Trauma-related Admissions to Intensive Care Unit: Single Center Experience for Major Trauma

Süheyla Karadağ Erkoç; Pınar Karabak; Volkan Baytaş; Ali Abbas Yılmaz; Mustafa Kemal Bayar

doi:10.4274/atfm.galenos.2020.62534

Trauma-related Admissions to Intensive Care Unit: Single Center Experience for Major Trauma

Abstract

Objectives: Major trauma is one of the main reasons for admission to the intensive care unit (ICU) with the increase in complications and mortality. The aim of this studyis to investigate the complications and characteristics of major trauma patients admitted to ICU. Materials and Methods: In this study, we retrospectively analyzed major trauma patients with an “injury severity score” (ISS)>15 who were admitted to ICU between 2015 and 2018. Demographic and clinical data including age, sex, type of injury, rates of complications and 30-day mortality, length of stay (LOS) in ICU and hospital were determined. Acute physiology and chronic health evaluation (APACHE II) score, ISS, trauma revised injury severity score (TRISS), revised trauma score (RTS) and Glasgow coma scale (GCS) score were calculated. Risk factors causing mortality and complications in patients were investigated. Results: Sixty-one patients [19 (31.1%) males and 42 (68.9%) females] aged between 15 and 88 years (mean 42.6±19.2 years) were admitted to our intensive care unit during the study period. Blunt trauma rate (86.8%) was higher than the penetrating injury rate (13.1%). Complications developed in 67.2% of trauma patients, and acutekidney injury (AKI, 45%), pneumonia (34.4%), severe sepsis or septic shock (32.8%) and pulmonary embolism (PE, 9.8%) were detected respectively according to their prevalence. Mortality rates and LOS in ICU and hospital were higher in patients with complications than in those without complications (p<0.05). There were no statistically significant risk factors for the development of complications according to univariate logistic regression analysis (p>0.05). The 30-day mortality rate was 27.8%. Risk factors for mortality were determined as age, APACHE II, RTS, GCS, ISS, TRISS, AKI, PTE by univariate Cox regression analysis and age, RTS, GCS, AKI, PE by multivariate Cox regression analysis (p<0.05). Conclusion: Major trauma is an important cause of mortality due to both itself and complications occurring during ICU treatment. AKI and PE were observed to be complications that increased mortality.

Keywords

Major Trauma, Intensive Care Unit, Mortality, Complications

Ethical Statement

Etik Kurul Onayı: Ankara Üniversitesi Tıp Fakültesi Klinik Araştırmalar Etik Kurul onayı alınmıştır (Tarih: 11.03.2019 ve karar no: 05-392-19). Hasta Onayı: Retrospektif çalışmadır. Hakem Değerlendirmesi: Editörler kurulunun dışından olan kişiler tarafından değerlendirilmiştir. Yazarlık Katkıları Cerrahi ve Medikal Uygulama: M.K.B., S.K.E., V.B., Konsept: S.K.E., M.K.B., Dizayn: M.K.B., A.A.Y., Veri Toplama veya İşleme: P.K., S.K.E., Analiz veya Yorumlama: S.K.E., M.K.B., A.A.Y., Literatür Arama: S.K.E., V.B., P.K., Yazan: S.K.E., M.K.B., A.A.Y. Çıkar Çatışması: Yazarlar tarafından çıkar çatışması bildirilmemiştir. Finansal Destek: Yazarlar bu çalışma için mali destek almadıklarını beyan etmişlerdir.

References

1. Krug EG, Sharma GK, Lozano R. The global burden of injuries. Am J Public Health. 2000;90:523-526.
2. Domingues CA, Coimbra R, Poggetti RS, et al. New Trauma and Injury Severity Score (TRISS) adjustments for survival prediction. World J Emerg Surg. 2018;13:12.
3. Kehoe A, Smith JE, Edwards A, et al. The changing face of major trauma in the UK. Emerg Med J. 2015;32:911-915.
4. Prin M, Li G. Complications and in-hospital mortality in trauma patients treated in intensive care units in the United States, 2013. Inj Epidemiol. 2016;3:18.
5. Mondello S, Cantrell A, Italiano D, et al. Complications of trauma patients admitted to the ICU in level I academic trauma centers in the United States. Biomed Res Int. 2014;2014:473419.
6. Shafi S, Barnes S, Nicewander D, et al. Health care reform at trauma centers--mortality, complications, and length of stay. J Trauma. 2010;69:1367-1371.
7. Ingraham AM, Xiong W, Hemmila MR, et al. The attributable mortality and length of stay of trauma-related complications: a matched cohort study. Ann Surg. 2010;252:358-362.
8. Busse JW, Bhandari M, Devereaux PJ. The impact of time of admission on major complications and mortality in patients undergoing emergency trauma surgery. Acta Orthop Scand. 2004;75:333-338.
9. Harrois A, Soyer B, Gauss T, et al. Prevalence and risk factors for acute kidney injury among trauma patients: a multicenter cohort study. Crit Care. 2018;22:344.
10. Bahloul M, Chaari A, Dammak H, et al. Post-traumatic pulmonary embolism in the intensive care unit. Ann Thorac Med. 2011;6:199-206.

11. Gudipati S, Fragkakis EM, Ciriello V, et al. A cohort study on the incidence and outcome of pulmonary embolism in trauma and orthopedic patients. BMC Med. 2014;12:39.
12. Ho KM, Burrell M, Rao S, et al. Incidence and risk factors for fatal pulmonary embolism after major trauma: a nested cohort study. Br J Anaesth. 2010;105:596-602.
13. Dezman ZDW, Comer AC, Smith GS, et al. Repeat lactate level predicts mortality better than rate of clearance. Am J Emerg Med. 2018;36:2005-2009.
14. Halvachizadeh S, Baradaran L, Cinelli P, et al. How to detect a polytrauma patient at risk of complications: A validation and database analysis of four published scales. PLoS One. 2020;15:0228082.
15. Moore HB, Moore EE, Liras IN, et al. Targeting resuscitation to normalization of coagulating status: Hyper and hypocoagulability after severe injury are both associated with increased mortality. Am J Surg. 2017;214:1041-1045.
16. Yousefzadeh-Chabok S, Hosseinpour M, Kouchakinejad-Eramsadati L, et al. Comparison of Revised Trauma Score, Injury Severity Score and Trauma and Injury Severity Score for mortality prediction in elderly trauma patients. Ulus Travma Acil Cerrahi Derg. 2016;22:536-540.
17. Paffrath T, Lefering R, Flohé S; Trauma Register DGU. How to define severely injured patients? -- an Injury Severity Score (ISS) based approach alone is not sufficient. Injury. 2014;45:64-69.
18. Waydhas C, Bieler D, Hamsen U, et al. ISS alone, is not sufficient to correctly assign patients post hoc to trauma team requirement. Eur J Trauma Emerg Surg. 2020 Jun 16.
19. Roden-Foreman JW, Rapier NR, Foreman ML, et al. Rethinking the definition of major trauma: The need for trauma intervention outperforms Injury Severity Score and Revised Trauma Score in 38 adult and pediatric trauma centers. J Trauma Acute Care Surg. 2019;87:658-665.
20. Korkmaz Toker M, Gülleroğlu A, Karabay AG, ve ark. SAPS III or APACHE IV: Which score to choose for acute trauma patients in intensive care unit? Ulus Travma Acil Cerrahi Derg. 2019;25:247-252.
21. Darbandsar Mazandarani P, Heydari K, Hatamabadi H, et al. Acute Physiology and Chronic Health Evaluation (APACHE) III Score compared to Trauma-Injury Severity Score (TRISS) in Predicting Mortality of Trauma Patients. Emerg (Tehran). 2016;4:88-91.
22. Dossett LA, Redhage LA, Sawyer RG, et al. Revisiting the validity of APACHE II in the trauma ICU: improved risk stratification in critically injured adults. Injury. 2009;40:993-998.
23. Adams SD, Cotton BA, McGuire MF, et al. Unique pattern of complications in elderly trauma patients at a Level I trauma center. J Trauma Acute Care Surg. 2012;72:112-118.
24. Kirshenbom D, Ben-Zaken Z, Albilya N, et al. Older Age, Comorbid Illnesses, and Injury Severity Affect Immediate Outcome in Elderly Trauma Patients. J Emerg Trauma Shock. 2017;10:146-150.
25. Wang CY, Chen YC, Chien TH, et al. Impact of comorbidities on the prognoses of trauma patients: Analysis of a hospital-based trauma registry database. PLoS One. 2018;13:0194749.
26. Lai CH, Chen KH, Wang CH, et al. Comparison of mortality among severe trauma patients treated in a trauma centre versus a non-trauma centre. Hong Kong J Emergency Med. 2017;24:18-24.
27. Harnod D, Chen R-J, Chang WH, et al. Mortality factors in major trauma patients: nation-wide population-based research in Taiwan. Int J Gerontol. 2014;8:18-21

Details

Primary Language

English

Subjects

Anaesthesiology

Journal Section

Research Article

Authors

Süheyla Karadağ Erkoç ^*
0000-0001-5086-5916
Türkiye

Pınar Karabak This is me
0000-0002-1718-8957
Türkiye

Volkan Baytaş This is me
0000-0003-2143-5823
Türkiye

Ali Abbas Yılmaz This is me
0000-0001-7629-2802
Türkiye

Mustafa Kemal Bayar This is me
0000-0002-0506-4869
Türkiye

Publication Date

April 30, 2021

Submission Date

October 14, 2020

Acceptance Date

November 3, 2020

Published in Issue

Year 2021 Volume: 74 Number: 1

DOI

https://doi.org/10.4274/atfm.galenos.2020.62534

IZ

https://izlik.org/JA85GB32AN

APA

Karadağ Erkoç, S., Karabak, P., Baytaş, V., Yılmaz, A. A., & Bayar, M. K. (2021). Trauma-related Admissions to Intensive Care Unit: Single Center Experience for Major Trauma. Ankara Üniversitesi Tıp Fakültesi Mecmuası, 74(1), 104-111. https://doi.org/10.4274/atfm.galenos.2020.62534

AMA

1.Karadağ Erkoç S, Karabak P, Baytaş V, Yılmaz AA, Bayar MK. Trauma-related Admissions to Intensive Care Unit: Single Center Experience for Major Trauma. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2021;74(1):104-111. doi:10.4274/atfm.galenos.2020.62534

Chicago

Karadağ Erkoç, Süheyla, Pınar Karabak, Volkan Baytaş, Ali Abbas Yılmaz, and Mustafa Kemal Bayar. 2021. “Trauma-Related Admissions to Intensive Care Unit: Single Center Experience for Major Trauma”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 74 (1): 104-11. https://doi.org/10.4274/atfm.galenos.2020.62534.

EndNote

Karadağ Erkoç S, Karabak P, Baytaş V, Yılmaz AA, Bayar MK (April 1, 2021) Trauma-related Admissions to Intensive Care Unit: Single Center Experience for Major Trauma. Ankara Üniversitesi Tıp Fakültesi Mecmuası 74 1 104–111.

IEEE

[1]S. Karadağ Erkoç, P. Karabak, V. Baytaş, A. A. Yılmaz, and M. K. Bayar, “Trauma-related Admissions to Intensive Care Unit: Single Center Experience for Major Trauma”, Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 74, no. 1, pp. 104–111, Apr. 2021, doi: 10.4274/atfm.galenos.2020.62534.

ISNAD

Karadağ Erkoç, Süheyla - Karabak, Pınar - Baytaş, Volkan - Yılmaz, Ali Abbas - Bayar, Mustafa Kemal. “Trauma-Related Admissions to Intensive Care Unit: Single Center Experience for Major Trauma”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 74/1 (April 1, 2021): 104-111. https://doi.org/10.4274/atfm.galenos.2020.62534.

JAMA

1.Karadağ Erkoç S, Karabak P, Baytaş V, Yılmaz AA, Bayar MK. Trauma-related Admissions to Intensive Care Unit: Single Center Experience for Major Trauma. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2021;74:104–111.

MLA

Karadağ Erkoç, Süheyla, et al. “Trauma-Related Admissions to Intensive Care Unit: Single Center Experience for Major Trauma”. Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 74, no. 1, Apr. 2021, pp. 104-11, doi:10.4274/atfm.galenos.2020.62534.

Vancouver

1.Süheyla Karadağ Erkoç, Pınar Karabak, Volkan Baytaş, Ali Abbas Yılmaz, Mustafa Kemal Bayar. Trauma-related Admissions to Intensive Care Unit: Single Center Experience for Major Trauma. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2021 Apr. 1;74(1):104-11. doi:10.4274/atfm.galenos.2020.62534

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