Training to identify red flags in the acute care of trauma: who are the patients at risk for early death despite a relatively good prognosis? An analysis from the TraumaRegister DGU®

Nolte, Philip-C.; Häske, David; Lefering, Rolf; Bernhard, Michaël; Casu, Sebastian; Frankenhauser, Susanne; Gather, Andreas; Grützner, Paul Alfred; Münzberg, Matthias

doi:10.1186/s13017-020-00325-0

Cited by 3 publications

(3 citation statements)

References 24 publications

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“…7,[9][10][11][12][13][14][15] Recently it was demonstrated that severe thoracic trauma is associated with a higher risk of death within the first 24 h in patients with a low estimated risk of death. 16 These patients' likelihood of independent survival improves with early diagnoses and subsequent resuscitative interventions. 10,13 Early life-saving interventions (LSI) for thoracic trauma include intubation/ventilation, pleural decompression, haemostatic transfusion and resuscitative thoracotomy.…”

Section: Introductionmentioning

confidence: 99%

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The first hour of trauma reception is critical for patients with major thoracic trauma

Helsloot

Fitzgerald

Lefering

et al. 2023

European Journal of Anaesthesiology

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BACKGROUND Up to 25% of trauma deaths are related to thoracic injuries.OBJECTIVE The primary goal was to analyse the incidence and time distribution of death in adult patients with major thoracic injuries. The secondary goal was to determine if potentially preventable deaths occurred within this time distribution and, if so, identify an associated therapeutic window.DESIGN Retrospective observational analysis. SETTING TraumaRegister DGU.PATIENTS Major thoracic injury was defined as an Abbreviated Injury Scale (AIS) 3 or greater. Patients with severe head injury (AIS ! 4) or injuries to other body regions with AIS being greater than the thoracic injury (AIS other >AIS thorax) were excluded to ensure that the most severe injury described was primarily thoracic related. MAIN OUTCOME MEASURESIncidence and time distribution of mortality were considered the primary outcome measures. Patient and clinical characteristics and resuscitative interventions were analysed in relation to the time distribution of death.RESULTS Among adult major trauma cases with direct admission from the accident scene, 45% had thoracic injuries and overall mortality was 9.3%. In those with major thoracic trauma (n ¼ 24 332) mortality was 5.9% (n ¼ 1437). About 25% of these deaths occurred within the first hour after admission and 48% within the first day. No peak in late mortality was seen. The highest incidences of hypoxia and shock were seen in non-survivors with immediate death within 1 h and early death (1 to 6 h). These groups received the largest number of resuscitative interventions. Haemorrhage was the leading cause of death in these groups, whereas organ failure was the leading cause of death amongst those who survived the first 6 h after admission.CONCLUSION About half of adult major trauma cases had thoracic injuries. In non-survivors with primarily major thoracic trauma, most deaths occurred immediately (<1h) or within the first 6 h after injury. Further research should analyse if improvements in trauma resuscitation performed within this time frame will reduce preventable deaths.TRIAL REGISTRATION The present study is reported within the publication guidelines of the TraumaRegister DGU1 and registered as TR-DGU project ID 2020-022.

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Section: Introductionmentioning

confidence: 99%

“…Recently it was demonstrated that severe thoracic trauma is associated with a higher risk of death within the first 24 h in patients with a low estimated risk of death. 16 These patients’ likelihood of independent survival improves with early diagnoses and subsequent resuscitative interventions. 10 , 13 …”

Section: Introductionmentioning

confidence: 99%

The first hour of trauma reception is critical for patients with major thoracic trauma

Helsloot

Fitzgerald

Lefering

et al. 2023

European Journal of Anaesthesiology

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“…2 Some previous studies on adult trauma reported that vital signs, the state of consciousness, and comorbidities which were not treated in time were risk factors worthy of attention. [3][4][5][6] However, the study is limited by its retrospective design and missing data (7.36%). A large-scale, multi-center, prospective study is needed to evaluate its effectiveness and capability further.…”

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confidence: 99%

Effectiveness Evaluation of Early Assessment Tools for Earthquake Trauma Patients

Jia

Cao

Bai

2022

Prehosp. Disaster med.

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No trauma-related diagnosis in emergency trauma room whole-body computer tomography of patients with inconspicuous primary survey

Suda,

Pepke,

Obertacke

et al. 2024

Eur J Trauma Emerg Surg

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Purpose Whole-body computer tomographic examinations (WBCT) are essential in diagnosing the severely injured. The structured clinical evaluation in the emergency trauma room, according to ATLS® and guidelines, helps to indicate the correct radiological imaging to avoid overtriage and undertriage. This retrospective, single-center study aimed to evaluate the value of WBCT in patients with an inconspicuous primary survey and whether there is any evidence for this investigation in this group of patients. Methods This retrospective, single-center study was conducted with patients admitted to a maximum-care hospital and supraregional trauma center in Germany and part of the TraumaNetwork DGU® in southwest Germany between January 2012 and November 2017. Hospital files were used for evaluation, and WBCT was carried out using a 32-row MSCT device from Siemens Healthineers, Volume Zoom, Erlangen, Germany. For evaluation, non-parametric procedures such as the chi-square test, U test, Fisher test, and Wilcoxon rank sum test were used to test for significance (p < 0.05). Results From 3976 patients treated with WBCT, 120 patients (3.02%) showed an inconspicuous primary survey. This examination did not reveal any trauma sequelae in any of this group. Additionally, 198 patients (4.98%) showed minor clinical symptoms in the primary survey, but no morphological trauma sequence could be diagnosed in WBCT diagnostics. Three hundred forty-two patients were not admitted as inpatients after WBCT and discharged to further outpatient treatment because there were no objectifiable reasons for inpatient treatment. Four hundred fifteen patients did not receive WBCT for, e.g., isolated extremity trauma, child, pregnancy, or death. Conclusion Not one of the clinically asymptomatic patients had an imageable injury after WBCT diagnostics in this study. WBCT should only be performed in severely injured patients after clinical assessment regardless of “trauma mechanism.” According to guidelines and ATLS®, the clinical examination seems to be a safe and reliable method for reasonable and responsible decision-making regarding the realization of WBCT with all well-known risk factors.

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Training to identify red flags in the acute care of trauma: who are the patients at risk for early death despite a relatively good prognosis? An analysis from the TraumaRegister DGU®

Cited by 3 publications

References 24 publications

The first hour of trauma reception is critical for patients with major thoracic trauma

The first hour of trauma reception is critical for patients with major thoracic trauma

Effectiveness Evaluation of Early Assessment Tools for Earthquake Trauma Patients

No trauma-related diagnosis in emergency trauma room whole-body computer tomography of patients with inconspicuous primary survey

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