Independent Predictors of Mortality in Torso Trauma Injuries

Abstract

Noncompressible torso injuries (NCTIs) represent a trauma-related condition with high lethality. This study’s aim was to identify potential prediction factors of mortality in this group of trauma patients at a Level 1 trauma center in Italy. Materials and Methods: A total of 777 patients who had sustained a noncompressible torso injury (NCTI) and were admitted to the Niguarda Trauma Center in Milan from 2010 to 2019 were included. Of these, 166 patients with a systolic blood pressure (SBP) <90 mmHg were considered to have a noncompressible torso hemorrhage (NCTH). Demographic data, mechanism of trauma, pre-hospital and in-hospital clinical conditions, diagnostic/therapeutic procedures, and survival outcome were retrospectively recorded. Results: Among the 777 patients, 69% were male and 90.2% sustained a blunt trauma with a median age of 43 years. The comparison between survivors and non-survivors pointed out a significantly lower pre-hospital Glasgow coma scale (GCS) and SBP (p < 0.001) in the latter group. The multivariate backward regression model identified age, pre-hospital GCS and injury severity score (ISS) (p < 0.001), pre-hospital SBP (p = 0.03), emergency department SBP (p = 0.039), performance of torso contrast enhanced computed tomography (CeCT) (p = 0.029), and base excess (BE) (p = 0.008) as independent predictors of mortality. Conclusions: Torso trauma patients who were hemodynamically unstable in both pre- and in-hospital phases with impaired GCS and BE had a greater risk of death. The detection of independent predictors of mortality allows for the timely identification of a subgroup of patients whose chances of survival are reduced.

Torso hemorrhage: noncompressible? never say never

“…Meanwhile, descending aorta (45.3%), renal artery (10.7%) and internal iliac artery (43.7%) were the most easily involved vessels in thoracic, abdominal and pelvic cavity, respectively. Subsequently, Italian researchers highlighted the urgent importance of early hemostatic intervention via revealing that the majority of NCTH mortality occurred in the early stage of injuries [ 63 ].…”

Variables fisiológicas del “componente metabólico” del estado ácido base y mortalidad en pacientes de cuidados intensivos

“…Otra variable ampliamente estudiada como predictora de mortalidad en diferentes escenarios clínicos es la BE. Algunos estudios han reportado relación de la BE con los resultados clínicos adversos incluyendo la mortalidad, en poblaciones específicas de pacientes críticos (17,18), especialmente en pacientes con trauma (19)(20)(21), sin embargo, un estudio Realizado por Masevicius et al (22), en una UCI médico-quirúrgica donde recolectaron 4901 pacientes durante 9 años, no mostró asociación de la BE con la mortalidad hospitalaria (22). En el presente estudio la BEst no mostró significancia estadística en el análisis bivariado.…”