Multiple Trauma and Emergency Room Management

Frink, Michael; Lechler, Philipp; Debus, Florian; Ruchholtz, Steffen

doi:10.3238/arztebl.2017.0497

Cited by 39 publications

(32 citation statements)

References 25 publications

(19 reference statements)

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“…Missing or delayed initial test results (e.g. delayed diagnostics results, missing disease severity scores) from patients with MTI is disadvantageous, particularly during the primary resuscitation phase when critical decisions, including any early decision to transfer patients to the next suitable clinic, have to be made immediately 37 . Here, we observed that the BChE activity, when measured at the time point of patient admission to the hospital, correlates with the disease severity scores obtained within 24 hours.…”

Section: Discussionmentioning

confidence: 99%

Bedside-measurement of serum cholinesterase activity predicts patient morbidity and length of the intensive care unit stay following major traumatic injury

Zivkovic

Schmidt

Stein

et al. 2019

Sci Rep

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Major traumatic injury (MTI), a life-threatening condition requiring prompt medical intervention, is associated with an extensive inflammatory response often resulting in multiple organ dysfunction. Early stratification of trauma severity and the corresponding inflammation may help optimize resources at the intensive care unit (ICU). The cholinergic system counters inflammation by quickly modulating the immune response. Serum cholinesterase (butyrylcholinesterase, BChE) is an enzyme that hydrolyses acetylcholine. We tested whether a change in the BChE activity correlates with the morbidity and the length of ICU stay. Blood samples from 10 healthy volunteers and 44 patients with MTI were gathered at hospital admission, followed by measurements 12, 24 and 48 hours later. Point-of-care approach was used to determine the BChE activity. Disease severity was assessed by clinical scoring performed within 24 hours following hospital admission. BChE activity, measured at hospital admission, showed a significant and sustained reduction and correlated with disease severity scores obtained 24 hours following admission. BChE activity, obtained at hospital admission, correlated with the length of ICU stay. Bedside measurement of BChE activity, as a complementary addition to established procedures, might prove useful in the primary assessment of the disease severity and might therefore optimize therapy in the ICU.

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Section: Discussionmentioning

confidence: 99%

Bedside-measurement of serum cholinesterase activity predicts patient morbidity and length of the intensive care unit stay following major traumatic injury

Zivkovic

Schmidt

Stein

et al. 2019

Sci Rep

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“…All data were extracted from the electronic medical records of Chosun University Hospital. This study was conducted on injured patients aged ≥18 years who met Chosun University Hospital's criteria for severe trauma team activation, as shown in Table 1, and the severe trauma team was activated when one or more of the criteria were met [10]. The exclusion criteria were patients aged <18 years, those for whom excessive time had passed after the accident because of transfer from another hospital, those who died within 24 hours of presenting to the hospital, those with known chronic kidney disease, and those with incomplete urea nitrogen, and creatinine levels, arterial blood gas analysis findings, and NLR) ( Tables 2, 3).…”

Section: Methodsmentioning

confidence: 99%

Role of the Neutrophil-to-Lymphocyte Ratio at the Time of Arrival at the Emergency Room as a Predictor of Rhabdomyolysis in Severe Trauma Patients

2020

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In patients with trauma, rhabdomyolysis (RM) can lead to fatal complications resulting from muscle damage. Thus, RM must be immediately diagnosed and treated to prevent complications. Creatine kinase (CK) is the most sensitive marker for diagnosing RM. However, relying on CK tests may result in delayed treatment, as it takes approximately 1 hour to obtain CK blood test results. Hence, this study investigated whether the neutrophil-to-lymphocyte ratio (NLR) could predict RM at an earlier time point in patients with trauma, since NLR results can be obtained within 10 minutes. methods: This retrospective study included 130 patients with severe trauma who were admitted to the emergency room of a tertiary institution between January 2017 and April 2020. RM was defined as a CK level ≥1,000 U/L at the time of arrival. Patients with severe trauma were categorized into non-RM and RM groups, and their characteristics and blood test results were analyzed. Statistical analysis was performed using SPSS version 26.0 for Windows. results: Of the 130 patients with severe trauma, 50 presented with RM. In the multivariate analysis, the NLR (odds ratio [OR], 1.252; 95% confidence interval [CI], 1.130-1.386), pH level (OR, 0.006; 95% CI, 0.000-0.198), presence of acute kidney injury (OR, 3.009; 95% CI, 1.140-7.941), and extremity Abbreviated Injury Scale score (OR, 1.819; 95% CI, 1.111-2.980) significantly differed between the non-RM and RM groups. A receiver operating characteristic analysis revealed that a cutoff NLR value of 3.64 was the best for predicting RM. Conclusions: In patients with trauma, the NLR at the time of arrival at the hospital is a useful biochemical marker for predicting RM.

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“…The institution is an urban emergency medical center, admitting approximately 20,000 trauma patients each year, of which approximately 3,000 admissions present with multiple trauma. As in Frink et al (2017), we defined multiple trauma as two or more body region injuries where one or a combination of multiple injuries may endanger the patient's life. We determined multiple trauma by reviewing medical records and computed tomography (CT).…”

Section: Settings and Subjectsmentioning

confidence: 99%

An improved modified early warning score that incorporates the abdomen score for identifying multiple traumatic injury severity

Jiang

2020

PeerJ

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Background Rapid identification of trauma severity is essential for the timely triage of multiple trauma patients. Tools such as the modified early warning score (MEWS) are used for determining injury severity. Although the conventional MEWS is a good predictor of mortality, its performance assessing injury severity is moderate. This study hypothesized that adding an injury site severity-related score (e.g., abdomen score) may enhance the capability of the MEWS for identifying severe trauma. Method To validate the hypothesis, we propose an improved modified early warning score called MEWS-A, which incorporates an injury site-specific severity-related abdomen score to MEWS. The utility of MEWS and MEWS-A were retrospectively evaluated and compared for identifying trauma severity in adult multiple trauma patients admitted to the emergency department. Results We included 1,230 eligible multiple trauma patients and divided them into minor and severe trauma groups based on the injury severity score. Results of logistic regression and receiver operating characteristic (ROC) curve analyses showed that the MEWS-A had a higher area under the ROC curve (AUC: 0.81 95% CI [0.78–0.83]) than did the MEWS (AUC: 0.77 95% CI [0.74–0.79]), indicating that the MEWS-A is superior to the MEWS in identifying severe trauma. The optimal MEWS-A cut-off score is 4, with a specificity of 0.93 and a sensitivity of 0.54. MEWS-A ≥ 4 can be used as a protocol for decision-making in the emergency department. Conclusions Our study suggests that while the conventional MEWS is sufficient for predicting mortality risk, adding an injury site-specific score (e.g., abdomen score) can enhance its performance in determining injury severity in multiple trauma patients.

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Multiple Trauma and Emergency Room Management

Abstract: The care of the severely injured patient should be performed in structured fashion according to the A-B-C-D-E scheme, which involves the securing of the airway, breathing, and circulation, the recognition of neurologic deficits, and whole-body examination by the interdisciplinary team.

Cited by 39 publications

References 25 publications

Bedside-measurement of serum cholinesterase activity predicts patient morbidity and length of the intensive care unit stay following major traumatic injury

Bedside-measurement of serum cholinesterase activity predicts patient morbidity and length of the intensive care unit stay following major traumatic injury

Role of the Neutrophil-to-Lymphocyte Ratio at the Time of Arrival at the Emergency Room as a Predictor of Rhabdomyolysis in Severe Trauma Patients

An improved modified early warning score that incorporates the abdomen score for identifying multiple traumatic injury severity

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