. The mean age was 48 ± 21 years, mean ISS was 27.9 ± 11.5, mean length of ICU stay was 11.7 ± 13.8 days, mean time on mechanical ventilator was 7.1 ± 11.3 days, and mean ventilation free days (spontaneous respiration) was 19.5 ± 11.9 days. We observed a reduction in the intubation rates (87.5 % in 2002 versus 63.6 % in 2014), and early extubation (10 ventilation days in 2002, and 5.9 days in 2014) over time.ConclusionOur study reveals a reduction in intubation rates and ventilation duration during the observation period. Moreover, we were able to observe decreased incidence of systemic complications such as sepsis over the 13 year study period, while no changes in incidence of MOF were registered. The exact relationship can not be proven in our study. This needs to be addressed in further analysis.

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“…6 La tendencia en el mundo es que la atención de estos pacientes incluye la necesidad de procedimientos quirúrgicos y/o ingreso a Unidades de Cuidado Intensivo (UCI) ha cambiado a través de los años optimizando los recursos, más pacientes requieren menos días de ventilación o estancia, menores complicaicones, realizando una mejor evaluación de los pacientes con ayudas diagnósticas, mejorando las condiciones desde la sala de emergencias a cirugía con la reanimación. 10,11 Por ello, es pertinente describir las características de los pacientes politraumatizados que requirieron UCI que poco se ha descrito en Colombia para lograr identificar desde el ingreso a urgencias, cuáles son los que la requerirán.…”

Section: 5005/jp-journals-10030-1196unclassified

Características clínicas y factores asociados a ingreso a Unidad de Cuidado Intensivo de pacientes con trauma en un hospital de alta complejidad en Cali, Colombia

Badiel¹,

Cevallos²,

Garcia³

et al. 2018

Panamerican Journal of Trauma, Critical Care &Amp; Emergency Surgery

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RESUMENIntroducción: Errase Colombia. la muerte por lesiones de causa externa es la segunda causa de muerte en Colombia y la primera en Cali. Parte de la atención de estos pacientes incluye la necesidad de procedimientos quirúrgicos y/o ingreso a Unidades de Cuidado Intensivo (UCI). Se describen las características de los pacientes que requirieron UCI. Material y métodos:A partir del Registro Internacional de Trauma de la Sociedad Panamericana de Trauma (ITR/SPT-ITSDP) en un hospital privado de primer nivel se revisan todos los registros consecutivos de los sujetos que ingresaron por lesión de causa externa con injury severity score (ISS) ≥ 9 o con al menos 6 horas en observación-urgencias entre enero-2012 a Diciembre-2014 y requirieron UCI.Resultados: De 3791 ingresos, el 31.71% (n = 1.202) correspondieron a sujetos que requirieron la UCI. El 78.2% fueron hombres. La edad promedio fue 33.5 ± 21 años. El 43.1% ingresaron con ISS ≥ 15. Solo el 16.4% de los lesionados tuvieron compromiso craneoencefálico, el 35.7% presentaron heridas penetrantes por arma de fuego o cortopunzantes. EL 69.88% (n = 840) fueron sometidos a cirugía. La mediana de estancia en UCI fue de 4 [IQR 2-7 días], el 65.56% (n = 788) requirieron uso de ventilador. La mortalidad total fue de 11.2% (133/1202) vs 4.8% (123/1900) por fuera de UCI. EL RR para mortalidad fue del 2.3 de los sujetos que ingresan a UCI comparado con los que no. Al ingreso a urgencias, los factores predictores de necesidad de UCI fueron Glasgow coma scale (GCS) < 13 (RR = 5.77), ISS > 15 (RR = 6.56), politraumatismo (RR = 1.86), politraumatismo sin trauma de cráneo (RR = 2.32), trauma craneoencefálico (RR = 2.55) y herida por arma de fuego (RR = 2.46). Conclusión:De los sujetos con lesiones de causa externa, con trauma con compromiso moderado o severo que ingresaron a un hospital de primer nivel, el 31.71% requirieron una UCI. La mortalidad fue del 11.2%. Factores asociado al ingreso a UCI fueron GCS < 13, ISS > 15, politraumatismo, trauma craneoencefálico y herida por arma de fuego.Palabras Clave: Indices de gravedad del trauma, Sistemas de datos, Trauma, Unidad de cuidados intensivos.How to cite this article: Ordoñez CA, García MAM, Cevallos C, Carpio JMV, Badiel M. Características clínicas y factores asociados a ingreso a Unidad de Cuidado Intensivo de pacientes con trauma en un hospital de alta complejidad en Cali, Colombia. Panam J Trauma Crit Care Emerg Surg 2018;7(1):1-3. ABSTRACTIntroduction: Violence continues to be one of the leading causes of mortality in Colombia. We sought to describe and analyze a series of trauma patients that required intensive unit care in a high-complexity center in Cali, Colombia.

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Change of initial and ICU treatment over time in trauma patients. An analysis from the TraumaRegister DGU®

Abstract: The reduction LOS in the analyzed dataset is mainly explained by the relevantly reduced rate of patients being intubated at the time of ICU admission. Our data demonstrate that trauma patients' in-hospital course is influenced by reduced intubation rate at the time of ICU admission.

Cited by 10 publications

References 33 publications

Thoracic trauma now and then: A 10 year experience from 16,773 severely injured patients

Thoracic trauma now and then: A 10 year experience from 16,773 severely injured patients

Trends in intubation rates and durations in ventilated severely injured trauma patients: an analysis from the TraumaRegister DGU®

Características clínicas y factores asociados a ingreso a Unidad de Cuidado Intensivo de pacientes con trauma en un hospital de alta complejidad en Cali, Colombia

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