Potential Risk Factors for In-Hospital Mortality in Patients with Moderate-to-Severe Blunt Multiple Trauma Who Survive Initial Resuscitation

Abstract

Introduction The aim was to identify risk factors that influence in-hospital mortality for patients with moderate-to-severe blunt multiple trauma (BMT) who survive initial resuscitation. Methods The prospective study involved 195 adult patients with BMT who were admitted to a referral hospital's emergency department (ED) between May 1, 2015, and May 31, 2016. Results Forty-three (22%) of the 195 patients died in hospital. Multivariate analysis identified low blood pH (odds ratio [OR] 6.580, 95% confidence interval [CI] 1.12-38.51), high serum lactate level (OR 1.041, 95% CI 1.01-1.07), high ISS (OR 1.109, 95% CI 1.06-1.16), high APACHE II score (OR 1.189, 95% CI 1.07-1.33), traumatic brain injury (TBI) (OR 4.358, 95% CI 0.76-24.86), severe hemorrhage (OR 5.314, 95% CI 1.07-26.49), and coagulopathy (OR 5.916, 95% CI 1.17-29.90) as useful predictors of acute in-hospital mortality. High ISS (OR 1.047, 95% CI 1.02-1.08), TBI (OR 8.922, 95% CI 2.57-31.00), sepsis (OR 4.956, 95% CI 1.99-12.36), acute respiratory distress syndrome (ARDS) (OR 8.036, 95% CI 1.85-34.84), respiratory failure (OR 9.630, 95% CI 2.64-35.14), renal failure (OR 74.803, 95% CI 11.34-493.43), and multiple organ failure [MOF] (OR 10.415, 95% CI 4.48-24.24) were risk factors for late in-hospital mortality. High Glasgow Coma Scale (GCS) was a good predictor for survival at 2, 7, and 28 or more days of hospitalization (OR 0.708 and 95% CI 0.56-0.09; OR 0.835 and 95% CI 0.73-0.95; OR 0.798 and 95% CI 0.71-0.90, resp.). Conclusion Several factors signal poor short-term outcome for patients who present to the ED with moderate-to-severe BMT: low blood pH, high serum lactate level, presence of TBI, severe hemorrhage, coagulopathy, organ failure (respiratory, renal, and MOF), and ARDS. For this patient group, ISS and APACHE II scores might be helpful for stratifying by mortality risk, and GCS might be a good predictor for survival.

Evaluation of independent predictors of in-hospital mortality in patients with severe trauma

“…In our study the largest proportion of patients was traumatized in car crash (33.2%), followed by falls from the height (26.4%) and as pedestrians (22.6%). Our findings were similar like in previous studies [12].…”

Incidence of post-traumatic pneumonia in poly-traumatized patients: identifying the role of traumatic brain injury and chest trauma

“…TBI alone is also an independent predictor of in-hospital mortality in poly-traumatized patients. The study by Yucel et al, who found an even greater odds ratio for TBI as a risk factor for mortality, strongly supports our results [39]. This result is not unexpected, as even isolated TBI is considered one of the most lethal traumatic injuries, as illustrated by the study by Para et al [40].…”

Advantage of surgical intensive care unit (SICU) predominant by cardiothoracic surgeons in multiple trauma management in a primary hospital

“…Although tertiary hospitals are familiar with how to decrease mortality following injury, primary hospitals still have difficulty to handle the tough situation. The three top reasons demonstrated to cause death in multiple trauma patients are 2 , 3 , 4 , 5 : (1) missing the chance to treat patients within the so called “golden hour of shock”, (2) hemorrhagic shock, (3) multiple organ dysfunction syndrome (MODS). So, how to reasonably handle these three challenges are still the focuses of the clinical research.…”