The Effect of Anticoagulation and Antiplatelet Use in Trauma Patients on Mortality and Length of Stay

2021 ◽  
pp. 000313482198904
Author(s):  
Nisha Narula ◽  
Savas Tsikis ◽  
Sayuri P. Jinadasa ◽  
Charles S. Parsons ◽  
Charles H. Cook ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Injury Severity ◽  
Trauma Registry ◽  
Multivariable Analysis ◽  
Trauma Patients ◽  
Inclusion Criteria ◽  
Hemorrhage Control ◽  
Discharge Outcomes ◽  
Control Procedures ◽  
The Impact

Background Though many trauma patients are on anticoagulation or antiplatelet therapy (AAT), there are few generalizable data on the risks for these patients. The purpose of this study was to analyze the impact of anticoagulation (AC) and antiplatelet (AP) therapy on mortality and length of stay (LOS) in general trauma patients. Methods A retrospective review was performed of patients in the institutional trauma registry during 2019 to determine AAT use on admission and discharge. Outcomes were compared using standard statistics. Results Of 2261 patients who met the inclusion criteria, 2 were excluded due to an incomplete medication reconciliation, resulting in 2259 patients. Patients on AAT had a higher mortality (4.5% vs 2.1%). On multivariable analysis, preadmission AC (odds ratio OR, 3.325, P = .001), age (OR 1.040, P < .001), and injury severity score ((ISS) 1.094, P < .001) were associated with mortality. Anticoagulation use was also associated with longer LOS on multivariable analysis (OR: 1.626, P = .005). Antiplatelet use was not associated with higher mortality or longer LOS. More patients on AAT were unable to be discharged home. However, patients on AAT did not have a greater blood transfusion requirement or need more hemorrhage control procedures. Lastly, 23.7% of patients on preadmission AAT were not discharged on any AAT. Discussion These data demonstrate that patients on AC, but not AP, have greater mortality and longer hospital LOS. This may provide guidance for those being newly started on AAT. Further work to determine which patients benefit most from restarting AAT would lead to improvement in the care of trauma patients.

An Objective Study of the Impact of the Electronic Medical Record on Outcomes in Trauma Patients

2012 ◽  
Vol 78 (11) ◽  
pp. 1249-1254 ◽  
Author(s):  
Paul J. Schenarts ◽  
Claudia E. Goettler ◽  
Michael A. White ◽  
Brett H. Waibel
Keyword(s):  
Length Of Stay ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Injury Severity ◽  
Unit Length ◽  
Traumatic Injury ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Delay In Diagnosis ◽  
The Impact

It is commonly believed that the electronic medical record (EMR) will improve patient outcomes. However, there is scant published literature to support this claim and no studies in any surgical population. Our hypothesis was that the EMR would not improve objective outcome measures in patients with traumatic injury. Prospectively collected data from our university-based Level I trauma center was retrospectively reviewed. Demographic, injury severity as well as outcomes and complications data were compared for all patients admitted over a 20-month period before introduction of the EMR and a 20-month period after full, hospital-wide use of the EMR. Implementation of the EMR was associated with a decreased hospital length of stay, P = 0.02; intensive care unit length of stay, P = 0.001; ventilator days, P = 0.002; acute respiratory distress syndrome, P = 0.006, pneumonia, P = 0.008; myocardial infarction, P = 0.001; line infection, P = 0.03; septicemia, P = 0.000; renal failure, P = 0.000; drug complication, P = 0.001; and delay in diagnosis, P = 0.04. There was no difference in mortality, unexpected cardiac arrest, missed injury, pulmonary embolism/deep vein thrombosis, or late urinary tract infection. This is the first study to investigate the impact of the EMR in surgical patients. Although there was an improvement in some complications, the overall impact was inconsistent.

PP8 Trauma and the obesity epidemic: a systematic review of the impact of obesity on trauma mortality and morbidity

2019 ◽  
Vol 36 (10) ◽  
pp. e5.1-e5
Author(s):  
Simon Mayer ◽  
Sumitra Lahiri ◽  
Joseph Rowles
Keyword(s):  
Systematic Review ◽  
Length Of Stay ◽  
Injury Severity ◽  
Traumatic Injury ◽  
Strong Relationship ◽  
Normal Weight ◽  
The Body ◽  
Trauma Patients ◽  
Mortality And Morbidity ◽  
The Impact

BackgroundTrauma and obesity are both current global epidemics. A simple way to measure the body habitus of patients, to identify the overweight or obese is via the internationally recognized calculation of body mass index (BMI). The primary aim of this systematic review is to assess the mortality rate of those patients with a BMI > 30 kg/m2 in relation to traumatic injury and secondly to assess the effect of those patients with BMI > 30 kg/m2 upon the length of stay in hospital with regards to traumatic injury.MethodA systematic review of the literature was conducted via an internet search of databases and hand searching of references in identified publications from 1st January 1990 to 17th February 2018. Data was extracted from identified publications to include odds ratios of mortality and total length of stay in hospital (days) for patients with a BMI >30 kg/m2 from included studies when compared to patients with a BMI <24.9 kg/m2.ResultsA total of 23 studies met the inclusion criteria. 32, 378 patients were admitted to hospital with a BMI >30 kg/m2 and recorded injury severity score (ISS). Data collated identified BMI >30 kg/m2 OR 1.66 (95% CI 0.75 – 4.2) vs BMI <24.9 kg/m2 OR 0.93 (95% CI 0.82–1.5) to suffer mortality. ISS, BMI >30 kg/m2–19.93 vs 22.3 respectively. Furthermore, those categorised as BMI >30 kg/m2 have 3.78 additional days in the hospital compared to those defined as normal weight.ConclusionThis systematic review presents a strong relationship of increased mortality and complications in trauma patients with BMI >30 kg/m2. Complications are suggestive of those who have a BMI >30 kg/m2 are more likely to suffer detrimental effects following trauma predominantly due to pre-existing unknown co-morbidities. Although, the direct relationship between obesity, trauma and mortality is not fully understood at present and requires more research.

The Impact of Enhanced Intensive Care on Outcome of Major Trauma Patients in a Regional Hospital in Hong Kong

2008 ◽  
Vol 15 (4) ◽  
pp. 218-229
Author(s):  
ANL Chan ◽  
ACH Lit
Keyword(s):  
Hong Kong ◽  
Intensive Care ◽  
Mortality Rate ◽  
Length Of Stay ◽  
Major Trauma ◽  
Injury Severity ◽  
Regional Hospital ◽  
Blunt Injury ◽  
Trauma Patients ◽  
The Impact

Objectives To describe an updated epidemiology of major trauma cases presenting to a regional hospital in Hong Kong and to analyse the impact of enhanced intensive care on the outcome of major trauma patients. Methods This was a retrospective comparative study. In late 2004, we amended our trauma care system with enhancement of intensive care in the management of major trauma patients. An 18-month period was chosen before and after the amendment respectively and patients' data and crude mortality rate between the two periods were compared. Stratified analyses based on mechanism of injury, injury severity and physiological parameters were also performed. Finally, a TRISS analysis was included. Results Altogether 163 and 155 patients were included in our study from the two periods respectively. The majority involved blunt injury and one third of them had injury severity score (ISS) greater than 15. Road traffic accidents and fall from height remained as the two leading causes of major trauma. The median length of stay in the intensive care unit increased for one day (p<0.01) in the later period but the median total length of stay in hospital remained the same. The mortality rate decreased from 10.4% to 9.7% (p=0.82). Conclusion With enhanced intensive care, there is an apparent decrease in mortality of major trauma patients but its significance needs to be determined with a larger scale study.

Impact of Acute Care General Surgery Coverage by Trauma Surgeons on the Trauma Patient

2008 ◽  
Vol 74 (6) ◽  
pp. 494-502 ◽  
Author(s):  
Paul J. Schenarts ◽  
Sachin V. Phade ◽  
Claudia E. Goettler ◽  
Brett H. Waibel ◽  
Steven C. Agle ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Trauma Patient ◽  
Acute Care ◽  
General Surgery ◽  
Injury Severity ◽  
Trauma Patients ◽  
Trauma Service ◽  
Severity Scores ◽  
Trauma Surgeons ◽  
The Impact

Although acute care general surgery (ACS) coverage by trauma surgeons may help re-invigorate the field of trauma surgery, introducing additional responsibilities to an already overburdened system may negatively impact the trauma patient. Our purpose was to determine the impact on the trauma patient of a progressive integration of ACS coverage into a trauma service. Data from a university, Level I trauma registry was retrospectively reviewed to compare demographics, injury severity, complications, and outcomes over a 6-year period. During this study period, the trauma service treated only trauma patients for 32 months, then added ACS coverage 2 days per week for 32 months, and then expanded to 4 days per week coverage for 9 months. Trauma patients admitted during periods of ACS coverage were not different with respect to gender, mechanism of injury, Revised Trauma Score, or Glasgow Coma Score; however, they were slightly older and had slightly higher injury severity scores. As ACS coverage progressively increased, trauma patients had an increase in ventilator days ( P < 0.0001), intensive care unit length of stay ( P < 0.0001), and hospital length of stay ( P < 0.0001). Occurrences of neurologic, pulmonary, gastrointestinal, and infectious complications were similar during all three time periods, whereas cardiac and renal complications progressively increased after ACS coverage was added. Mortality remained unchanged after ACS integration.

scholarly journals Validation of the BATT score for prehospital risk stratification of traumatic haemorrhagic death: usefulness for tranexamic acid treatment criteria

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Francois-Xavier Ageron ◽  
Timothy J. Coats ◽  
Vincent Darioli ◽  
Ian Roberts
Keyword(s):  
Tranexamic Acid ◽  
Acid Treatment ◽  
Injury Severity ◽  
External Validation ◽  
Research Network ◽  
Brier Score ◽  
Trauma Patients ◽  
Using Data ◽  
The Uk ◽  
The Impact

Abstract Background Tranexamic acid reduces surgical blood loss and reduces deaths from bleeding in trauma patients. Tranexamic acid must be given urgently, preferably by paramedics at the scene of the injury or in the ambulance. We developed a simple score (Bleeding Audit Triage Trauma score) to predict death from bleeding. Methods We conducted an external validation of the BATT score using data from the UK Trauma Audit Research Network (TARN) from 1st January 2017 to 31st December 2018. We evaluated the impact of tranexamic acid treatment thresholds in trauma patients. Results We included 104,862 trauma patients with an injury severity score of 9 or above. Tranexamic acid was administered to 9915 (9%) patients. Of these 5185 (52%) received prehospital tranexamic acid. The BATT score had good accuracy (Brier score = 6%) and good discrimination (C-statistic 0.90; 95% CI 0.89–0.91). Calibration in the large showed no substantial difference between predicted and observed death due to bleeding (1.15% versus 1.16%, P = 0.81). Pre-hospital tranexamic acid treatment of trauma patients with a BATT score of 2 or more would avoid 210 bleeding deaths by treating 61,598 patients instead of avoiding 55 deaths by treating 9915 as currently. Conclusion The BATT score identifies trauma patient at risk of significant haemorrhage. A score of 2 or more would be an appropriate threshold for pre-hospital tranexamic acid treatment.

scholarly journals A retrospective cohort study of 27,049 polytraumatized patients age 60 and above: identifying changes over 16 years

2021 ◽  
Author(s):  
Y. Kalbas ◽  
M. Lempert ◽  
F. Ziegenhain ◽  
J. Scherer ◽  
V. Neuhaus ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Injury Severity ◽  
Descriptive Analysis ◽  
Patient Characteristics ◽  
Severe Trauma ◽  
Diagnostic Tools ◽  
Trauma Patients ◽  
Treatment Algorithms ◽  
Injured Patients ◽  
Over Time

Abstract Purpose The number of severely injured patients exceeding the age of 60 has shown a steep increase within the last decades. These patients present with numerous co-morbidities, polypharmacy, and increased frailty requiring an adjusted treatment approach. In this study, we establish an overview of changes we observed in demographics of older severe trauma patients from 2002 to 2017. Methods A descriptive analysis of the data from the TraumaRegister DGU® (TR-DGU) was performed. Patients admitted to a level one trauma center in Germany, Austria and Switzerland between 2002 and 2017, aged 60 years or older and with an injury severity score (ISS) over 15 were included. Patients were stratified into subgroups based on the admission: 2002–2005 (1), 2006–2009 (2), 2010–2013 (3) and 2014–2017 (4). Trauma and patient characteristics, diagnostics, treatment and outcome were compared. Results In total 27,049 patients with an average age of 73.9 years met the inclusion criteria. The majority were males (64%), and the mean ISS was 27.4. The proportion of patients 60 years or older [(23% (1) to 40% (4)] rose considerably over time. Trauma mechanisms changed over time and more specifically low falls (< 3 m) rose from 17.6% (1) to 40.1% (4). Altered injury patterns were also identified. Length-of-stay decreased from 28.9 (1) to 19.5 days (4) and the length-of-stay on ICU decreased from 17.1 (1) to 12.7 days (4). Mortality decreased from 40.5% (1) to 31.8% (4). Conclusion Length of stay and mortality decreased despite an increase in patient age. We ascribe this observation mainly to increased use of diagnostic tools, improved treatment algorithms, and the implementation of specialized trauma centers for older patients allowing interdisciplinary care.

scholarly journals Does emergency medicine length of stay predict trauma outcomes at a Level 1 Trauma Center?

2015 ◽  
Vol 4 (5) ◽  
pp. 1 ◽  
Author(s):  
Erin Powers Kinney ◽  
Kamal Gursahani ◽  
Eric Armbrecht ◽  
Preeti Dalawari
Keyword(s):  
Length Of Stay ◽  
Trauma Center ◽  
Injury Severity ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Hospital Capacity ◽  
Significant Difference ◽  
Level 1 ◽  
Level 1 Trauma Center

Objective: Previous studies looking at emergency department (ED) crowding and delays of care on outcome measures for certain medical and surgical patients excluded trauma patients. The objectives of this study were to assess the relationship of trauma patients’ ED length of stay (EDLOS) on hospital length of stay (HLOS) and on mortality; and to examine the association of ED and hospital capacity on EDLOS.Methods: This was a retrospective database review of Level 1 and 2 trauma patients at a single site Level 1 Trauma Center in the Midwest over a one year period. Out of a sample of 1,492, there were 1,207 patients in the analysis after exclusions. The main outcome was the difference in hospital mortality by EDLOS group (short was less than 4 hours vs. long, greater than 4 hours). HLOS was compared by EDLOS group, stratified by Trauma Injury Severity Score (TRISS) category (< 0.5, 0.51-0.89, > 0.9) to describe the association between ED and hospital capacity on EDLOS.Results: There was no significant difference in mortality by EDLOS (4.8% short and 4% long, p = .5). There was no significant difference in HLOS between EDLOS, when adjusted for TRISS. ED census did not affect EDLOS (p = .59), however; EDLOS was longer when the percentage of staffed hospital beds available was lower (p < .001).Conclusions: While hospital overcrowding did increase EDLOS, there was no association between EDLOS and mortality or HLOS in leveled trauma patients at this institution.

scholarly journals Improving length of stay on a trauma service

2021 ◽  
Vol 6 (1) ◽  
pp. e000744
Author(s):  
Walter L Biffl ◽  
Ning Lu ◽  
Peter R Schultz ◽  
Jiayan Wang ◽  
Matthew R Castelo ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Care Management ◽  
Injury Severity ◽  
Trauma Registry ◽  
Elective Surgery ◽  
Level Of Evidence ◽  
Trauma Service ◽  
Specific Factors ◽  
A Prospective Study ◽  
Study Type

BackgroundReducing length of stay (LOS) is a major healthcare initiative. While LOS is closely linked to the diagnosis and procedure in elective surgery, many additional factors influence LOS on a trauma service. We hypothesized that more standardized patient management would lead to decreased LOS.MethodsRetrospective analysis of Trauma Registry data compared LOS before (PRE) and after (POST) implementation of standardized processes on a trauma service. Patients were subdivided by age (over and under 65 years). Data were compared using unpaired t-test, χ2 test and analysis of variance tests, where appropriate.Results1613 PRE and 1590 POST patients were compared. Although age and Injury Severity Score were similar, median LOS decreased by 1 day for the group overall (p<0.0001), and for subgroups over and under the age of 65 years (p<0.0001). Older patients were discharged home 13% more often in POST, compared with 4% more for younger patients.ConclusionsImproved standardization of processes on a trauma service reduced LOS in patients of all ages. A prospective study may identify specific factors associated with prolonged LOS, to allow further improvement.Level of evidenceIII.Study typeTherapeutic/Care management.

scholarly journals CORRELATION OF FACIAL INJURY SEVERITY SCALE (FISS) WITH LENGTH OF STAY, THE NEED FOR SURGERY AND THE INVOLVEMENT OF OTHER SPECIALISTS IN MAXILLOFACIAL TRAUMA PATIENTS AT H. ADAM MALIK GENERAL HOSPITAL MEDAN

2019 ◽  
pp. 1-3
Author(s):  
Darwin Firmansyah Siregar ◽  
Frank Bietra Buchari ◽  
Utama Abdi Tarigan ◽  
Aznan Lelo
Keyword(s):  
Length Of Stay ◽  
General Hospital ◽  
Injury Severity ◽  
The Body ◽  
Maxillofacial Trauma ◽  
Mandibular Fractures ◽  
Trauma Patients ◽  
Facial Injury ◽  
Single Operator ◽  
Surgery Department

Background: Facial Injury Severity Severity Score (FISS) has been used to assess the severity of facial injuries. However, FISS scores as a useful predictor of length of stay and changes between FISS scores and injuries to other parts of the body have not evaluated. In this study, we want to know the relationship between FISS score as the clinical assessment of maxillofacial trauma with the length of stay, the need for surgery, and the involvement of other specialist elds. Method: This research was conducted using analytical research through a retrospective approach by looking at the medical records of patients who suffered maxillofacial trauma at H. Adam Malik General Hospital Medan from June to August 2019. Result : From a total of 43 patients included in the study, there were 22 mandibular fractures, with mandibular angulus (29.0%), parasymphysis (22.4%), and mandibular corpus (21.5%). Thirty subjects (69.8%) needed surgery, and xation of the fracture and subjects without intervention were 13 (30.2%). Patients who needed surgical intervention, the average time needed for hospitalization was 10.98 + 7.72 days (p = 0.007). The most collaboration found with neurosurgeons specialists, 39.53% of subjects who performed the surgery. A total of 55.8% of surgeries performed by a single operator from the plastic surgery department. Relationship between the length of stay with FISS, obtained for FISS> 3 (OR 14.37) (p = 0.01), meaning that patients with FISS> 3 are likely to stay longer for 14 times. Subsequent results related to the need for surgery obtained signicant results (OR = 8.26, p = 0.026). signicant (p = 0.059). Conclusion: A FISS score signicantly affects the length of stay for a maxillofacial trauma patient. FISS score also affects the involvement of other specialists in maxillofacial trauma patients but not statistically signicant.

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