Trauma patients who present in a delayed fashion: a unique and challenging population

Kao, Mary; Nunez, Hector; Monaghan, Sean F.; Heffernan, Daithi S.; Adams, Charles A.; Lueckel, Stephanie N.; Stephen, Andrew H.

doi:10.1016/j.jss.2016.09.037

Cited by 3 publications

(4 citation statements)

References 19 publications

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“…It is plausible that given the location to larger metropolitan areas, our patients may be relatively less affluent and lack proper access to care. 8 In our area, it is quite common to see a patient for the first time in an acute care setting with advanced disease. This observation may be due to an inherent distrust of medical professionals or an access to care issue.…”

Section: Discussionmentioning

confidence: 99%

“…It is plausible that given the location to larger metropolitan areas, our patients may be relatively less affluent and lack proper access to care. 8…”

Section: Discussionmentioning

confidence: 99%

“…To our knowledge, this relationship in trauma patients has only been explored in a single study comparing outcomes of all trauma patients after delayed presentation after 24 h. 8 Johnson City Medical Center (JCMC) is a Tennessee designated level I trauma center located in Johnson City, TN in rural Appalachia. At our center, a ground level fall is the mechanism of injury for roughly 40% of entries into the trauma registry annually.…”

Section: Introductionmentioning

confidence: 99%

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Poor Outcomes of Patients From Delayed Care After Ground Level Falls

Heard

Suresh

Leonard

et al. 2023

The American Surgeon™

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Background Ground level falls are a common cause of morbidity and mortality in trauma patients. Delayed presentation in many conditions has been proven to lead to worsened outcomes. Currently, there are limited data on outcomes of those who have a delayed presentation after a ground level fall. Materials and Methods This study was a retrospective analysis of the Trauma Registry at our center. Any adult patient who presented after a ground level fall was grouped based on their time to presentation post-injury: less than or greater than 24 h. Age, gender, hospital length of stay (LOS), intensive care unit (ICU) LOS, mechanical ventilation days, Injury Severity Score, and mortality were patient characteristics gathered. A Student’s t-test and Chi-squared testing were utilized to determine the presence of significant differences between the groups. Significance was set at P < .05. Results Two hundred of 4018 patients had delayed presentation. Those with delayed presentation were more likely to be male ( P = .028), younger in age (71 vs 74 years old, P < .01), had greater hospital LOS (6 vs. 5, P < .01), ICU LOS (5 vs. 3, P < .01), and mechanical ventilation days (13 vs. 5 days, P < .01). They also had higher ISS (8 vs. 7, P < .01), and mortality was significantly higher in those who presented after 24 h ( P = .034). Conclusion Patients with delayed presentation after a ground level fall have worsened Injury Severity Scores and outcomes to include hospital and ICU LOS, ventilator days, and overall mortality.

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Section: Discussionmentioning

confidence: 99%

“…It is plausible that given the location to larger metropolitan areas, our patients may be relatively less affluent and lack proper access to care. 8…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Poor Outcomes of Patients From Delayed Care After Ground Level Falls

Heard

Suresh

Leonard

et al. 2023

The American Surgeon™

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“…> 24 hours) post-injury. 24 Additionally, the blood-based biomarker assay technology has improved over time, and many are far more sensitive, with much lower limits of detection/quantification, than older assays used in prior studies. 23 , 25 , 26 Thus, further investigation of the impact of age and time since injury on evolution and performance of leading blood-based biomarker candidates is critically important to guide appropriate use and warn against potential misuse.…”

Section: Introductionmentioning

confidence: 99%

Effects of age and time since injury on traumatic brain injury blood biomarkers: a TRACK-TBI study

Gardner

Puccio

Korley

et al. 2022

Brain Communications

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Older adults have the highest incidence of traumatic brain injury globally. Accurate blood-based biomarkers are needed to assist with diagnosis of patients across the spectrum of age and time post-injury. Several reports have suggested lower accuracy for blood-based biomarkers in older adults, and there is a paucity of data beyond day-1 post-injury. Our aims were to investigate age-related differences in diagnostic accuracy and 2-week evolution of 4 leading candidate blood-based traumatic brain injury biomarkers – plasma glial fibrillary acidic protein, ubiquitin carboxy-terminal hydrolase L1, S100 calcium binding protein B, and neuron specific enolase – among participants in the 18-site prospective cohort study Transforming Research And Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI). Day-1 biomarker data were available for 2602 participants including 2151 patients with traumatic brain injury, 242 orthopedic trauma controls, and 209 healthy controls. Participants were stratified into 3 age categories (young: 17-39 years, middle-aged: 40-64 years, older: 65-90 years). We investigated age-stratified biomarker levels and biomarker discriminative abilities across 3 diagnostic groups: head CT-positive/negative; traumatic brain injury/orthopedic controls; traumatic brain injury/healthy controls. The difference in day-1 glial fibrillary acidic protein, ubiquitin carboxy-terminal hydrolase L1, and neuron specific enolase levels across most diagnostic groups was significantly smaller for older versus younger adults, resulting in a narrower range within which a traumatic brain injury diagnosis may be discriminated in older adults. Despite this, day-1 glial fibrillary acidic protein had good to excellent performance across all age-categories for discriminating all 3 diagnostic groups (area under the curve 0.84-0.96; lower limit of 95% confidence intervals all >0.78). Day-1 S100 calcium binding protein B and ubiquitin carboxy-terminal hydrolase L1 showed good discrimination of CT-positive vs. negative only among adults under age 40 years within 6 hours of injury. Longitudinal blood-based biomarker data were available for 522 hospitalized patients with traumatic brain injury and 24 hospitalized orthopedic controls. Glial fibrillary acidic protein levels maintained good to excellent discrimination across diagnostic groups until day 3 post-injury irrespective of age, until day 5 post-injury among middle-aged or younger patients, and until week 2 post-injury among young patients only. In conclusion, the blood-based glial fibrillary acidic protein assay tested here has good to excellent performance across all age-categories for discriminating key traumatic brain injury diagnostic groups to at least 3 days post-injury in this trauma center cohort. The addition of a blood-based diagnostic to the evaluation of traumatic brain injury, including geriatric traumatic brain injury, has potential to streamline diagnosis.

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Delayed presentation or delayed diagnosis? A retrospective study of prospectively collected data of 482 foot and ankle injuries

Shah

2017

Injury

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Trauma patients who present in a delayed fashion: a unique and challenging population

Cited by 3 publications

References 19 publications

Poor Outcomes of Patients From Delayed Care After Ground Level Falls

Poor Outcomes of Patients From Delayed Care After Ground Level Falls

Effects of age and time since injury on traumatic brain injury blood biomarkers: a TRACK-TBI study

Delayed presentation or delayed diagnosis? A retrospective study of prospectively collected data of 482 foot and ankle injuries

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