Increased reduction in exsanguination rates leaves brain injury as the only major cause of death in blunt trauma

Jochems, Denise; Leenen, Loek P. H.; Hietbrink, Falco; Houwert, Roderick M.; Wessem, Karlijn J. P. van

doi:10.1016/j.injury.2018.05.012

Cited by 31 publications

(28 citation statements)

References 14 publications

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“…We conducted a 11 year retrospective cohort study of severely injured trauma patients admitted to the University Medical Center Utrecht (UMCU) from 1 January 2007 to 31 December 2017. PICS patients were identified in two ways: (1) by their clinical course and (2) by markers described in the literature [5,7,16]. The incidence of PICS was calculated, and the sensitivity and specificity of the markers were analyzed.…”

Section: Methodsmentioning

confidence: 99%

“…In recent decades, there has been much improvement in the clinical care for trauma patients, which has led to a decrease in mortality by exsanguination and life-threatening inflammatory complications, such as Acute Respiratory Distress Syndrome (ARDS), sepsis and multiple organ dysfunction syndrome (MODS) [1,2]. In particular, the initial approach and resuscitation, the introduction of standardized operating procedures, early hemorrhage control and improved clinical critical care have contributed to this decrease [3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

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Persistent Inflammation, Immunosuppression and Catabolism Syndrome (PICS) after Polytrauma: A Rare Syndrome with Major Consequences

Hesselink

Hoepelman

Spijkerman

et al. 2020

JCM

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Nowadays, more trauma patients develop chronic critical illness (CCI), a state characterized by prolonged intensive care. Some of these CCI patients have disproportional difficulties to recover and suffer from recurrent infections, a syndrome described as the persistent inflammation, immunosuppression and catabolism syndrome (PICS). A total of 78 trauma patients with an ICU stay of ≥14 days (CCI patients) between 2007 and 2017 were retrospectively included. Within this group, PICS patients were identified through two ways: (1) their clinical course (≥3 infectious complications) and (2) by laboratory markers suggested in the literature (C-reactive protein (CRP) and lymphocytes), both in combination with evidence of increased catabolism. The incidence of PICS was 4.7 per 1000 multitrauma patients. The sensitivity and specificity of the laboratory markers was 44% and 73%, respectively. PICS patients had a longer hospital stay (median 83 vs. 40, p < 0.001) and required significantly more surgical interventions (median 13 vs. 3, p = 0.003) than other CCI patients. Thirteen PICS patients developed sepsis (72%) and 12 (67%) were readmitted at least once due to an infection. In conclusion, patients who develop PICS experience recurrent infectious complications that lead to prolonged hospitalization, many surgical procedures and frequent readmissions. Therefore, PICS forms a substantial burden on the patient and the hospital, despite its low incidence.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Persistent Inflammation, Immunosuppression and Catabolism Syndrome (PICS) after Polytrauma: A Rare Syndrome with Major Consequences

Hesselink

Hoepelman

Spijkerman

et al. 2020

JCM

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“…In 1999 the Netherlands implemented an inclusive trauma system, which organized the country in 11 trauma regions [9]. The goal of this inclusive system is to present all patients on a timely basis at the right hospital, with the centralisation of the most severely injured patients in level 1 centres [10][11][12][13][14][15][16][17][18][19][20][21][22][23]. The less severely injured patients are ideally treated at level 2 and level 3 centres.…”

Section: The Evolution Of Mortality In Traumamentioning

confidence: 99%

“…This organizational change had a major impact on trauma care, as it did in most countries that implemented inclusive trauma systems [24,25]. The data presented in every time period is based on previous publications and where possible adjusted odd ratios presented in those publications were used [10][11][12][13][14][15][16][17][18][19][20][21][22][23]. Before centralisation (step 1) a regional mortality rate of 2.6% was documented, of which 40% died due to exsanguination.…”

Section: The Evolution Of Mortality In Traumamentioning

confidence: 99%

“…These combined measures resulted that to date, the most important cause of death is neurotrauma (> 80%). Even more, in most cases of extensive neurotrauma it is a medical decision to stop treatment after adequate resuscitation and when a complete overview of the patients history and comorbidities is retrieved [16,17]. Finally, next to the improved mortality rates, the care for trauma patients becomes increasingly efficient.…”

Section: The Evolution Of Mortality In Traumamentioning

confidence: 99%

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The evolution of trauma care in the Netherlands over 20 years

Hietbrink

Houwert

Wessem

et al. 2019

Eur J Trauma Emerg Surg

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Introduction In 1999 an inclusive trauma system was initiated in the Netherlands and a nationwide trauma registry, including all admitted trauma patients to every hospital, was started. The Dutch trauma system is run by trauma surgeons who treat both the truncal (visceral) and extremity injuries (fractures). Materials and Methods In this comprehensive review based on previous published studies, data over the past 20 years from the central region of the Netherlands (Utrecht) was evaluated. Results It is demonstrated that the initiation of the trauma systems and the governance by the trauma surgeons led to a regionwide mortality reduction of 50% and a mortality reduction for the most severely injured of 75% in the level 1 trauma centre. Furthermore, major improvements were found in terms of efficiency, demonstrating the quality of the current system and its constructs such as the type of surgeon. Due to the major reduction in mortality over the past few years, the emphasis of trauma care evaluation shifts towards functional outcome of severely injured patients. For the upcoming years, centralisation of severely injured patients should also aim at the balance between skills in primary resuscitation and surgical stabilization versus longitudinal surgical involvement. Conclusion Further centralisation to a limited number of level 1 trauma centres in the Netherlands is necessary to consolidate experience and knowledge for the trauma surgeon. The future trauma surgeon, as specialist for injured patients, should be able to provide the vast majority of trauma care in this system. For the remaining part, intramural, regional and national collaboration is essential

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Preventable deaths in hospitalized trauma patients

Alao,

Cevik,

Al Shamsi

et al. 2024

World j. surg.

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AimTo study the preventable trauma deaths of hospitalized patients in the United Arab Emirates and to identify opportunities for improvement.MethodsWe analyzed the Abu Dhabi Emirate Trauma Registry data of admitted patients who died in the emergency department or in hospital from 2014 to 2019. A panel of experts categorize the deaths into not preventable (NP), potentially preventable (PP), and definitely preventable (DP).ResultsA total of 405 deaths were included, and 82.7% were males. The majority (89.1%) were NP, occurring mainly in the emergency department (40.4%) and the intensive care unit (49.9%). The combined potentially preventable and preventable death rate was 10.9%. The median (Interquartile range) age of the DP was 57.5 (37–76) years, compared with 32 (24–42) and 34 (25–55) years for NP and PP, respectively (p = 0.008). Most of the PP deaths occurred in the intensive care unit (55.6%), while the DP occurred mainly in the ward (50%). Falls accounted for 25% of PP and DP. Deficiencies in airway care, hemorrhage control, and fluid management were identified in 25%, 43.2% and 29.5% of the DP/PP deaths, respectively. Seventy‐two percent of the Airway deficiencies occurred in the prehospital, while 34.1% of hemorrhage control deficiencies were in the emergency department. Fluid management deficiencies occurred in the emergency department and the operation theater.ConclusionsDP and PP deaths comprised 10.9% of the deaths. Most of the DP occurred in the emergency department and ward. Prehospital Airway and in‐hospital hemorrhage and excessive fluid were the main areas for opportunities for improvement.

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Increased reduction in exsanguination rates leaves brain injury as the only major cause of death in blunt trauma

Cited by 31 publications

References 14 publications

Persistent Inflammation, Immunosuppression and Catabolism Syndrome (PICS) after Polytrauma: A Rare Syndrome with Major Consequences

Persistent Inflammation, Immunosuppression and Catabolism Syndrome (PICS) after Polytrauma: A Rare Syndrome with Major Consequences

The evolution of trauma care in the Netherlands over 20 years

Preventable deaths in hospitalized trauma patients

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